Peripheral Vascular Disorders Flashcards
Atherosclerosis:
Rest Pain
Ischemia at rest. Distal pain in forefoot or toes. Persistent, often worse at night. Aggravated by elevation, like when in bed. Relived by sitting with legs dependent. A/W numbness, tingling, tropic signs, color changes of art insufficiency
Artherosclerosis:
Intermittent Claudication
Episodic muscle ischemia, induced by exercise, d/t atherosclerosis of large or medium arteries. Usually calf muscle but could be in buttock, hip, thigh, foot, depending on level of obstruction. Distal pain, toes or forefoot. Timing brief, pain forces person to rest. Aggravated by exercise. Relieved by rest in 1-3 minutes. A/w local fatigue, numbness, dim pulses; signs of arterial insufficiency
Acute Arterial Occlusion
Embolism or thrombus, possibly superimposed on arteriosclerosis obliterans.
Raynaud’s Disease/ Phenomenon
Disease: episodic spasm of small arteries/arterioles; no vascular occlusion. Phenomenon: syndrome 2nd to other conditions such as collagen vascular disease, arterial occlusion, trama or drugs.
Distal portions of one or more fingers. Pain is not prominent unless fingertip ulcers develop. Numbness and tingling common. Brief in minutes, recurrent. Aggravated by cold, emotional upset. Relived with warm. A/w color changes in distal fingers; severe pallor, followed by cyanosis them redness
Superficial Thrombophlebitis
Clot formation and acute inflammation in sup vein. Pain in local area along course of sup vein. Usually saphenous. Acute episode lasts days or longer. A/w local redness, swelling, tenderness, palpable cord, possibly fever.
DVT
Clot in deep vein. Tight, bursting pain, if present usually in calf, may be painless. Timing: may have lack of symptoms. Aggravated by walking. Elevation provides relief. A/w possible swelling of foot, calf; local calf tenderness. Prior h/o DVT
Chronic Venous Insufficiency
Chronic venous engorgement secondary to venous occlusion or incompetent venous valves. Pain is diffuse aching of legs. Chronic, pain increases as days go on. Worse when standing, better when elevated. A/w chronic Edelman, pigmentation, possibly ulceration
Thrombangiitis Obliterans
Buerger’s disease
Inflammatory and thrombotic occlusions of small arteries and veins, occurs in smokers.
Int Clad particularly in arch of foot. Pain brief but recurrent, worse with exercise, better at rest.
Rest Pain in fingers or toes. Chronic, persistent, worse at night. Permanent cessation of smoking helps both kinds of pain.
A/w distal coldness, sweating, numbness, cyanosis, ulcerations, gangrene at tips fingers/toes; migratory thrombophlebitis.
Compartment Syndrome
Pressure builds from trauma/bleeding into 1 of 4 major muscle compartment between ankle and knee. Each section closed by fascia, no room to expand. Tight bursting pain in calf usually anterior tibial compartment, sometimes overlying dusky red skin. Timing ; several hours if acute, pressure must be relieved to avoid necrosis. Chronic during exercise. Aggravated acutely by steroids, surgical complications, crush injury. Aggravated chronically by exercise. Acute relief with surgery, chronic with rest, avoid exercise and ice elevation. A/w tingling, burning sensation in calf, muscles feel tight, full, numbness, paralysis if unrelieved.
Acute Lymphangitis
Acute bacterial infection, usually strep, spreads up lymph channels from portal of entry- like injury or ulcer. Pain at site: arm or leg. Acute episodes last for days or longer. A/w red streaks on skin, tenderness, enlarged tender lymph nodes and fever.
Mimics
Acute Cellulitis
Acute bacterial infection of the skin and subq tissues. Located in arms, legs or elsewhere. An acute episode lasting days or longer. A/w a local area of diffuse swelling, redness and tenderness with enlarged, tender lymph nodes and fever; no palpable cord.
Mimics
Erythema Nodusum
Raised tender bilateral subq lesion seen in systemic condition such as pregnancy, sarcoidosis, TB, strep Inf, IBS. Pain on anterior surfaces of BLE. Pain a/w series of lesions over several weeks. Lesions recur in crops often malaise, joint pain, and fever.
Advanced chronic art insuff. Vs
Adv. chronic venous insuff.
ART: pain int clad., progressing to pain at rest. Tissue ischemia, pulses dim or absent. Pale, ESP with elevation, dusky red when dependent. Cool, edema absent or mild but may develop if leg dependent while resting. Skin: trophic, thin, shiny, hair loss over toes and food, nails thick with ridges. If ulcers present, on toes or point of trauma. Gangrene may result.
VEN: painful, d/t venous HTN. Pulses normal, may be hard to palpate d/t edema. Color normal or cyanotic on dependent. Chronic with petichiae and brown pigmentation. Temp normal. Edema present. Skin: brown pigment around ankle, stasis dermatitis, thick skin, narrowing of legs if scars formed. Ulcers may be present would be on sides of ankles, mostly medial. No gangrene.
Pitting edema
Soft, bilateral, pitting with pressure. No thick skin, ulcers, pigment changes. Causes: standing/ sitting for long time: increased hydrostatic pressure of veins and capillaries. D/T CHF leading to low CO, nephrotic syndrome, cirrhosis, malnutrition leading to low albumin and decreased intravascular colloid oncotic pressure, drug use.
Lymphedema
Early, edema soft, late indurated, hard, non pitting. Skin markedly thickened: ulcers rare. No pigment changes. Edema is in toes and feet, often bilaterally. Develops when lymph channels blocked by tumor, fibrosis, inflammation or with axillary node dissection and radiation
