Peripheral Venous Disease and Lymphatic Disease - Exam 3 Flashcards
Combination of progressive _____ and _____ is the hallmark of chronic venous disease
venous reflux
venous hypertension
What are varicose veins due to? What are the 3 contributing factors?
high venous pressure
postpartum women
prolonged standing
heavy lifting
______ venous valve does not close appropriately leading to backward blood flow into lower extremities
venous reflux
________ increased venous pressure as a result of reflux
venous hypertension
______ vein and its tributaries may be affected in varicose veins. Name one additional vein
great saphenous
and short saphenous veins may also be affected
Give 3 causes of secondary varicosities
thrombophlebitis
proximal venous occlusion
congenital or acquired AV fistulas
What is the MC symptom of varicose veins? give one additional symptom
dull, aching, heaviness of legs following a period of standing
itching
Is s/s severity correlated with extent of varicose veins dz?
Symptom severity is not correlated with the number and size of the varicosities
Some patients may have no pain but numerous varicosities
What can varicose veins progress to?
Long standing varicose veins may progress to chronic venous insufficiency
Associated with the development of ankle edema, brownish skin hyperpigmentation, and chronic skin induration or fibrosis
What is the dx testing needed in varicose veins?
No diagnostic testing is needed
would need duplex US if planning for therapy
What is the non-sx tx for varicose veins?
compression stockings (20–30 mm Hg pressure)
leg elevation, especially at night
What is the pt education with regards to varicose veins?
worn while awake and taken off at night
prefer the stockings that go up past the thigh
What are the sx therapy options for varicose veins? Which one is the last resort?
Sclerotherapy
Endovenous Laser Therapy (EVLA)
Endovenous Radiofrequency Ablation (EVRFA)
Vein stripping is last resort
**What are the complications for sclerotherapy?
Complications such as phlebitis, tissue necrosis, or infection may occur
** What are the complications of Endovenous Laser Therapy (EVLA)?
Could result in heat-induced thrombosis, requiring prolonged anticoagulation
chronic venous insufficiency is a severe manifestation of ______. What is the MC etiology? ______ is a complicating factor
venous hypertension
prior deep venous thrombophlebitis
obesity
What is the etiology of chronic venous insufficiency? Chronic thrombus/scarring causes ______, worsening the problem
valve leaflets do not close because they are thickened and scarred (post-thrombotic syndrome) or are functionally inadequate due to vein dilation
proximal venous obstruction
following proximal venous obstruction, ______ ensues leading to blood back up in the lower leg/foot. The leg develops _______ and an abnormally ______ is transmitted to the subcutaneous veins and tissues of the lower leg
The result is _____
venous reflux
venous hypertension
high hydrostatic force
edema
What is the primary symptom of chronic venous insufficiency? What does the skin look like? secondary ____ can occur
progressive pitting edema of the lower leg
Stasis dermatitis, taut, shiny skin at the ankle due to edema, hemosiderin staining, can develop ulcers, secondary cellulitis and eventually relative fixation of the ankle joint secondary to tissue fibrosis
lymphedema
Skin induration
Increased pigmentation
Swelling
Redness
“Inverted champagne bottle” or “bowling pin” appearance
What am I?
This is a type of _____
Lipodermatosclerosis
panniculitis
**“Inverted champagne bottle” or “bowling pin” appearance should instantly think ______
Lipodermatosclerosis
What is this? Describe it in words
Atrophie Blanche
Star-shaped or polyangular, ivory-white depressed atrophic plaques
Prominent red dots within the scar due to enlarged capillary blood vessels
Surrounding hyperpigmentatio
What is this?
stasis dermatitis
What is this?
stasis dermatitis
What is this?
hemosiderin staining
What is this?
lipodermatosclerosis
What is the dx testing needed in chronic venous insufficiency? What is the pt is planning therapy?
nothing!
duplex US
What is the management for Chronic Venous Insufficiency? What is used in refractory cases?
compression stockings 20-30mm hg pressure
pneumatic compression
What is superficial venous thrombophlebitis? What is the MC cause?
Defined as inflammation of a superficial vein (think infection)
MC a result of a recent venous catheter placement (IV)
What is an Unna boot? What is the goal? What is the major challenge when using?
paste gauze compression dressing
provides both compression and topical therapy
compliance!! have to be changed weekly!!
**What is the pt education for compression stockings?
Avoidance of long periods of sitting or standing
Intermittent elevations of the involved leg
Sleeping with the legs elevated
**only wear during waking hours and need to remove them at night
Besides IV placement, what are some additional causes of Superficial Venous Thrombophlebitis? Where do they commonly occur?
Varicose veins
Spontaneous in pregnant or postpartum women
Trauma
Hypercoagulable states
lower extremities
Typical pt from lecture: think pregnant women who has an IV
What is the presentation of Superficial Venous Thrombophlebitis? **describe the timing. ** What vein is commonly involved?
Localized redness, induration, and tenderness along a superficial vein
**spontaneous
**most commonly involves the great saphenous vein
in Superficial Venous Thrombophlebitis, a _______ may be present for several weeks, even after initial inflammatory reaction is past
palpable cord
What are some complications of Superficial Venous Thrombophlebitis?
can extend into deep venous system
hyperpigmentation over the affected vein
persistent, firm nodule at the site of the affected vein
conversion to suppurative thrombophlebitis
What 3 things can suppurative thrombophlebitis lead to?
Metastatic abscess formation
Septicemia
Septic emboli
What is the dx needed in Superficial Venous Thrombophlebitis? What 2 things do you need to consider?
clinical dx, no testing is required!
WBC may be elevated due to inflammation or infection
venous doppler US: if it involves the proximal lower extremity or pt is a mixed picture
aka concerned about a possible DVT
What is the tx for mild, localized Superficial Venous Thrombophlebitis?
mild analgesics, such as aspirin or NSAIDs, and the use of some type of elastic support usually are sufficient
continue ADLs as normal
What is the tx for more severe, larger Superficial Venous Thrombophlebitis? When would you need to add on anticoag?
elevate the extremity and apply massive, hot, wet compresses
5 cm or longer → prophylactic dose Fondaparinux (Arixtra), LMWH, or Rivaroxaban (Xarelto) x 45 days
OR
Rapidly progressing disease or extension into deep system → full dose anticoagulation
What is the tx for sepsis due to Superficial Venous Thrombophlebitis?
Vancomycin 15mg/kb Q12 hrs PLUS Ceftriaxone 1g Q24 hrs empirically
Urgent treatment with Heparin or Arixtra
What is Lymphangitis? What is the underlying cause? What are the 2 MC pathogens?
Infectious or noninfectious inflammation of the lymphatic channels
MC develops after cutaneous inoculation of microorganisms that invade the lymphatic vessels and spread toward the regional lymph nodes
Often caused by hemolytic streptococci or S. aureus
What is nodular lymphangitis? Name 6 causes
painful or painless nodular subcutaneous swellings along the course of the lymphatic channels
Sporothrix schenckii, Nocardia (most often N. brasiliensis), Mycobacterium marinum, leishmaniasis, tularemia, and systemic mycoses
What are the common cancers that lead to Lymphangitis?
Breast, lung, stomach, pancreas, rectal, and prostate cancers are the most common tumors
_____ is the infectious cause in dog and cat bites that can lead to lymphangitis
Pasteurella multocida
_______ can contaminate wounds that occur in freshwater and can lead to lymphangitis
Aeromonas hydrophila
** _______ filarial nematode that is a major cause of acute lymphangitis worldwide; leads to a chronic Filariasis resulting in subsequent lymphedema with thickening of skin and subcutaneous tissue
Wuchereria bancrofti
A history of abrasion or trauma distal to the site of infection
Fever, chills, myalgias, and malaise may be reported, especially in children
Nausea, anorexia, and headache may also be present
erythematous and irregular linear streaks
What am I?
What direction does it tend to spread?
lymphangitis
extending from the primary infection site toward draining regional nodes
What lab must be obtained in lymphagitis?
CBC w/ diff and blood cultures must be obtained
What is the tx for lymphangitis? What do you need to cover for? When would you consider sx?
-Dicloxacillin, Cephalexin, Cefazolin, Cefuroxime, Ceftriaxone, Clindamycin, Nafcillin, Trimethoprim and sulfamethoxazole (TMP/SMZ) are all good options
-analgesics/NSAIDs for pain
-hot, moist compresses
-elevate and immobilize affected areas
covering for GABHS
Nodular lymphangitis often require surgical intervention
What are the 2 different types of lymphedema? What does each mean?
Primary form and secondary form
primary: congenital hypoplastic or hyperplastic proximal or distal lymphatics
Pelvic or lumbar lymph channel and node obstruction present when the disease is extensive and progressive
secondary: involves inflammatory or mechanical lymphatic obstruction from trauma, regional lymph node resection/irradiation, or malignant disease or filariasis. May occur following surgical removal of the lymph nodes in the groin or axilla
________ can occur in both form of lymphedema and leads to incompetence of the valve system, poor lymphatic fluid flow, and results in progressive stasis of a protein-rich fluid. What does it result in?
Secondary dilation of the lymphatics
Can result in episodes of acute and chronic inflammation, worsening the edema
Painless limb hypertrophy
Markedly thickened and fibrotic skin and subcutaneous tissue
Pt typically w/o ulceration, varicosities, or stasis pigmentation
What am I?
How do you dx?
lymphedema
clincial dx: can use MRI to confirm no lymphatic or proximal obstructing masses
What is the tx for lymphedema? What is RARELY helpful and should NOT be used in lymphedema?
No cure for lymphedema! Treatment is aimed at controlling edema and restoring patient function
leg elevation
compression stockings
massages
refer to wound care
goody hygiene to reduce chances of infection
**DO NOT USE DIURETICS!! not helpful
