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PVD Flashcards

1
Q

Signs and Symptoms of Arterial Disease (Pain, Pulses, Edema, Skin Changes)

A

Pain: Acute Sharp pain relieved by rest
Pulses: Diminished or absent
Edema: Absent
Skin Changes: cool or cold, dry, shiny, scaling, thin, pallor develops w/ elevation, erthematous with dangling, cyanotic

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2
Q

Signs and Symptoms of Venous Disease (Pain, Pulses, Edema, Skin changes)

A

Pain: Aching, deep muscle pain that is relieved by activity or elevation
Intermittent claudication
Pulses: Present
Edema: present,; increases by end of day; extremity dependent
Skin Changes: warm, thick tough, rubor and darkened pigmentation, varicose veins, stasis ulcers

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3
Q

What are the pulses in the foot and describe where to palpate them

A

Dorsalis pedis: fingers go just lateral to extensor tendon of great toe
Posterior Tibial: fingers just behind and slightly below medial malleolus

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4
Q

4 Major risk factors of Arterial Occlusive

A
  1. SMOKING
  2. Diabetes
  3. High-fat diet
  4. Hypertension
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5
Q

Describe an emboli (found in Acute Arterial Occlusive)

A

Cardiac origin is most common

Migrates to a peripheral arterial vessel and blocks it

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6
Q

Is an emboli or thrombus more common in Acute Arterial Occlusive?

A

Emboli

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7
Q

Describe a thrombis

A

less common compared to emboli
Usually from in conjunction with atherosclerotic lesion
Platelets gather behind lesion an dform thrombus
Severely dependent on size

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8
Q

What are the symptoms of Acute Arterial Occlusive?? (The 5 P’s)

A
  1. Pain
  2. Pallor
  3. Paralysis
  4. Parasthesia
  5. Pulselessness
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9
Q

Pathology of PAD (atherosclerosis)

A

Slow Progression
Initial injury to vessel from HTN or trauma
Fatty deposits line artery wall at injury site
leads to vessel narrowing and blockage

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10
Q

Symptoms of Chronic Arterial Disease

A 
Intermittent Claudication
-cramping and pain
-symptomatic threshold at 50%
-rest pain at 80-90%
Diminished/absent pulses
Trophic changes
Wound formation
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11
Q

What is another name for Thromboangiitis Obliterans and describe

A

Buerger’s Disease
Occurs in young men who are heavy smokers
Inflammatory process in small vessels in feet and hands
leads to thrombus formation
starts DISTALLY and progress PROXIMALLY
Smoking cessation arrests disease

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12
Q

What subjective clues will your patient give you about arterial disease during the evaluation?

A

Cramping with walking
Rest pain, relieved by dependency
Wounds may have no history of trauma

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13
Q

Objective Signs of Arterial Disease

A

Trophic skin changes (loss of hair growth, abnormal nails, dry skin)
Cool skin
Decreased pulses

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14
Q

Medical Management of Chronic Arterial Disease

A

PT: stop smoking, wound care, walking program
Surgery
High risk of stroke, MI or death

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15
Q

what is vasculitis

A

inflammation of vessel wall resulting from immune complex despoiion or cell-mediated immune reactions directed against the vessel wall

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16
Q

What is the cause, medical management and PT for vasculitic syndromes

A

Cause is unknown
Early diagnosis and prevention of progression
PT: pain relief, functional mobility, wound care

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17
Q

Functions of lymphatic system:

A

Transport interstitial fluids back to blood, Transport absorbed fat from small intestine, Lymphocytes provide immunological defenses

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18
Q

Structure of lymph vessels

A

Tunics: Three layers, similar to veins; Close-ended tubes; Inner layer forming valves which prevent back flow of lymph

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19
Q

Movement of lymph in lymph vessels occurs via which mechanisms?

A

Peristaltic motion and valvular closure

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20
Q

Names different manifestations/types of peripheral vascular disease

A

PVD is organized based on pathology: Arterial occlusive, Inflammatory, Vasomotor Disorder, Venous

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21
Q

Describe Primary Raynaud’s Disease:

A

Temporary vasospasm in arterioles causing cyanosis, Most often occurs in the fingers; Caused by cold temps or strong emotions

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22
Q

Describe Secondary Raynaud’s Disease:

A

Occurs secondary to another disease, such as

Buerger’s Disease and/or Connective tissue diseases

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23
Q

Varicose veins definition

A

Abnormally dilated veins resulting from intrinsic vessel wall weakness and chronic valvular insufficiency. Most frequently occur in LEs. Women 3:1 vs. men

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24
Q

Those w/ varicose veins are at an increased risk for what 2 conditions?

A

Increased risk of thrombosis and chronic venous insufficiency

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25
Definition of DVT, common location of occurrence, and most serious consequence of a DVT.
Caused by coagulation of blood collected in deep veins due to obstructed flow. Most common in deep veins of calf. Most serious consequence is pulmonary embolism.
26
Causes of DVT (3):
Occurs with prolonged bed rest after surgery, prolonged sitting, trauma to vessels, etc
27
Symptoms of DVT (4):
Symptoms include dull ache, swelling in calf, increased warmth, pain when calf is squeezed (Homann’s sign)
28
PT's role if DVT is suspected:
Call MD immediately. Hold ambulation 48-72 hours after anticoagulation therapy.
29
Risk factors for venous disease development (6):
``` Aging Pregnancy Obesity Long hours of standing/sitting Lack of regular activity Family history ```
30
What is venous insufficiency / venous hypertension?
Inadequate drainage of venous blood
31
What are the 3 parts of the peripheral vascular system?
1. Arterial System 2. Venous System 3. Lymphatic System
32
What is the function of the arterial system?
Carry oxygenated blood to the capillaries of the body organs
33
What are the 3 tunics?
1. Tunica Intima – endothelium, CT, basement membrane 2. Tunica Media – smooth muscle. The strength of the artery 3. Tunica Adventitia – elastic and collagenous fibers
34
What happens to the large arteries during systolic and diastolic phase?
Systolic phase - Elastic fibers in the large arteries allow them to expand as blood pressure rises with heart contraction Diastolic phase - They recoil and drive the blood through the system as the heart relaxes
35
Muscular smaller arteries expand ________ regardless of the pressure.
only slightly | - Blood pressure is greatest here.
36
What happens to BP and blood flow in the smaller, arterioles and capillaries? Why?
- BP lessens & blood flow slows | - allowing gas & nutrient exchange
37
What are the differences between arterial, venous and lymphatics?
- -> Arterial - carry rich oxygenated blood away from heart - -> Venous - returns depleted blood from tissues back to the heart - -> Lymphatics - facilitates movement of fluid between bloodstream (veins/arteries) & interstitium to remove wastes, extra fluid & proteins
38
What is Arteriosclerosis?
A hardening of arterial walls
39
What is Atherosclerosis?
A common form of arteriosclerosis, often plaque deposits on endothelial lining -caused by a history of smoking, diet, etc
40
What is Arteriosclerosis obliterans?
Atherosclerosis manifested peripherally (usually LE)
41
What is Thromboangiitis obliterans?
Specific arterial disease with tissue ischemia in young men who smoke. AKA - Buerger’s disease
42
What is Raynaud’s disease?
Disease which causes constriction in the small arteries
43
What are risk factors for arterial disease?
- Smoking - Cardiac disease (and its related risk factors) - Diabetes - High blood pressure - Kidney disease
44
What is the function of the venous system?
Return deoxygenated blood from the body organs to the heart (and move waste products to the appropriate organs)
45
How many tunics does the venous system have?
3 - less distinct - tunica media is insignificant - veins cannot contract
46
What forms the valves int he venous system?
the inner layer of vessel wall
47
What happens when the pressure in the venous system is low?
insufficient to return all of the blood back to the heart.
48
What are 2 things that aid the movement of blood within the veins?
1. Skeletal muscle pump | 2. Breathing
49
How does the skeletal muscle pump aid in the movement of blood in the veins?
- Veins pass between muscle groups that provide a massaging action - Muscles squeeze the veins with one-way flow controlled by valves - This mechanism moves blood from lower extremities to abdominal veins
50
How does the breathing aid in the movement of blood in the veins?
- Contraction of the diaphragm increases pressure in the abdomen, squeezing the abdominal veins, & decreases pressure in the thoracic cavity - Pressure difference forces blood into the thoracic veins and on to heart
51
Protective Sensation
- sensory loss = loss of protective sensation | - the ability to sense pressure at different locations in the foot with a 5.07 mm monofilament
52
What Neuropathy Looks Like - Subjective Information
- gradual onset with tingling and numbness | - there's an acute onset with significant pain --> sensory loss
53
What type of things will you expect to see in the objective portion with neuropathy?
- loss of protective sensation - skin changes - inflammation - ulceration - infection - foot deformity: Charcot's - pulses may or may not be present
54
Describe Neuropathic Wounds
- typically pain free - often on the plantar aspect of the foot - punched out appearance - calloused edges
55
What are Charcot Joints?
- diseased joints marked by hypermobility | - associated with Tabes Dorsalis, Syringomyelia or other conditions w/SCI
56
What is the process of Charcot Joints?
- bone decalcification on joint surfaces - boney overgrowth about the margins - P usually absent - some exceptions - deformity & instability characteristic
57
Physiology of Wound Healing: Inflammatory Phase
- vasodilation, migration of leukocytes, histamine release | - platelet derived growth factors facilitate migration of granulocytes and macrophages
58
Physiology of Wound Healing: Proliferative Phase
- formation of granulation tissue (collagen + vascular network), wound contraction, re-epithelialization - Macrophages are key
59
Physiology of Wound Healing: Maturation Phase
- Day 9 - 2 Years - remodeling of new skin: collagen re-organized & tensile strength increases, cont. even after wound closure (overlaps w/proliferation phase) - Wounds can get "stuck" - PT wound interventions at this stage
60
What is primary lymphedema?
hereditary or congenital underdeveloped lymphatic system
61
What is secondary lymphedema?
Injury to a part of the lymphatic system that leads to blockage
62
Risk factors for lymphedema
Hereditary/congenital factors; breast cancer with surgical and radiation therapy; long standing edema; paralysis; damage during surgery; filariasis
63
subjective complaints of lymphedema
feeling of fullness; heaviness; numbness/tingling
64
What does lymphedema look like?
swelling, not usually improved with elevation; pitting (non pitting with fibrosis); dermal changes (cysts, hyperkeratosis); decreased ROM; lymph leakage
65
How can we as PTs modify lymphedema?
complete decongestive therapy (CDT) including bandaging, compression, manual lymph drainage, exercise, and self care
66
Name 3 inflammatory disorders of the vessels
Vasculitis, arteritis, and Kawasaki Disease
67
What is Kawasaki disease?
febrile disease in children
68
What is effected by peripheral neuropathy?
sensory, motor, and anatomic changes
69
What are the risk factors of neuropathy?
Diabetes, spina bifida, lupus, HIV/AIDS, chemotherapy, MS, vascular disease

Orthotics (11 decks)

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