PVD Flashcards
which artery is found at the bend of elbow and medial to the biceps tendon
Brachial
Which artery is found lateral aspect of forearm
radial
medial aspect of forearm is which artery
ulnar
Atheroma formation begins where
in the intima
major precipitant of ischemia and infarction in vessels?
plaque activation
luminal stenosis
if a major artery is blocked, how does body respond
creates anastomoses b/w branching networks of smaller arteries—- these increase over time and form collateral circulation that perfuses structures distal to occlusion
what are the main arteries found in the abdomen
celiac trunk
superior mesenteric artery
inferior mesenteric artery
what does the celiac trunk supply
foregut
- esoph
- stomach
- liver
- GB
- spleen
what does superior mesenteric artery supply
midgut
- small intest
- jejunum
- ileu
- cecum
- ascend/descend colon
what does the inferior mesenteric artery supply
hindgut
- desc colon
- sigmoid colon
- proximal rectum
which artery is the only palpable pulse felt in abdomen
aorta
which arteries can you palpate in leg?
- femoral artery
- popliteal artery
- dorsalis pedis artery
- posterior tibial artery
which artery is right below the inguinal ligament
femoral
which artery passes medially behind femur and behind the knee
popliteal
which artery is at the dorsum of foot just lateral to extensor tendon of big toe
dorsalis pedis
which artery lies behind medial malleolus
posterior tibial
veins have thin or thick walls
thin
veins are highly distensible or not distensible
highly distenstible
veins from where drain into SVC
veins from:
- arms
- upper trunk
- head
- neck drain
veins from where drain into IC
abdominal viscera
lower trunk
legs
what is the one exception for veins draining into SVC/IVC
liver— has its own system
veins are susceptible to?
- irregular dilation
- compression
- ulceration due to weaker walls
arteries or veins are susceptible to:
- irregular dilation
- compression
- ulceration due to weaker walls
veins
name the two superficial veins of the legs
great and small saphenous veins
deep veins of the legs carry ___% of the venous return from lower extremities
90%
____ veins of the ____ carry 90% of venous return from lower extremities
deep veins
legs
mechanisms that develop edema (5)
- increased plasma volume from Na+ retention
- Altered cap dynamics resulting in net filtration
- inadequate removal of filtered lymph fluid
- lymphatic or venous obstruction
- increased capillary permeability
list the lymph node discriptors
shotty
fluctuant
matted
what is a shotty lymph node
small, nontender nodes that feel like BBs or buckshot under the skin
what is a lymph node that is small, nontender that feel like BBs or buckshot under the skin
shotty
describe fluctuant
wavelike motion that is felt when the node is palpated
wavelike motion that is felt when the node is palpated
fluctuant LN
what is a matted lymph node
group of nodes that feel connected and seem to move as a unit
matted, firm, rubbery, progressively getting bigger can be suspicious of?
malignancy
list the common or concerning symptoms (7)
- abdominal, flank or back pain
- Pain or weakness in arms or legs
- intermittent claudication
- cold, numbness, pallor in legs–hair loss
- swelling in calves, legs or feet
- color change in fingertips or toes in cold weather
- swelling with redness or tenderness
PAD refers to……?
stenotic, occlusive, and aneurysmal dz of the abdominal aorta, mesenteric and renal branches and the arteries of the lower extremities, exclusive of the coronary arteries
V in PVD stands for
Peripheral VASCULAR disease (not vein)
hair loss on anterior tibial surfaces suggests?
PAD
*decreased arterial perfusion
symptomatic limb ischemia with exertion is?
atherosclerotic PAD
pain with walking or prolonged standing, radiating from spinal area into the buttocks, thighs or lower legs or feet is?
neurogenic claudication
fingers or toes change color in cold weather or when PT handles cold objects suggests?
arterial spasm
Intermittent claudication is assoc with
PAD
ulcers on lower legs often near ankles suggests
PVD–venous
ulcer more lateral suggests ___ in nature
venous
ulcer more medial suggests ____ in nature
arterial
match the symptom location to the site of aterial ischemia:
- buttock
- ED
- thigh
- upper calf
- lower calf
- foot
- aortoiliac
- iliac-pudendal
- common femoral or aortoiliac
- superficial femoral
- popliteal
- tibial or peroneal
abd pain after meals and food fear + wt loss suggests?
intestinal ischemia of the celiac or superior or inferior mesenteric arteries
prevalence of AAA in first degree relatives is __%-__%
15%-28%
define intermittent claudication
any pain or cramping in the leg during exertion that is relieved by rest w.in 10 mins
only ___% o patients have classic features of leg pain with exertion relieved by rest
10%
another ___%-__% have atypical leg pain
30-50%
up to ___% may be asymptomatic for intermittent claudication
60%
define atherosclerotic PAD
symptomatic limb ischemia with exertion
define neurogenic claudication
pain with walking/prolonged standing radiating from spinal area into buttocks and down leg to feet
pain with walking/prolonged standing radiating from spinal area into buttocks and down leg to feet
—pain relieved by sitting and bending forward suggests?
spinal stenosis
PAD red flags
fatigue aching numbness pain **that limits walking or leg exertion -ED -poorly healing/non-healing wound lower extremities -first degree relative with AAA
asymmetric blod pressures seen with
- coarctation of aorta
2. dissecting AA
list the arteries most commonly get atherosclerotic dz
- carotid bifurcation
- proximal renal arteries (proximal lef anterior desc coronary artery)
what happens when there is atherosclerotic dz in aorta
- ectasia
- formation of aneurysms
dilation or distention of a tubular structure
ectasia
artery is widely dilated is?
aneurysmal
bounding carotid, radial and femoral pulses are present in?
aortic regurgitation
asymmetric dimminished pulses point to?
arterial occlusion from atherosclerosis or embolism
swelling from lymphedema of arm and hand may come after?
axillary node dissection and radiation therapy
visible venous collaterals, swelling, edema and discoloration point to?
upper extremity DVT
what is the MCC of upper extremity DVT
catheter-associated thrombosis (central venous catheter)
compared Periph Artery Dz and Periph Venous dz
- pain
- Mechanism
- pulses
- color
- temperature
- edema
- skin changes
- ulceration
- gangrene
- PAD: intermittent claudication, progressing to pain at rat
PVD: often painful - PAD: tissue ischemia
PVD: Venous hypertension - PAD: decreased or absent
PVD: normal, though skin may be diff to feel thru edema - PAD: pale, esp on elevation, dusky red on dependency
PVD: normal or cyanotic on dependency, petechiae and then brown pigmentation appear with chronicity - PAD: cool
PVD: normal - PAD: absent or mild, may develop as the patient tries to relieve rest pain by lowering the leg
PVD: present, often marked - PAD: trophic changes: thin, shiny, atrophc skin, loss of hair over the foot and toes, nails thickened and ridged
PVD: often brown pigmentation around the ankle, stasis dermatitis, and possible thickening of the skin and narrowing of the leg as scarring develops - PAD: if present, involves toes or points of trauma on feet
PVD: if present, develops at sides of ankle, esp medially - PAD: may develop
PVD: does not develop
intermittent claudication progressing to pain at rest seen with?
Periph artery dz
tissue ischemia is seen wth?
periph artery dz
pulses are decreases to absent?
periph artery dz
pulses are normal though may be diff to feel through edema
Periph venous dz
color of leg is pale, esp on elevation
dusky red on dependency
periph artery dz
leg color is normal or cyanotic on dependency
petichiae and brown pigmentation appear when it becomes chronic
periph venous dz
cool leg to touch
periph artery dz
normal leg temp
periph venous dz
edema is mild to absent
periph artery dz
edema is present and often marked
periph venous dz
skin changes: thin, shiny, atrophic skin, loss of hair over the foot and toes with nails thickened and riged
periph artery dz
skin changes: brown pigmentation around ankle, stasis dermitits, possible thickening of skin and narrowing of the leg as scarring develops
periph venous dz
ulceration: if present, invovles toes or poitns of trauma on feet
periph artery dz
ulceration: if present, dvelops at sides of ankle, esp medially
periph venous dz
gangrene does NOT develop with peripheral ___ dz
venous
grading for amplitude of arterial pulses
3+ =? *what does this indicate
2+=?
1+=?
0=?
3+ is bounding and indicates aortic regurg
2+ is brisk, expected– normal
1+ diminished, weaker than expected
0 is absent and unable to palpate
waterhammer or bounding pulse?
aortic regurgitation
enlarged epitrochlear node suggests?
local or distal infection
-can be assoc with lymphadenopathy from lymphoma or HIV
spasm of distal arteries causes episodes of sharply demarcated pallor of the fingers
-esp when exposed to cold air
raynauds dz
how long do you press on edema to assess it?
2 seconds
normal cap refill?
<2 seconds
how should patients knee be when feeling for popliteal pulse
flexed with the leg relaxed
NAVEL?
stands for
direction?
Femoral NERVE Femoral ARTERY Femoral VEIN empty space Lymphatics
lateral to medial
edema:
list the gradings and what it means
push down on edema and after removing the finger… grade the edema on the following scale:
1+= slight pitting, no visible distortion, disappears rapidly
2+= deeper than 1+ and disappears in 10-15 seconds
3+= noticebly deep and may last >1 minute with dependent extremity full and swollen
4+= very deep and lasts 2-5 min, with grossly distorted dependent extremity
what grade edema:
slight pitting, no visible distortion, disappears rapidly
1+
what grade edema:
deeper than 1+ and disappears in 10-15 seconds
2+
what grade edema:
noticebly deep and may last >1 minute with dependent extremity full and swollen
3+
what grade edema:
very deep and lasts 2-5 min, with grossly distorted dependent extremity
4+
describe grade 3+ edema
noticebly deep and may last >1 min with dependent extremitiy full and swollen
allen test tests for?
-when do we do this test
tests the blood supply to the hand (ulnar patency)
done prior to ABGs
steps for allen test
- palpate ulnar pulse
- Compress radial and ulnar arteries and have the patient making a fist
- ask PT to open hand to relaxed position
- release pressure over the ulnar artery
- Negative or positive test?
NEG=palmar flushing occurs when releasing ulnar artery
POS=if palmar pallor remains
what artery is compressed during allen test?
ulnar artery
can also assess radial artery patency
what test is done prior to ABGs
allen test
asymmetric BPs suggest?
coarctation of aorta
dissecting AA
dilated and tortuous veins
varicose veins
local swelling, redness, warmth, and a subcutaneous cord suggests?
superficial thrombophlebitis
OR
DVT which is deeper
marked pallor on elevation of extrem
arterial insufficiency
pitting edema? causes
prolonged standing (due to incr hydrostatic pressure in veins)
cardiac issues like CHF
how to evaluate competency of venous valves
assess retrograde filling with the trendelenburg test
positive trendelenburg test indicates?
- rapid filling of the superficial veins during occlusion of saphenous veins indicates incompetent valvues in the communicating veins that allow rapid retrograde flow from the deep veins to the saphenous veins
- sudden additional filing of superficial veins after relese of compression indicates incompetent saphenous vein valves
findings for cellulitis?
WARM to touch unilateral pulses are normal to bounding fever ***its an infection
is vascular dz bilateral or unilateral
bilateral
cyst behind the knee
bakers cyst
what is a bakers cyst assoc with
osteoarthritis
bakers cyst
benign or pathologic?
usually benign
but if they rupture it can cause damage
define embolus
piece of clot breaks off and travels
define thrombus
clot
PE findings for DVT
redness
swelling
warmth
palpable cord
calf pain on dorsiflexion of the foot is a + ____
positive homan’s sign
what is homan’s sign
calf pain on dorsiflexion.. indicates DVT
what is most reliable test for DVT
measuring the calf circumference
edema is initiallly soft and then hardens
lymphedema
skin is thick and edema is soft—>hardens
bilaterally in feet/toes
lymphedema
when can lymphedema occur
after axillary node dissection
radiation
what can you not do on the arm of the same side as a mastectomy/axillary node dissection and/or radiation?
take a BP
desribe the spreading of lymphangitis
spreads from distal port of entry—->up to lymphatic channels
red streaking on arm
lymphangitis
retrograde filling test or?
trendelenburg test
Trendelenburg test results:
1. *rapid filling of the superficial veins during occlusion of saphenous veins indicates?
- *sudden additional filing of superficial veins after relese of compression
- incompetent valvues in the communicating veins that allow rapid retrograde flow from the deep veins to the saphenous veins
- indicates incompetent saphenous vein valves
trendelenberg test
- test what?
- which vessels?
assess retrograde filling–competency of the venous valves
*assess the valves of the communicating veins and saphenous veins
