PV System Flashcards
Celiac trunk?
Foregut: Esophagus, stomach, liver, gallbladder, spleen
Superior Mesenteric Artery?
Midgut: Small intestine, jejunum, ileum, cecum, large intestine (ascending/transverse colon)
Inferior Mesenteric Artery?
Hindgut: Large intestine (descending, sigmoid colon), proximal rectum
What is the only pulsation palpable in the abdomen?
Aorta pulsation
Femoral artery?
Right below inguinal ligament.
Popliteal artery?
Passes medially behind femur and behind knee.
Dorsalis Pedis Artery?
Dorsum of foot just lateral to extensor tendon of big toe.
Posterior Tibial Artery?
Lies behind medial malleolus.
Veins?
Thin walled, highly distensible.
Veins from arms, upper trunk, head, and neck drain to SVC–> R. atrium.
Veins from abdominal varices, lower trunk, and legs drain to IVC.
Exception is liver as circulation is through portal vein.
What are veins susceptible to due to weaker walls?
Irregular dilation, compression, and ulceration.
Great saphenous vein?
Up medial aspect of leg.
Small saphenous vein?
Passes upward along posterior calf to popliteal fossa.
What carries 90% of the venous return from lower extremities?
Deep veins of the legs.
What is the lymphatic system?
Extensive vascular network that drains lymph from body tissues and returns it to venous circulation. Moves lymph from tissues to the blood stream.
What is a lymph?
Clear/white fluid that carries WBC’s (lymphocytes).
What are lymph nodes?
Round, oval, or bean-shaped structures.
Vary in size according to location.
What is the important role of lymphatic system in body’s immune system?
Cells in lymph nodes engulf cellular debris/bacteria and produce antibodies.
Lymph nodes that are matted, firm, rubbery, progressively getting bigger?
Malignancy.
What are shotty lymph nodes?
Small nontender nodes that feel like BBs or buckshot under the skin.
What are fluctuant lymph nodes?
Wavelike motion that is felt when the node is palpated.
What are matted lymph nodes?
Group of nodes that feel connected and seem to move as a unit.
Pt w/ cold, numbness, pallor in the legs, hair loss at anterior tibial surfaces?
PAD
Pt w/ swelling in calves, legs and feet?
CHF/DVT
Pt w/ color change in fingertips/toes in cold weather?
Raynold’s
Pt w/ swelling w/ redness/tenderness?
cellulitis
Pt w/ intermittent claudication?
PAD
What is intermittent claudication?
Any pain or cramping in the leg during exertion that is relieved by rest within 10 minutes. (Only 10% of patients have classic presentation. 30-50% have atypical leg pain, and up to 60% may be asymptomatic.)
What is atherosclerotic PAD?
Symptomatic limb ischemia with exertion.
What is neurogenic claudication?
Pain with walking/prolonged standing radiating from the spinal area into buttocks and down leg to feet.
If pain with walking/prolonged standing radiating from the spinal area into buttocks and down leg to feet is relieved by sitting or bending forward?
Spinal stenosis
Red flags of PAD?
Fatigue, aching, numbness or pain that limits walking or leg exertion. Ask about erectile dysfunction.
Poorly healing/non-healing wound lower extremities.
First degree relative with AAA.
Peripheral Venous Disease (chronic venous insufficiency)?
AKA Venous Thromboembolism.
Painful.
Mechanism: Venous HTN.
Pulses: Nml but hard too eel thru edema.
Color: Nml or cyanotic on dependency. Petechiae and then brown pigmentation appear w/ chronicity.
Temp: Nml.
Edema: Present, often marked.
Skin changes: Often brown pigmentation around ankle, stasis dermatitis, and possible thickening of the skin and narrowing of the leg as scarring develops.
Ulceration: At sides of ankles medially.
No gangrene.
UE DVT MC from?
Catheter associated thrombosis (Central venous catheter).
PAD (chronic arterial insufficiency)?
Pain: Int claudication, progressing to pain at rest.
Mechanism: Tissue Ischemia
Pulses: Decreased or absent.
Color: Pale, especially on elevation, dusky red on dependency.
Temp: Cool
Edema: Absent or mild; may develop as pt tries to relieve rest pain by lowering leg.
Skin changes: Thin, shiny, atrophic skin. Loss of hair over foot and toes; nails thickened and rigid.
Ulceration: Involves toes or points of trauma on feet.
Gangrene: Maybe.
3+ bounding of arterial pulses?
Aortic regurgitation.
2+ brisk, expected arterial pulses?
NML
Enlarged epitrochlear node?
Local/distant infx. Assx w/ lymphadenopathy from lymphoma or HIV.
What does spasm of distal arteries cause?
Episodes of sharply demarcated pallor of the fingers (cold air).
1+ pitting edema?
Slight pitting, no visible distortion, disappears rapidly
2+ pitting edema?
Deeper than 1+ and disappears in 10-15 sec.
3+ pitting edema?
Noticeably deep and may last >1 min, with dependent extremity full and swollen.
4+ pitting edema?
Very deep and lasts 2-5 min, with grossly distorted dependent extremity.
When is Allen Test done?
Prior to arterial blood gas (ABG).
Pt w/ asymmetric blood pressures?
Coarctation of the aorta and dissecting aortic aneurysm.
Pt w/ local swelling, redness, warmth, and a subcutaneous cord?
superficial thrombophlebitis, (or DVT deeper)
Pt w/ marked pallor on elevation?
Arterial insufficiency.
Pt w/ pitting edema?
Prolonged standing (inc. hydrostatic pressure in veins), cardiac issues (CHF).
Test to assess retrograde filling and evaluate competency of venous valves?
Trendelenburg test
Swelling to back of leg?
Baker’s Cyst
Baker’s Cyst eval?
Assx w/ osteoarthritis. US and usually incidental finding. Fluid filled, benign, but can rupture and cause damage. If painful removed.
DVT?
Blood clot (thrombus) that forms in deep vein. If a piece breaks off and travels: embolism PE findings: redness, swelling, warmth, palpable cord.
Homan’s Sign?
Calf pain on dorsiflexion of the foot (not a great test: “discredited by Homan himself”?).
Reliable way to confirm DVT?
Measuring calf circumference.
Lymphedema?
Edema initially soft then hard. Skin thickened. Usually bilaterally in feet/toes.
Can occur after axillary node dissection and/or radiation.
?? No BP on arm same side mastectomy/axillary node dissection and/or radiation.
Lymphangitis?
Acute infection (usually staph/strep), spreading from distal portal of entry up lymphatic channels. Also referred to as “ streaking”.
