The Vascular and Lymphatic Examination Flashcards
Symptoms of Peripheral Vascular Disease can be divided into arterial insufficiency symptoms and venous insufficiency symptoms. Define these terms and provide examples.
Arterial insufficiency = lack of blood supply = pain/cramps during activity, pallor, absent/diminished pulse, tissue atrophy, numbness/tingling
Venous insufficiency = lack of blood return = pain/tenderness when standing, red pallor, warmth, oedema, ulcerations, numbness/tingling
Acute arterial insufficiency is a red flag. What are the 6 Ps that indicate an emergency?
Painful Pale Pulseless Perishingly cold Paraesthesia Paralysed
What are common signs or symptoms of CHRONIC arterial insufficiency?
Intermittent pain/limping during activity, skin changes (atrophy of hair, skin, nails), loss of muscle mass, paraesthesia, development of collateral blood supply
What are common signs and symptoms of both ACUTE and CHRONIC venous insufficiency?
Acute - progressive venous stasis caused by deep vein thrombosis or superficial thrombophlebitis, leg oedema, skin changes/pigmentation, ulcers
Chronic - pain, swelling, cramps, dark red/purple pallor, varicose veins, leg ulcers, restless leg syndrome
During the observation component of a vascular examination of the lower limb, what are we looking for?
Skin - pallor (red = inflammation or infection; pale = obstruction)
Fingertips and nail beds - clubbing = hypoxia; brittle nails can indicate poor general health
Size and symmetry - atrophy; swelling (obstruction of lymph if pale or venous if dark red)
Venous pattern - prominent = venous obstruction
What are the 3 steps followed when performing a vascular and lymphatic examination of the lower limb?
1 - observation
2 - palpation of pulses, temperature and oedema
3 - palpation of lymph nodes
How are pulses graded?
0 = absent 1 = weaker/diminished 2 = normal/brisk 3 = bounding
Why do we palpate pulses?
Assessing arterial patency - not pulse rate/bpm
Where are pulses palpated? Describe their location.
Dorsalis pedis - b/w FDL and FHL; 2-3 cms distal from anterior ankle
Posterior tibial - inferior posterior to medial malleolus
Popliteal - medial side of lateral gastrocnemius
Femoral - mid femoral triangle
When is temperature tested?
Immediately following palpation of pulses (with patient still in supine position); tested distal to proximal with back of hand; can also check for oedema
What does the lymphatic system do?
Vascular role - returns lymph fluid from tissues to venous circulation
Immune role - node cells engulf cellular debris and bacteria; also form antibodies
When might inguinal lymph nodes become enlarged?
Infection - systemic (TB/HIV) or local (cellulitis of the leg or foot)
Malignancy - lymphoma or metastases
Other - systemic inflammatory illnesses (e.g. MS)
What are the 5 characteristics assessed when palpating lymph nodes?
1 - size 2 - shape 3 - mobility (malignancy) 4 - consistency (malignancy) 5 - tenderness (inflammation)
What are the 2 types of palpable inguinal lymph nodes called and where are they located?
Horizontal - inferior to lateral aspect of inguinal ligament
Vertical - 1-2 cms medial sartious muscle/along great saphenous vein
