PVE Flashcards
Intima
single continuous lining of endothelial cells, when plaque forms it gets in this layer and there is an inflammatory response
Media
smooth muscle elastic properties that allows variants in BP and blood flow, elastin allows for change in pressure in the vessels
Adventitia
CT layer that has nerve fibers in it that allows for changes and sensory to the vessels but meds that affect BP to allow for the lowering of BP or vice versa
Arterioles are known as
resistance muscles
Venous system highlights
- veins thin walled, distendable
- capacity for 2/3 circulating volume
- Unidirectional valves that promote flow to heart
- Head/Arms/Trunk > SVC
- Abd wall/liver/LE> IVC
- Leg Veins susceptible to irregular dilatation, compression, ulceration
_______ veins carry 90% of venous return from LE
deep
_________ veins are not well supported by surrounding tissues and they are
superficial
great saphenous vein
small saphenous vein
What is the lymphatic system?
Extensive vascular network that drains lymph from body tissues and returns to venous circulation
they collect fluid, plasma protein, and cellular debris
Ultimately drain into neck
What causes edema?
Increased plasma volume due to extra sodium. Filtration changes, increased capillary permeability which causes fluid to leave intravascular spaces and go extravascular into the soft tissues
What is pitting dependent upon?
viscosity of fluid due to protein concentration.
Low protein
CHF- brief pitting
High protein
Protein-Lymphedema- non-pitting
What are causes of pitting edema
Cirrhosis, malnutrition, low protein low albumin and certain meds
Chronic venous insufficiency
Overtime ulcers occur from skin breakdown. This is a venous problem where you have chronic venous obstruction, venous obstruction that doesn’t allow blood to return to the heart.
Lymphedema
No pitting, thicker skin, still swollen foot where the highest point of edema is soft/doughy there’s no pigmentation changes usually occurs b/l in feet and ankles and because it is a high protein disorder its an accumulation of interstitial fluids with high concentration of proteins
What is the goal of a PV history?
to determine integrity of the system
During a PV history, outside etiology should NOT alter __________ of extremity
perfusion
What are the 6 Ps of acute arterial occlusion
- paresthesia
- pallor
- pulselessness
- poikilothermia
- paralysis
- pain out of proportion to exam
What is peripheral artery disease
Atherosclerotic disease distal to aortic bifurcation
Marker for CV morbidity and mortality
Risk of death from MI and stroke 3x with PAD
Only 10% of patients with pain or swelling in extremity have pain relieved with _________
rest
30-50% of patients with pain or swelling in extremity have ___________
atypical leg pain
60% of patients with pain/swelling in extremity are ____________. They may have ____________ impairment.
asymptomatic, functional
What are risk factors for PAD?
Age > 50
Smoking
DM
HTN
Elevated cholesterol
AA ancestry
CAD
PAD warning signs/risks
- fatigue, aching, numbness or pain that limits walking or exertion in the legs
- ED
- poor healing/nonhealing of wounds in legs and feet
- pain present at rest in LE
- pain after meals and associated food fear and wt loss
- 1st degree relative with abdominal aortic aneurysm (AAA)
If pain is relieved by sitting, bending forward or B/L buttock pain it is likely a __________ pathology
spinal
With Abd, back and flank pain there is
food fear:
weight loss
dark stool
Venous Thromboembolism
very common
Most have unilateral or asymptomatic swelling of extremity
Is there arm pain/discomfort, paresthesias, weakness
Pain or swelling of the calf
Use Wells Criteria and/or Geneva Score
What is a 2+ pulse
brisk, expected, NORMAL
Epitrochlear Nodes are ____ palpable in healthy individuals
NOT and if they are, they are associated with HIV, lymphadenopathy and lymphoma
What is the absence of the dorsalis pedis pulse a significant risk of if absent with normal Fem/Pop pulses
PAD
Poikilothermia
Assess temperature of feet/legs with back of hands/fingers
What is an ABI and what is the normal value
Looking to asses ratio of arterial flow comparing UE TO LE
normal is 0.90- 1.40
Allen test
Palmar arches
Patency of Radial and Ulnar Arteries
1. Make a tight fist
2. Compress radial and ulnar artery simultaneously
3. Open hand in relaxed, slightly flexed position
Palm will be pale
4. Release pressure over ulnar artery- if patent—flushes within 3-5 seconds
5. Repeat with leaving ulnar artery occluded and opening radial aspect.
Pitting edema scale
1+ Barely palpable
2+ Slight indentation; 15s rebound
3+ Deeper indentation; 30 seconds
4+ > 30 seconds to rebound
What are risks for PVD
Age>65
Risk Factors- Cardiac risks
DM, Tobacco, Hyperlipidemia, HTN
Known atherosclerosis from another area of the body
What is the screening for PVD?
Major Risk for M&M
ABI
< 0.90 abnormal
Much debate over screening tools.
AAA is defined as infrarenal aortic > _____cm
3
What are the risk factors for AAA
Risk Factors
Older Age
Male
Smoking
Family Hx
Hx of vascular abnormalities
Height
CAD/ CVD
Atherosclerosis
Who do you want to screen for AAA
Screen asymptomatic men from age 65-75 who have smoked > 100 cigarettes in a lifetime.
Grade B Evidence
What is chronic venous insufficiency ?
Medial and sometimes lateral malleolus
Ulcer contains small painful granulation tissue
Exposed tendons rare
Pain > 75%
What is arterial insufficiency?
Occurs in toes, feet, shins
Surrounding area no callus
Severe pain
Gangrene is possible
Decreased pulses, foot pallor on elevation, rubor on dependency
What is chronic arterial insufficiency?
Intermittent claudication(pain w walking), gangrene
What is Chronic Venous Insufficiency ?
doesn’t affect arteries, temp changes not normal usually will see persistent edea and pigmentation changes.
What is a nephrotic ulcer?
Pressure points under decreased sensation
Surrounding skin calloused
No pain-> Unnoticed
