signs/Sx/mechanisms Flashcards
with limb pain, (claudication) disease is usually _ to the symptoms
proximal
does the patient have good days and bad days?
if the pain is not consistent every time than problem may be neurogenic/ orthopedic in nature.
what is claudication
pain in muscle during activity and subsides with rest, due to inadequate blood supply .
pain subsides within minutes after ending of activity .
Ischemic rest pain is
severe symptom of reduced blood flow
where does ischemic rest pain usually present?
forefoot
heel -plantar
toes
what type of energy creates relief for ischemic rest pain?
potential energy/ hydrostatic pressure
pain occurs when the limb is not dependent.
end stage of chronic arterial disease
necrosis of tissue
claudication and ischemic rest pain is chronic arterial disease (T) or (F)
True- usually caused by atherosclerosis
Acute arterial occlusion signs and symptoms (p’s)
6
6 (P's) pain pallor pulselessness paresthesia - numbness tingling paralysis polar
(3) causes for acute arterial occlusion
thrombus
emboli
trauma
what makes acute arterial occlusion an emergency situation and not chronic occlusion
no time for development of collateral channels
Vasospastic disorders
Primary Raynaud’s
Secondary Raynaud’s
Primary Raynauds is marked by what
intermittent digital ischemia due to cold exposure to emational stress
what symptoms present with primary Raynauds
3
pallor
cyanosis
rubor - due to vasodialation may cause warmth due to ischemic cond’
Primary Raynauds is a _ condition
benign
Ischemia in Primary Raynauds is due to __
is common in __population, commonly__ and occurs __
digital arterial spasm
young women
hereditary
bilateral
Secondary Raynauds is also known as __
obstructive Raynauds syndrome
mechanism of Secondary Raynauds is
vasoconstriction of arterioles present with a FIXED artery obstruction
With secondary Raynauds ischemia is ___ present
constantly
Secondary Raynauds may be the beginnings of what other disease
Buerger’s which is Arteritis
what (3) signs of occlusion will present on physical exam
pallor
cyanosis
rubor
cyanosis is
concentration of deoxygenated hemoglobin
rubor suggests
dilated vessels
dilated vessels secondary to reactive hyperemia
reactive hyperemia is
aka venous hyperemia
increase in organ blood flow occurring following brief period of ischemia
what is the difference between hyperemia and congestion
hyperemia-
active process, red raised temp increased volume enhanced function
congestion
passive process, cyanosis , hypoxia, low temp, increased volume edema, decreased function,
eg; local obstruction or CHF
capillary filling test is ____ and accomplished how?
qualitiative
squeezing toe cut off circulation and seeing how blood returns to the skin
Refill time for qualitative capillary refill time is
3 seconds
greater than 3 seconds indicates ischemic conditions
elevation and dependency changes indicative of ischemic conditions appear how
(2)
pallor - elevation
ruborous discoloration- dependent position
aneurysms can be desctibed as ____ when palapated
bounding
pulses are graded on a scale of ___ to ___
0 - none
4+ - bounding
Arterial ulceration locations typically occur (inner or outer) area of LE or on tips of or between ____. Or where there is ____ from walking or footwear.
tibial area –OUTER ankle
on tips or between toes
preassure
Arterial ulcerations are characterized by a ______ look.
Usually ____ in shape. with ______, ____ wound margins.
punched -out look
well-defined, even wound margins
The wounds are (shallow/deep).
and (does/does not) bleed.
deep
does not bleed.
colors of arterial ulcerations
4
yellow
brown
grey
black
with arterial ulcers the affected area will have little to no ____, nails appear___ and hair____ with skin taking on shiny thin dry and taut appearance with delayed capillary return.
pulse
atrophic
hair loss
difference between arterial ulcer and venous ulcer
arterial ulcers- VERY Painful. temporary relief is gravity dependant
venous ulcers- redness and edema at site of ulcer and may be painless, and relief is found with elevating limb
palpable thrill is_____may indicate ____, ____, or ______
thrill is vibration that you FEEL
(you can FEEL a Thrill)
fistula, dialysis, post-stenotic turbulence
palpable pulses are found over what LE vessels
6
aorta femoral popliteal dorsalis pedis (DPA) posterior tibial (PTA)
Bruits are _______ found by _____
noise you can hear
auscultation
BRUEE are loud
Bruits are commonly mentioned with what exam
carotid
the dr heard one and wants to know were the stenosis is coming from
auscltation of bruits can be found in the following (5) areas
aorta femoral popliteal carotid heart
Risk factors for arterial disease
controllable factors
diabetes
HTN
hyperlipidemia
smoking
uncontrollable arterial disease risk factors
age
male
family history
Diabetes affects vessels through mechanism of ____________ and occurs at older or younger age
atherosclerosis
affects people at a younger age
diabetes induced atherosclerosis has higher insidence of what (I2)location on LE
distal popliteal and tibial arteries
medial calcification develops in LE arteries, this is associated with increased risk for ___________ events as the disease process affects what layer of the vessel.
cardiovascular
medial layer of the vessel is affected
diabetes induced atherosclerotic disease is associated with a higher incidence of what end stage symptoms
gangrene and amputations
caused by lack of feeling due to co occurring neuropathy
hypertension affects arterial disease by one of what two processes
cause or enhance atherosclerotic processes
what causes hyperlipidemia
diet high in fat, metabolic tissues based on heredity
how does smoking induce atherosclerotic disease
chemicals irritate artery intimal lining causing vasoCONSTRICTION
what is ASO
atherosclerosis obliterans
atherosclerosis obliterans is
hardening of the artery thickening and loss of elasticity
in ASO where do changes occur in the vessel wall
intima and media
what are most important risk factors for ASO:
3
smoking
hyperlipidemia
family history
other risk factors for ASO
HTNm diabetes, sedentary lifestyle and arterial wall shear / stress
most common sites for ASO
(Think Bifurcations) carotid bifurcation aorto-iliac system * CFA bifurcation SFA-distal
what is Leriche Syndrome
Ao occlusion
Leriche syndrome affects ____population and is characterized by what 4 symptoms
Leriche syndrome affects male population more
fatigue in lower extremities (hips thighs calves) with excercize
absence of femoral pulses
impotence
pallor and coldness of LE
Acute occlusion is marked by ______, or ______. and can come in the form of ___, ___, or ____.
thrombus or plaque that has become mobile and traveled to a diameter vessel that it occludes
solid , liquid or gas
what is trash foot? and is related to sedentary atherosclerosis or embolism
onset usually is duration of ____ days
blue toe syndrome and is related to embolism
ischemia develops and improves due to collaterazation
1-2 days out …
what are main cause of embolism- 3
small plaque break loose due to
atherosclerotic lesion
arteritis
angiographic procedure
what other disease should be suspected if blue toe syndrome is present
AAA
what kind of aneurysm is the most common type of aneurysm
true aneurysm
define true aneurysm
name 2 subtypes of true aneurysm
dilatation of all tree arterial wall layers
saccular and fusiform
define saccular aneurysm
sac-like localized dilation
define fusiform aneurysm
circumferential
diffuse dilation
____ aneurysm is small tear of the ____ wall which allows blood to form between two layers in arterial wall
dissecting
intimal wall tear
where is most common place for dissecting aneurysm
thoracic
pseudoaneurysm the ___ arterial layer is affected, is usually ______ cause. And is presented as ______ structure usually found in ____area
outter arterial wall
iatrogenic cause
pulsatile structure outside vessel wall
groin area
what is most common site for true aneurysm
infrarenal
locations for aneurysm :
5
infrarenal renal popliteal artery commmon femoral thoracic
50% of patients with _________ are bilateral and include AAA
popliteal aneurysm
more often if aneurysm is in the CFA and popliteal artery have a higher insidence of ____
another aneurysm elsewhere
what are risk factors for true aneurysm
4
poor nutrition
atherosclerosis
infection
myrafans syndrome
most frequent complication of AAA is _____ and accumulates ______inside
rupture
thrombus
most frequent complication of peripheral aneurysm is ______ and accumulates _____inside
embolization
thrombus `
non atherosclerotic lesions
5
arteritis coarctation of the aorta dissection vasospastic disorders entrapment syndrome
Arteritis affects what vessels
2
think distal arterioles– small vessels
tibial
peroneal
inflammation of the arterial wall can lead to ________
thrombosis
most common type of arteritis
buerger’s disease
buerger’s disease is also called
thrombo-angitis obliterans
buergers disease affects men _____ who smoke heavily
<40 yrs of age
patients present with _______ of distal arteries
occlusion
Buerger’s disease patiens present with
3
ischemic fingers
ischemic ulceration
rest pain
Coarctation of the Aorta causes ______ in the artery
strictiure
congenital narrowing of the thoracic aorta , can present in the abdominal aorta as well
Clinical findings with coarctation of the aorta
2
HTN due to decreased kidney profusion
LE ischemia –reduced pulses
Dissection of arteries can affect both Aorta and peripheral arteries (T/F)
True
What are sonographic characteristics of a dissection
intimal flap
two flow patterns within the lumen- bidirectional flow
flow _____ will differ in each lumen in dissections
velocities
complications of dissection include
4
stenosis
occlusion
thrombosis
rupture
Aortic dissections can extend to _______ and could be due to ______, _____, or be _________.
iliacs.
HTN, severe chest trauma, or be spontaneous
is Ultrasound important diagnositc tool in identifing dissections
yes
