Test 5 Flashcards
why do women have a higher risk for DVT’s?
high levels of estrogen
may promote clotting and the large uterus can press against vessels and slow blood flow
where does pressure increase the pressure?
veins in pelvis and legs
how long does the risk for blood clots in women continue in pregnant women?
up to 6 weeks after you have the baby
why does your blood clot more easily when you pregnant?
body’s way of preventing too much blood loss during childbirth
what contains the female hormone estrogen?
- combined contraceptive pill
- HRT
what does estrogen do to your blood?
causes blood to clot more easily
is there a increased risk for progesterone only?
no
what can be a significant risk factor for DVT’s?
travel
-sluggish blood flow in the bent and stationary legs
how does surgery increase for blood clots?
- injury to your veins or surgery can slow blood flow
- general anesthetics can make them wider which can increase blood pooling then clotting
how does a cast increase risk for DVT’s?
injury to the vein during injury
why do cancer patients have a higher risk for DVT’s?
higher number of platelets and clotting factors in their blood (because cancer cells produce and release chemicals that stimulate the body to make platelets)
what are platlets?
blood cells that play an important role in helping your blood to clot
why may cancer patients under treatment have an increased risk?
when chemotherapy kills cancer cells, the cells can release substances that cause an increase in blood clotting. (coagulation)
what cancer treatment drug increases blood clots?
tamoxifen
what disease increases the disease of IBD?
IBD
-ulcerative colitis
what hospital stay may increase DVT?
having an operation for an inflammatory or abdominal condition such as appendicitis
cellulitis
bacterial infection if the deep layer of skin (dermis)
lymphedema
swelling in an arm or leg
tennis leg
term describing pain in leg caused by a tear in the inner head of gastrocnemius and plantaris muscle
muscle tear appeaerance
well localized hypo echoic interposed between medial head of the gastrocnemius and the soleus muscle, typical of a tear
bakers cyst
longitudinal image of the calf
what is seen posterior to knee joint in ruptured baker’s cyst?
hypo echoic effusion
what is the path of the ruptures bakers cyst?
superficially to medial head of gastrocnemius and dissects between the gastrocnemius and the soleus towards the ankle joint
where does the bakers cyst extend?
proximal to the formation of the schilles tendon by the soleus and gastrocnemius
what are vascular diagnostic procedures?
- duplex imaging
- ABI measurements
- segmental pressures
- exercise testing
- reactive hyperemia
- plethysmography, pneumo and photo
- digital pressures
- cold stress
- penile
ankle-brachial index
comparison of ankle blood pressure to brachial blood pressure
what does ankle-brachial index effecient for?
documenting the presence of lower extremity arterial disease
ABI less than what has a sensitivity of 90% and specificity of 98% for detecting a stenosis over 50%
less than 0.9
where are blood pressure cuffs placed?
both arms and ankles
what pressure do you use for ABI?
highest brachial pressure and the highest of the 2 ankle pressures
how do you calculate ABI?
- brachial is taken on BOTH arms
- highest brachial systolic number is used
- posterior tibial and dorsalis pedis pressures are obtained
- highest systloic of 2 pressures is used in ratio
ankle/brachial
dorsalis pedis artery?
distal anterior tibial artery
what is a normal result in a ABI ratio?
greater than 0.9
what ABI indicates PAD?
under 0.9
the lower the ABI __________
the more severe the disease will be
what arteries can be assessed with doppler?
common femoral
femoral
popliteal
calf
what ratio indicates atleast 50% stenosis-using PSV?
a ratio of 2 or more between normal and stenosed segment
what are used to measure BP in legs?
doppler ultrasound
blood pressure cuffs
when are segmental pressures taken?
when there is intermittent claudication
intermittent clauducation
pain subsides when walking ceases and resumes when walking resumes
what is the BP in legs similar to?
BP in arms
when there are lower pressure in legs, what does this mean?
plaque
who are segmental pressures usually done on?
diabetics-prone to small vessel disease
what is an indicator of severity of PAD with exercising?
fall in ankle systolic pressure after exercise
describe exercise testing
Pressures are recorded at rest,then the patient is placed on treadmill for 3 minutes or as long as they can withstand the pain=claudication
the higher the fall in pressure=____________
the more severe the PAD will be
what is an alternative test for patients with heart conditions or shortness of breath?
reactive hyperemia test
describe reactive hyperemia test
- thigh cuffs are inflated for 3-5 minutes than deflated
- ankle cuffs are inflated immediately and briefly, than deflated slowly
- using doppler, BP’s are taken at both ankles
using reactive hyperemia test, what indicates PAD?
over 50% or more decrease in ankle pressure
Plethysmography
pulse volume reading
measures blood flow within the arteries
when may Plethysmography be used?
- PAD
- arm artery disease
- thoracic outlet syndrome
- Raynauds disease
how many cuffs are used in Plethysmography?
3-4 blood pressure cuffs on thighs, calves, and ankles
what is Plethysmography used in conjunction with?
segmental pressures
Pneumoplethysmography (PPG)
ABI is measured first
PPG toe pressure
uses an infrared PPG to determine small vessel vasculature distal to ankle
what are toe pressure studies useful to determine?
ulcer healing potential in the diabetic foot
PPG-venous reflux testing
measures effciency of musculovenous calf pump
what does PPG-venous reflux testing measure?
changes in skin blood volume using a small light probe places on skin above ankle
describe how venous reflux is determined?
- After exercising the calf by moving the foot up and down at the ankle, the patient rests
- The rate at which the blood returns to the skin is measured
- Poor emptying of the skin = venous reflux
why is the assessment and diagnosis of lower limb peripheral arterial occlusive disease (PAD) is important?
it can lead progressively to disabling claudication, ischaemic rest pain and gangrene
Pulse contours can be used to obtain the same information obtained from ___________
digital arteries
what do pressure measurements of the toe allow us to predict?
the healing potential of foot lesion
over 90% of foot lesions heal when toe pressure exceeds _________
30 mmHg
what toe pressure are consistent with rest pain?
under 20 mmHg
where are toe pressures especially useful in?
diabetic patients with in compressible calcific ankle arteries
Photoplethysmography PPG
provides more reliable results and offers the you to view a waveform of blood flow from the tip of the toe
In diabetic patients, what would ABI readings above 1.3 indicate?
hardening of the leg arteries
why do hardening of leg arteries produce high ABI?
because arteries require more pressure to compress and toe arteries are used as an alternative
when should diabetics take the ABI/toe test??
annually
where are digital pressures placed?
pneumatic toe cuffs on big toe, ankle, and arm
what does digital pressures predict?
outcome of future amputation due to PAD of small vessels in foot
TBI
toe brachial index
TBI over 0.8
no significant PAD
TBI 0.2-0.5
claudication
TBI less than 0.2
rest pain
what is the cold stress test?
assesses the change in circulation of the digits in response to induced vasospasm
what is used in a cold stress test?
- PPG
- PVR
- digital thermisters
- doppler and segmental pressures
describe cold stress test
- waveforms are all recorded prior to cold water bath
- waveforms are recorded post cold water bath immediately and at several intervals until temperatures return to normal
- waveforms are analyzed and compared for change
when is a penile doppler used?
presence of impotence-ED
what may penile doppler be the result of?
nervous, arterial, venous and sinusoidal factors
what are taken with doppler of the cavernosal artery?
baseline PSV and EDV
what is used before doing a penile doppler?
60 mg of papavarine is injected intercavernosally to induce erection
when is PSV and EDV measures in penile doppler?
5, 10, 15 & 20 minutes
PSV penile doppler
indicator for arterial dysfunction
EDV penile doppler
indicator for venous dysfunction
what is MRI used for?
image arterial blood vessels for stenoses, occlusions, and aneurysms
what does MRI display?
blood flowing through the vessel
duplex imaging
- safe
- inexpensive
- non-invasive
- reliable
what does duplex imaging help screen?
PAD
venous disease
what is the drawback of duplex imaging?
accuracy however is operator dependant
