Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio= Clin Med > Peripheral Venous Disorders > Flashcards

Peripheral Venous Disorders Flashcards

1
Q

4 Venous Disorders

A

Varicose Veins
Superficial Venous Thrombophlebitis
Chronic Venous Insufficiency
Deep Vein Thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Varicose Veins (3)

A

Dilated, tortuous superficial veins in the lower extremities
Develop in 15% of adults
The greater saphenous vein and its tributaries are most commonly involved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pathophysiology of Varicose Veins

A

Distention of the vein results in weakened/incompetent valves—–>dilation along the vein

Dilation—> increased pressure and distention of the vein segment below that valve—>progressive failure of the next lower valve—>increased dilation

Perforating veins may become incompetent as well reflux of blood from the deep vein system into the superficial veins through the incompetent perforators increasing venous pressure and distention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

4 Risk Factors of Varicose Veins

A

Genetics
Prolonged standing or heavy lifting
Pregnancy
Congenital or acquired AV fistulas or venous malformations (young patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Primary Varicose Veins (3)

A

Originate in the superficial system
More common in females than males
½ of these patients have a FH of varicose veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Secondary Varicose Veins

A

Originate from deep venous insufficiency and incompetent perforating veins or from deep venous occlusion that results in enlargement of superficial veins b/c they are acting as collaterals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Signs and Symptoms of Varicose Veins

A

Does not correlate to the # and size of varicosities
Asymptomatic or symptomatic
Dull ache/heaviness or fatigue of the legs after prolonged standing that is relieved w/ leg elevation
Venous stasis dermatitis may be present either above the ankle or directly overlying large varicosities
Varicosities may be visible upon standing or may only be palpable in the more obese patient.
If long duration, a brownish pigmentation and thinning of the skin above the ankle may be present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Imaging for Varicose Veins

A

Duplex Ultrasound is the test of choice for planning therapy to localize the site of venous reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Ddx for Varicose Veins (6)

A

Chronic venous insufficiency
Leg pain/discomfort from a secondary cause
Arthritis
Radiculopathy
Arterial insufficiency
Congenital malformation/atresia of deep veins in adolescent patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complications for Varicose Veins

A

Superficial venous thrombosis (rare)
Bleeding (secondary to trauma, more common in older patients)
Increased amount of bleeding d/t increased pressure in the varicosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Non-Surgical Treatment for Varicose Veins (3)

A 
Avoid prolonged standing
Compression stockings (medium to heavy weight) when standing****
Leg elevation when possible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Surgical Treatment for Varicose Veins (4)

A

Endovenous ablation (radiofrequency or laser)
Greater saphenous vein stripping
Phlebectomy w/ or w/o correction of reflux
Compression Sclerotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When to refer to a vascular surgeon for their Varicose Veins (4)

A

Bleeding from varicose vein
Superficial venous thrombosis
Pain
Cosmetic concerns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Superficial Venous Thrombosis

A

Pain localized to the site of a superficial thrombus
Indurated, warm, red and tender cord extending along a superficial vein, (common along the saphenous vein)
Most common cause: short term intravenous catheterization(IV’s) and PICC lines
Do not result in pulmonary emboli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

5 Risk Factors for Superficial Venous Thrombosis

A 
Pregnancy/postpartum
Varicose veins
Thromboangiitis obliterans
Trauma
Manifestation of systemic hypercoagulability secondary to cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ddx for Superficial Vein Thrombosis

A 
Cellulitis
Erythema Nodosum
Erythema induratum
Lymphangitis
DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment for Superficial Vein Thrombosis

A

Supportive
Elevation, warm compresses and NSAIDS

Anticoagulation
Only indicated if a thrombus has developed in the thigh or arm and is extending toward the saphenofemoral junction (leg) or the cephalo-axillary junction (arm)
To prevent extension of the thrombus into the deep vein system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Chronic Venous Insufficiency (CVI) Definition

A

A condition that occurs when the venous wall and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart from the legs. It causes blood to “pool” or collect in these veins (stasis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Chronic Venous Insufficiency (3)

A

40% of people in the US have CVI
More frequent in people >50
More common in females than males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of Chronic Venous Insufficiency

A

Changes secondary to acute DVT (post thrombotic syndrome)- delayed complication
History of leg trauma

Occurs in association with the following:
Superficial venous reflux
Varicose veins
Pelvic tumors obstructing the pelvic veins
Vascular malformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pathophysiology of Chronic Venous Insufficiency

A

Valve leaflets do not come together b/c they are either thickened and scarred (post thrombotic syndrome) or functionally inadequate (varicose/refluxed vein)

Results in an abnormally high hydrostatic force transmitted to the subcutaneous veins and tissues of the lower leg
Results in edema  secondary changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Secondary changes from chronic edema for Chronic Venous Insufficiency

A

Fibrosis of the subcutaneous tissue and skin
Pigmentation of the skin (hemosiderin)
Ulcerations that are slow to heal
Varicosities may develop if d/t post-thrombotic event

23
Q

8 Risk Factors for Chronic Venous Insufficiency

A 
DVT (Delayed complication- post thrombotic syndrome)
Varicose Veins
Obesity
Pregnancy
Inactivity
Smoking
Extended periods of standing or sitting
Female Sex
Age over 50
24
Q

Signs and Symptoms of Chronic Venous Insufficiency

A

Progressive pitting edema of the leg (lower leg) is the primary presenting symptoms
Secondary Changes develop over time(progressive):
Itching
Dull ache in the leg that worsens w/ prolonged standing and resolves w/ leg elevation
Skin at ankle is usually taut from swelling, shiny and a brownish pigmentation (hemosiderin)
Subcutaneous tissue becomes thick and fibrous
Ulcerations may occur near the medial and lateral malleolus
Cellulitis is common (blanching erythema)
Varicosities may develop

25
Q

Imaging for Chronic Venous Insufficiency

A

Duplex U/S to determine whether superficial reflux is present and to evaluate the degree of deep reflux and obstruction

26
Q

Generalized Treatment for Chronic Venous Insufficiency

A 
Compression stockings (mid foot to just below knee)- mainstay of treatment*** 1ST LINE
Avoid long periods of sitting/standing
Intermittent elevations of legs/sleeping w/ legs elevated above the level of the heart
27
Q

Ulcer Treatment for Chronic Venous Insufficiency

A

Wet to dry dressings or occlusive hydrocolloid dressings (consist of paste w/ zinc oxide, calamine, glycerin and gelatin)
Change every 2-3 days depending on the amount of drainage
Once ulcer has healed, compression stockings w/ graduated compression below the knee are used to prevent recurrent edema and ulceration

28
Q

Surgery for Chronic Venous Insufficiency

A

Radiofrequency ablation or endovenous laser tx to correct superficial reflux/incompetent perforator veins that feed the area of ulceration to promote healing

29
Q

Deep Vein Thrombosis Definition

A

A blood clot that develops in a vein deep in the body. The clot may partially or completely block blood flow through the vein.
Most occur in the lower extemity, but they can also occur in other parts of the body (ex. Arm, abdomen, pelvis, etc)

30
Q

Classic Triad of predisposing factors for DVT (Virchow’s Triad)

A

Venous Stasis
Injury to the vessel wall
Hypercoagulable state

31
Q

Complications of DVT’s

A

Pulmonary Embolism
Post thrombotic syndrome (chronic venous insufficiency)
Phlegmasia alba dolens
Phlegmasia cerulea dolens

32
Q

Etiology Of DVT– Venous Stasis

A

Immobilization…
Transient ( s/p Operation/surgery under general anaesthesia or Transcontinental flight)
Extended: Confined hospitalization after pelvic, hip or spinal surgery; Due to stroke or Paraplegia

Reduced return blood flow to the heart
Increased blood viscosity: (Polycythemia vera, Severe dehydration)
Increased Central Venous pressure (Rt. Heart failure, Pt. on Respirator with PEEP)

Reduced flow thru’ the leg veins
Abd. mass compressing Iliac Vein or IVC; Enlarged or Pregnant Uterus

33
Q

Etiology of DVT’s–Mechanical Injury to the Vein Wall

A

Obvious: ex. Trauma, Surgery
Obscure: ex. Hip Arthroplasty with Femoral Vein manipulation, Old DVT with persistent endothelial vein damage.

34
Q

Etiology of DVT’s –Hypercoagulable State

A

Primary: Mostly secondary to a genetic mutation leading to altered coagulation cascade eg. Antithrombin III deficiency, antiphospholipid syndrome, Protein C deficiency, Protein S deficiency)
Secondary: Surgery, Malignancy, Pregnancy, Oral Contraceptive Use etc.

35
Q

Phlegmasia Alba Dolens (White Leg)

A

Occurs when there is massive deep thrombosis with total occlusion of the deep venous system.
The venous drainage falls on the superficial system which is unable to handle the load. The leg becomes edematous which compromises the arterial circulation resulting in the leg turning white
May be reversed with emergent intervention possibly using Thrombolytic therapy

36
Q

Phlegmasia cerulea dolens( Venous Gangrene)

A

Continuation of the process(alba dolens) leads to complete occlusion of arterial supply to the limb
Without blood supply, the skin and toes become gangrenous
Prognosis very poor, usually requires emergent leg amputation.

37
Q

Risk Factors for DVT’s

A 
Hypercoagulable states
Thrombophilia
Trauma
Obesity
Recent Surgery/invasive procedures
Immobilization
Recent Prolonged Travel
Cancer
Pregnancy/Post-partum
OCP’s/HRT
Prior VTE
38
Q

Signs of DVT’s

A

Unilateral pitting edema
Increased calf circumference (>3cm)
Calf Tenderness
Homan’s Sign (controversial)

39
Q

Symptoms of DVT’s

A

Often asymptomatic (if subclinical)
Leg swelling
Leg pain
Unilateral leg tenderness

40
Q

Ddx for DVT’s

A 
Ruptured Baker’s Cyst
Cellulitis
Lymphedema
Thrombophlebitis
Post-thrombotic syndrome
Chronic Venous insufficiency
Trauma
Bone neoplasm
Heart failure
Nephrotic syndrome
Cirrhosis
41
Q

Diagnosis of DVT’s

A

Classic symptoms of DVT as well as classic signs are of LOW PREDICTIVE VALUE
However, combinations of clinical features in the form of clinical prediction can be useful to stratify patients into risk categories
Wells Criteria

42
Q

Lab Test for DVT’s

A

D-Dimer
Sensitivity is >80%, not specific
Combination of low-risk assessment & negative D-dimer assay effectively rules out DVT
Positive d-Dimer test does not raise the likelihood of DVT
False +: MI, Sepsis, Cancer, Post-op state, Late Pregnancy

43
Q

Imaging for DVT’s

A

Ultrasound- Most widely used study
Relies on loss of vein compressibility as the primary criteria for DVT, Visualization of thrombus and abnormal Doppler flow
Used in combination with Wells Criteria fairly accurately ( 80-85% Sensitivity & Specificity).
However, negative study in high-probability patient requires additional investigation to R/O DVT.
MR Venography w/ gadolinium contrast
Used when ultrasound is equivocal and there is high probability

44
Q

Treatments of DVT’s

A

Primary objective is to prevent complications
Mainstay of this objective is immediate anti-coagulation with parenteral unfractionated Heparin (UFH), Low Molecular Weight Heparin (LMWH) or fondaparinux followed by conversion to oral Coumadin ( Warfarin) or Thrombolytics
Continued as a “bridge” to long term anticoagulation with Warfarin which is started at the same time as parenteral agent
Takes 5-7 days to achieve therapeutic dosage of Coumadin (INR target of 2.5 w/ a range of 2.0-3.0)

45
Q

Immediate Anticoagulation of DVT’s

A

After 5-7 days of treatment, the residual thrombus will begin to endothelialize in the vein. The meds do not directly dissolve thrombus

46
Q

Immediate Anticoagulation of DVT’s— LMWH

A

LMWH
Has a greater bioavailability, a more predictable dose response and a longer half life than UFH
No monitoring or dose adjustment is required unless the patient is markedly obese or has CKD (reduce dose)
Enoxaparin (Lovenox): approved as a bridge to warfarin
1mg/kg bid till INR levels are at goal on Warfarin

47
Q

Immediate Anticoagulation of DVT’s—Fondaparinux (Arixtra)

A

Administered SQ once daily in a prefilled syringe as a bridge to Warfarin
No lab monitoring is required
Weight based dosage
Does not cause heparin induced thrombocytopenia

48
Q

Long term Oral Anticoagulation for DVT’s

A

Warfarin
Requires a minimum of 5 days to be therapeutic
Monitor INR (assesses the anticoagulant effect)
Typical starting dose is 5mg QD
Dose is titrated to achieve the target INR

49
Q

“Other” DVT Treatments

A

Role of Thromolystics in Acute DVT
Direct attack on the clot, unlike anti-coagulant therapy
Limited role at present
Only used in very select cases of Extensive DVT (Ileo-Femoral) of recent origin, in a pt. with low bleeding risks
Complications of bleeding high

50
Q

Inferior Vena Caval Filters (IVC)— DVT Treatment

A

Indications include:
Active bleeding that contraindicates anticoagulation
Recurrent venous thrombosis despite intensive anticoagulation
Can be used prophylactically: Multiple trauma with complex pelvic fractures, Severe head injury with Glasgow Coma scale < 8, patients with advanced malignancy

51
Q

Treatment setting for DVT’s

A

Typically treated as an outpatient if:
patient/family can administer the parenteral anticoagulant,
The patient has a good support system,
Ths patient has a permanent residence, telephone service and no hearing/language impairment is present

52
Q

Duration of Treatment for DVT’s

A

Provoked DVT in arm/calf (recent surgery, trauma, OCP/HRT, or indwelling catheter): 3 months of tx
Provoked proximal leg DVT: 3-6 months
Patients w/ cancer: 3-6 months of LMWH w/o warfarin and continue anticoagulation indefinitely unless patient becomes cancer-free
? LMWH or Warfarin
Unprovoked DVT (including long travel): consider indefinite tx d/t high rate of recurrence vs 6 months of tx w/ target INR b/w 2-3 followed by a lower target INR of 1.5-2
If mod-high levels of anticardiolipin Ab: indefinite duration recommended

53
Q

Well Criteria for DVT

A

Active Cancer……………………………………………………………….+1 point
Paralysis/Paresis or recent immobilization of lower leg…+1 pt
Bedridden for > 3 days or major surgery(within 4 wks)…+1 point
Localized tenderness along the deep veins…………..+1 point
Entire Leg Swollen………………………………………………………..+1 point
Calf swelling >3cm compared to other leg…………………….+1 point
Unilateral Pitting Edema……………………………………………….+1 point
Collateral (nonvaricose) Superficial Veins……………………..+1 point
Previously documented DVT…………………………………………+1 point
Alternative Diagnosis as likely as or more than DVT …….-2point
Risk Score Interpretation:
3 points: high risk (75%)
1 to 2 pts: Medium Risk (17%)
< 1 point: Low Risk(3%)

Cardio= Clin Med (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions