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Cardio > Peripheral Venous Disease and Lymphatic Disease - Exam 3 > Flashcards

Peripheral Venous Disease and Lymphatic Disease - Exam 3 Flashcards

1
Q

Combination of progressive _____ and _____ is the hallmark of chronic venous disease

A

venous reflux

venous hypertension

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2
Q

What are varicose veins due to? What are the 3 contributing factors?

A

high venous pressure

postpartum women
prolonged standing
heavy lifting

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3
Q

______ venous valve does not close appropriately leading to backward blood flow into lower extremities

A

venous reflux

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4
Q

________ increased venous pressure as a result of reflux

A

venous hypertension

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5
Q

______ vein and its tributaries may be affected in varicose veins. Name one additional vein

A

great saphenous

and short saphenous veins may also be affected

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6
Q

Give 3 causes of secondary varicosities

A

thrombophlebitis

proximal venous occlusion

congenital or acquired AV fistulas

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7
Q

What is the MC symptom of varicose veins? give one additional symptom

A

dull, aching, heaviness of legs following a period of standing

itching

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8
Q

Is s/s severity correlated with extent of varicose veins dz?

A

Symptom severity is not correlated with the number and size of the varicosities

Some patients may have no pain but numerous varicosities

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9
Q

What can varicose veins progress to?

A

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

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10
Q

What is the dx testing needed in varicose veins?

A

No diagnostic testing is needed

would need duplex US if planning for therapy

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11
Q

What is the non-sx tx for varicose veins?

A

compression stockings (20–30 mm Hg pressure)

leg elevation, especially at night

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12
Q

What is the pt education with regards to varicose veins?

A

worn while awake and taken off at night

prefer the stockings that go up past the thigh

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13
Q

What are the sx therapy options for varicose veins? Which one is the last resort?

A

Sclerotherapy

Endovenous Laser Therapy (EVLA)

Endovenous Radiofrequency Ablation (EVRFA)

Vein stripping is last resort

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14
Q

**What are the complications for sclerotherapy?

A

Complications such as phlebitis, tissue necrosis, or infection may occur

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15
Q

** What are the complications of Endovenous Laser Therapy (EVLA)?

A

Could result in heat-induced thrombosis, requiring prolonged anticoagulation

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16
Q

chronic venous insufficiency is a severe manifestation of ______. What is the MC etiology? ______ is a complicating factor

A

venous hypertension

prior deep venous thrombophlebitis

obesity

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17
Q

What is the etiology of chronic venous insufficiency? Chronic thrombus/scarring causes ______, worsening the problem

A

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

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18
Q

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 _____

A

venous reflux

venous hypertension

high hydrostatic force

edema

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19
Q

What is the primary symptom of chronic venous insufficiency? What does the skin look like? secondary ____ can occur

A

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

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20
Q

Skin induration
Increased pigmentation
Swelling
Redness
“Inverted champagne bottle” or “bowling pin” appearance

What am I?
This is a type of _____

A

Lipodermatosclerosis

panniculitis

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21
Q

**“Inverted champagne bottle” or “bowling pin” appearance should instantly think ______

A

Lipodermatosclerosis

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22
Q

What is this? Describe it in words

A

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

23
Q

What is this?

A

stasis dermatitis

24
Q

What is this?

A

stasis dermatitis

25
Q

What is this?

A

hemosiderin staining

26
Q

What is this?

A

lipodermatosclerosis

27
Q

What is the dx testing needed in chronic venous insufficiency? What is the pt is planning therapy?

A

nothing!

duplex US

28
Q

What is the management for Chronic Venous Insufficiency? What is used in refractory cases?

A

compression stockings 20-30mm hg pressure

pneumatic compression

29
Q

What is superficial venous thrombophlebitis? What is the MC cause?

A

Defined as inflammation of a superficial vein (think infection)

MC a result of a recent venous catheter placement (IV)

29
Q

What is an Unna boot? What is the goal? What is the major challenge when using?

A

paste gauze compression dressing

provides both compression and topical therapy

compliance!! have to be changed weekly!!

29
Q

**What is the pt education for compression stockings?

A

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

30
Q

Besides IV placement, what are some additional causes of Superficial Venous Thrombophlebitis? Where do they commonly occur?

A

Varicose veins
Spontaneous in pregnant or postpartum women
Trauma
Hypercoagulable states

lower extremities

Typical pt from lecture: think pregnant women who has an IV

31
Q

What is the presentation of Superficial Venous Thrombophlebitis? **describe the timing. ** What vein is commonly involved?

A

Localized redness, induration, and tenderness along a superficial vein

**spontaneous

**most commonly involves the great saphenous vein

32
Q

in Superficial Venous Thrombophlebitis, a _______ may be present for several weeks, even after initial inflammatory reaction is past

A

palpable cord

33
Q

What are some complications of Superficial Venous Thrombophlebitis?

A

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

34
Q

What 3 things can suppurative thrombophlebitis lead to?

A

Metastatic abscess formation
Septicemia
Septic emboli

35
Q

What is the dx needed in Superficial Venous Thrombophlebitis? What 2 things do you need to consider?

A

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

36
Q

What is the tx for mild, localized Superficial Venous Thrombophlebitis?

A

mild analgesics, such as aspirin or NSAIDs, and the use of some type of elastic support usually are sufficient

continue ADLs as normal

37
Q

What is the tx for more severe, larger Superficial Venous Thrombophlebitis? When would you need to add on anticoag?

A

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

38
Q

What is the tx for sepsis due to Superficial Venous Thrombophlebitis?

A

Vancomycin 15mg/kb Q12 hrs PLUS Ceftriaxone 1g Q24 hrs empirically

Urgent treatment with Heparin or Arixtra

39
Q

What is Lymphangitis? What is the underlying cause? What are the 2 MC pathogens?

A

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

40
Q

What is nodular lymphangitis? Name 6 causes

A

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

41
Q

What are the common cancers that lead to Lymphangitis?

A

Breast, lung, stomach, pancreas, rectal, and prostate cancers are the most common tumors

42
Q

_____ is the infectious cause in dog and cat bites that can lead to lymphangitis

A

Pasteurella multocida

43
Q

_______ can contaminate wounds that occur in freshwater and can lead to lymphangitis

A

Aeromonas hydrophila

44
Q

** _______ 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

A

Wuchereria bancrofti

45
Q

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?

A

lymphangitis

extending from the primary infection site toward draining regional nodes

46
Q

What lab must be obtained in lymphagitis?

A

CBC w/ diff and blood cultures must be obtained

47
Q

What is the tx for lymphangitis? What do you need to cover for? When would you consider sx?

A

-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

48
Q

What are the 2 different types of lymphedema? What does each mean?

A

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

49
Q

________ 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?

A

Secondary dilation of the lymphatics

Can result in episodes of acute and chronic inflammation, worsening the edema

50
Q

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?

A

lymphedema

clincial dx: can use MRI to confirm no lymphatic or proximal obstructing masses

51
Q

What is the tx for lymphedema? What is RARELY helpful and should NOT be used in lymphedema?

A

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

52
Q
A

Cardio (24 decks)

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