Peripheral vascular system Flashcards
What is the atherosclerotic disease distal to the aortic bifurcation with pain, swelling, and/or discoloration?
peripheral arterial disease
What is the thromboembolic disorder of peripheral venous systems in lower extremities that may present with DVT (2/3) or PE (1/3)?
peripheral venous disease
What are you examining in the upper extremities exam?
inspect size, symmetry, skin, color
palpate radial & brachial pulses
palpate axillary and epitrochlear lymph nodes
What are you examining in the lower extremities exam?
- size, symmetry, skin color
- palpate femoral pulse
- palpate popliteal, dorsalis pedis, and posterior tibial pulses
- check for peripheral edema, ulcerations
How do you grade a normal pulse?
2+ = brisk, expected
What are some abnormal pulse gradings?
0 = absent
1+ = diminished, weaker than expected
3+=bounding
What are you noting upon your peripheral arm inspection?
- symmetry
- swelling
- venous patterns
- color of skin and nail beds
- texture
What does a straight edge line formed by tops of knuckles mean?
Edema preventing full closure of hand
What does a shiny top of hand mean, with no tendons visible, nor any wrist wrinkles?
Edema
What disease involves spasms of distal arteries causing sharply demarcated pallor? Note: this can vary in color
Raynaud’s disease
In Raynaud’s disease can you feel radial and ulnar pulses?
Yes
Where can you find the brachial artery?
just medial to biceps tendon at antecubital crease, or can be found higher in the arm in groove between biceps and triceps tendon
What nodes are you palpating near the brachial artery and on the distal side as well?
epitrochlear nodes
How do you palpate epitrochlear nodes?
flex elbow 90 degrees and support elbow with hand while palpating groove between biceps and triceps approx 3 cm above medial epicondyle
difficult or impossible to identify in healthy people
Which hand would you use to examine the patient’s right axillae?
The left. always use the opposite.
What are you looking for in the abdomen examination?
AAA – aortic pulsation could be a sign
What is the normal range for an aorta?
1.4-3cm
Where else should you palpate in the abdomen vasculature?
superficial inguinal nodes
normal = 1-2cm non-tender, discrete
What arteries are you auscultating in the abdomen?
aorta, renal arteries, iliac arteries, femoral arteries
What are you looking for when inspecting the arteries of the leg?
- size, symmetry, swelling, edema
- venous patterns
- pigmentation
- color and texture
- distribution of hair
- varicosities
- unilateral or bilateral?
What do you do if you detect unilateral swelling?
- measure both calves and compare
- measure 10cm below tibial tuberosity
>3cm difference in circumfrence = higher risk for DVT
What’s the difference between rubor and cyanosis in skin?
rubor is dusky redness, while cyanosis has a blue tone to it
What does a diminished or absent femoral pulse indicate?
partial or complete proximal occlusion 6x more likely, with downstream pulses also diminished!
What does an absent pedal pulse with a normal femoral and popliteal pulse mean?
atherosclerotic disease in lower popliteal artery or distal artery 14x more likely
What are you looking for in regards to inspecting veins of the leg?
- unilateral vs bilateral abnormalities
- edema
- color/texture of the skin
- ulcerations
- weeping, vesicle formation
- varicosities
- hard areas/cords
What are clear signs of an arterial ulcer?
- punched out appearance
- smooth wound edges
- pain at night and relieved by elevation
- lateral foot
- lower extremities = cool to touch
- pale, shiny, thin skin
- minimal hair growth
- minimal drainage
What are the characteristics of a venous ulcer?
- shallow and superficial
- irregular shape
- painful from edema, phlebitis, infection
- usually in lower legs or ankles
What are risk factors for arterial ulcers?
- vascular insufficiency
- uncontrolled BS in DM
- limited joint mobility
- improper footwear
What are risk factors for venous ulcers?
- varicose veins
- deep vein thrombosis
- incompetent valves
- muscle weakness in legs
- immobility
- pregnancy
What is caused by insufficient blood supply to area, causing ischemia?
arterial ulcer
What is caused by pooling of blood causing increased pressure in veins?
venous ulcer
If swelling is present, where are the three places you should check for edema?
- dorsum of each foot
- behind each medial malleolus
- over the shins
What are the different stages of pitting edema?
- immediate rebound
- few seconds to rebound
- 10-12 seconds rebound
- > 20s
When should you consider DVT?
complaint of mild pain with walking and rest
If the clot from a DVT is in a proximal vein, what is the risk?
PE (50%)
What is the Homan’s sign?
calf pain on dorsiflexion of the foot
checking for DVT, but not very accurate - can make false positive in >50%, and less than 33% in actual DVT
What is the Allen test?
comparing the patency of the ulnar and radial arteries
What does it mean when there’s persisting pallor with the allen test?
occlusion of the ulnar artery
What is the Ankle-Brachial index?
ratio of BP measurements in foot and arm – detecting decreased BP distal to an arterial stenosis, often used to assess PAD
How do you measure brachial pressure?
Using a doppler, locating the brachial pulse and utilizing the BP cuff to record pressure at which the pulse becomes audible
x2 on each side and average
What is an ABI?
right ABI = highest pressure in right foot / highest pressure in both arms
What’s a normal ABI?
.9-1.4
What does an ABI >1.40 indicate?
noncompressible calcified vessel
What does an ABI <.9 indicate?
PAD; <.5 = severe PAD
What is the Buerger test?
test if pain or diminished pulses = arterial insufficiency
raise both legs to 60 degrees for 1 min until max pallor
- compare feet/soles of feet, then ask patient to sit up, dangling feet down, compare both feet, timing for return of pinkness <10s, filling of veins <15s
What means the Buerger test is abnormal?
- asymmetrical color changes
- delayed arterial and venous filling
- > 30s and/or unusual rubor to replace pallor
