Peripheral Venous & Lymphatic Vessel Disease Flashcards

Question

Clinical manifestations of chronic venous insufficiency

Answer 1

Primary symptom: progressive pitting edema of the lower leg Secondary changes in the skin and subcutaneous tissues develop over time Stasis dermatitis Other common symptoms are itching, a dull discomfort made worse by periods of standing, and pain if an ulceration is present Secondary lymphedema can occur Progressive sclerosis of lymph channels Taut, shiny skin at the ankle due to edema Brownish skin pigmentation Also known as hemosiderin staining Eventual loss of skin integrity with ulceration Can develop secondary cellulitis aggravating the process Diagnosed by blanching erythema with pain Can eventually have relative fixation of the ankle joint secondary to tissue fibrosis

Answer 2

antibiotics from prescriber thinking it was cellulitis, except there is no pain, no recovery, not hot to touch also bilateral crusty, friable

Answer 3

permanent discolation near the medial malleolus

Answer 4

manifestation of chronic venous insufficiency It is a type of panniculitis Affected legs typically have the following characteristics: Skin induration Increased pigmentation Swelling Redness “Inverted champagne bottle” or “bowling pin” appearance

Answer 5

white star deformities from decreased capillary blood flow to tissue Star-shaped or polyangular, ivory-white depressed atrophic plaques Prominent red dots within the scar due to enlarged capillary blood vessels Surrounding hyperpigmentation

Answer 6

Corona Phlebectatica Characterized by abnormally dilated veins around the ankle

Answer 7

arterial lesions have well-defined borders (skin is warm, has pulses) venous lesions do not have well-defined borders (worse pulses)

Answer 8

Clinically Duplex ultrasonography is the test of choice for planning therapy

Answer 9

Used if doppler US nondiagnostic Requires injection of IV dye $$ for chronic venous insufficiency

Answer 10

Same as vericose veins compression stockings during day or evening first line pneumatic compression if severe

Answer 11

Paste gauze compression dressing for chronic venous insufficiency prescribed by wound care takes FORVER to do allows venous blood to compress back up to

Answer 12

It can come back

Answer 13

Superficial Venous Thrombophlebitis (inflammation)

Answer 14

Red, painful induration along a superficial vein Commonly occurs at the site of a recent IV line Marked swelling of the extremity may occur

Answer 15

inflammation of a superficial vein, which typically results in a clot

Answer 16

inflammation of a superficial vein, which typically results in a clot

Answer 17

Complications in superficial thrombophlebitis: Extension into the deep venous system Hyperpigmentation over the affected vein Persistent, firm nodule in subcutaneous tissues at the site of the affected vein Conversion to suppurative thrombophlebitis

Answer 18

fluid and blood goes out of opening Metastatic abscess formation Septicemia Septic emboli not good to have

Answer 19

clinically WBC is elevated, but does not help change treatment Venous doppler ultrasound ONLY if involves the proximal lower extremity or if patient has mixed picture

Answer 20

Mild, localized disease → mild analgesics, such as aspirin or NSAIDs, and the use of some type of elastic support usually are sufficient Patients are encouraged to continue their usual daily activities

Answer 21

More severe, larger, associated with pain and redness → elevate the extremity and apply massive, hot, wet compresses 5 cm or longer → prophylactic dose Fondaparinux (Arixtra), LMWH, or Rivaroxaban (Xarelto) x 45 days Rapidly progressing disease or extension into deep system → full dose anticoagulation

Answer 22

removed and the device is cultured

Answer 23

Vancomycin + Ceftriaxone Urgent treatment with Heparin or Arixtra

Answer 24

Overall prognosis for most patients is good, as it is usually self-limiting, benign, and brief If associated with septicemia, mortality rate is 20% or more

Answer 25

Red streaking from wound or cellulitis towards regional lymph nodes, which are typically enlarged and tender Chills, fever, malaise may be present

Answer 26

Inflammation of the lymphatic channels May be infectious or noninfectious Lymphatic system function → resorb fluid and protein from tissues and extravascular spaces Lymphatic channels are situated in the deep dermis and subdermal tissues parallel to the veins and have a series of valves to ensure one-way flow it is the garbage truck

Answer 27

hemolytic streptococci or S. aureus red skin streaking extending proximally

Answer 28

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

Answer 29

Not really :(

Answer 30

→ painful or painless nodular subcutaneous swellings along the course of the lymphatic channels

Answer 31

culture it

Answer 32

malignancy

Answer 33

distal abrasian and follwing the streak up you see the lymph node

Answer 34

CBC w/ diff and blood cultures must be obtained Wound culture, abscess I&D if possible Consider involving infectious disease to assist in the diagnostic workup Imaging may be helpful for defining anatomic abnormalities → rarely useful for diagnosis of infectious etiologies Lymphangiography and lymphoscintigraphy have been used to evaluate for lymphedema and/or lymphatic obstruction (inject dye into lymph system and see what happens)

Answer 35

covering for GABHS Keflex is common

Answer 36

for patients who appear nontoxic, are afebrile, and not immunocompromised

Answer 37

Analgesics and/or anti-inflammatories for pain Can also help reduce inflammation and swelling Hot, moist compresses also help to reduce inflammation and pain Elevate and immobilize affected areas to reduce swelling, pain, and the spread of infection if possible An abscess may require surgical drainage Nodular lymphangitis often require surgical intervention

Answer 38

PAINLESS persistent edema of one or both lower extremities, primarily in young women PITTING edema w/o ulceration, varicosities, or stasis pigmentation Lymphangitis and cellulitis may develop

Answer 39

Congenital (lymph vessels are over or under developed) Secondary damage: 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

Answer 40

can occur in both forms → leads to incompetence of the valve system, poor lymphatic fluid flow, and results in progressive stasis of a protein-rich fluid Can result in episodes of acute and chronic inflammation, worsening the edema

Answer 41

PAINLESS mainly leads to unsightly and trouble with ADLs

Answer 42

No cure for lymphedema (LIFELONG): Treatment aimed at controlling lymphedema and allowing normal function Common treatment strategies Edema control Intermittent leg elevation, especially while sleeping (foot of bed elevated 15–20 degrees) Constant use of graduated elastic compression stockings Massage toward the trunk (either by hand or with pneumatic pressure devices designed to “milk” edema out of an extremity”) Common treatment strategies Referral to wound care centers Stress good hygiene and treatment of any secondary infection Intermittent use of diuretics therapy is rarely helpful Amputation is used only for the rare complication of lymphangiosarcoma in the extremity

Answer 43

No :( which is why it cannot be used for lymphedema