peripheral vascular exam 3 Flashcards
artherosclerosis
a chronic inflammatory disease initiated by injury (i.e., smoking or hypertension) to vascular endothelial cells, provoking atheromatous plaque formation.
what contributes to propagation of blood flow and arterial pulsatile flow
The elastic recoil and smooth muscle contraction and relaxation in the media of large- and medium-sized arteries
major precipitant of ischemia and infarction
plaque activation and luminal stenosis
what happens when an artery is obstructed?
anastomoses between branching networks of smaller arteries can increase in size over time to form collateral circulation that perfuses structures distal to the occlusion.
occlusion of the mesenteric arteries can result in acute…..
occlusion of the mesenteric arteries can result in acute mesenteric ischemia, a potentially life-threatening condition.
what are the leg veins susceptible to due to their weaker wall structure?
the leg veins are susceptible to irregular dilatation, compression, ulceration, and invasion by tumors, and, as such they warrant special attention.
what does the contraction of the calf muscles during walking serve as?
a venous pump, also propelling blood upward against gravity.
In addition to its vascular functions, the lymphatic system plays an important role in
the bodys immune system
mechanisms for the development of edema
increased plasma volume from sodium retention, altered capillary dynamics resulting in net filtration, inadequate removal of filtered lymph fluid, lymphatic or venous obstruction, and increased capillary permeability
common or concerning symptoms of the peripheral vascular system
Pain and/or swelling of legs or arms
Cramping in legs on exertion with relief with rest (intermittent claudication)
Cold, numbness, pallor or discoloration in the legs; hair loss
Abdominal, flank, or back pain
Symptomatic limb ischemia with exertion
is usually atherosclerotic PAD. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, is neurogenic claudication.
Is there associated swelling in the legs or arms with the pain?
Only 10% of patients have the classic features of leg pain with exertion relieved by rest.12 Another 30% to 50% have atypical leg pain, and up to 60% are asymptomatic. Asymptomatic patients can have significant functional impairment that limits or slows walking to avoid symptoms as PAD is progressing.
peripheral artery disease warning signs
-Fatigue, aching, numbness, or pain that limits walking or exertion in the legs; if present, identify the location
-Erectile dysfunction
-Any poorly healing or nonhealing wounds of the legs or feet
-Any pain present when at rest in the lower leg or foot and changes when standing or supine
-Abdominal pain after meals and associated food fear and weight loss
-Any first-degree relatives with an abdominal aortic aneurysm
Symptom location suggests the site of arterial ischemia based on the artery’s perfusion:
-Buttock, hip: aortoiliac
-Genitalia presenting as erectile dysfunction: aortoiliac– pudendal
-Thigh: common femoral or aortoiliac
-Upper calf: superficial femoral
-Lower calf: popliteal
-Foot: tibial or peroneal
Hair loss over the anterior tibiae points to…
Hair loss over the anterior tibiae points to decreased arterial perfusion. “Dry” or brown-black ulcers from gangrene may ensue.
An expanding hematoma from an abdominal aortic aneurysm (AAA) may cause symptoms by…
compressing the bowel, aortic branch arteries, or the ureters. Prevalence of AAAs in first-degree relatives is 15% to 28%.
If the pain is relieved by sitting and bending forward, or if there is bilateral buttock or leg pain, the etiology is more likely to be…
spinal stenosis
food fear and weight loss suggest…
chronic intestinal ischemia of the celiac or superior or inferior mesenteric arteries.
Because individual clinical features have poor diagnostic
value
experts recommend use of well-validated formal
clinical scoring systems like the Wells Clinical Score and
the Geneva Score for all patients with suspected DVT.
Most patients with thromboembolic disorders of peripheral venous system present with unilateral or asymmetric swelling of the extremities.
These symptoms point to upper extremity DVT, most commonly from catheter-associated thrombosis.19 Most patients are asymptomatic with thrombosis detected on routine screening.
Visible venous collaterals, swelling, edema, and discoloration signal what?
upper extremity DVT
Bounding carotid, radial, and femoral pulses are present in
aortal regurgitation
recommended grading of pulses
3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent, unable to palpate
pulsus parvus
refers to weak pulses, usually seen with atherosclerotic PVD,
pulsus tardus
refers to sluggish pulses, usually occurring in the setting of aortic stenosis or low cardiac output.
in raynaud disease..
wrist pulses are typically normal, but spasm of more distal arteries causes episodes of sharply demarcated pallor of the fingers
Capillary refill time in the digits of >5 seconds
has low sensitivity and specificity and is not considered diagnostically helpful
An enlarged epitrochlear node
suggests local or distal infection or may be associated with lymphadenopathy from lymphoma or human immunodeficiency virus (HIV).
Local swelling, redness, warmth, and a subcutaneous cord signal
superficial thrombophlebitis, an emerging risk factor for DVT
Asymmetric warmth and redness over the calf signal
ceullulitis
unilateral calf and ankle swelling, edema suggest
suggest venous thromboembolism (VTE) from DVT, chronic
venous insufficiency from prior DVT, or incompetent venous valves; or it may be lymphedema.
If you detect unilateral swelling or edema
measure the calves 10 cm below the tibial tuberosity. Bilateral edema is present in heart failure, cirrhosis, and nephrotic syndrome
Brownish discoloration or ulcers just above the malleolus suggest
chronic venous insufficiency.
Thickened, brawny skin suggests
lymphedema and advanced venous insufficiency.
An exaggerated, widened femoral pulse suggests the pathologic dilatation of a
femoral anuerysm
Acute arterial occlusion from embolism or thrombosis causes
pain and numbness or tingling. The limb distal to the occlusion becomes cold, pale, and pulseless. Pursue emergency treatment
poikilothermia
the relative hypothermia of one extremity as compared with another. It is usually seen in peripheral vascular disease.
If swelling or edema is present, palpate for pitting edema.
Press firmly but gently with your thumb for at least 2 seconds (1) over the dorsum of each foot, (2) behind each medial malleolus, and (3) over the shins
pitting edema scale
1+: Barely detectable impression when finger is pressed into skin
2+: Slight indentation; 15 seconds to rebound
3+: Deeper indentation; 30 seconds to rebound
4+: >30 seconds to rebound
A painful, pale, swollen leg, together with tenderness in the groin over the femoral vein, suggests
deep iliofemoral thrombosis
homan sign
discomfort behind the knee with forced dorsiflexion on the foot, is neither sensitive nor specific, and discredited by Homan himself.
interpreting the ABI
Values >1.40 suggest a noncompressible calcified vessel. A value <0.90 is considered diagnostic of PAD; values <0.5 suggest severe PAD
Absent or diminished pulses at the wrist occur in
acute embolic occlusion and in Buerger disease, or thromboangiitis obliterans.
the allen test
compares patency of the ulnar and radial arteries. It also ensures patency of the ulnar artery before puncturing the radial artery for blood samples. The patient should rest with hands in lap, palms up.
Ask the patient to make a tight fist with one hand; then compress both radial and ulnar arteries firmly between your thumbs and fingers
