Vascular 2 Flashcards
Thromboangiitis Obliterans aka
Buerger’s Disease
Thromboangiitis Obliterans is an inflammatory thrombotic process resulting from
vasculitis
Thromboangiitis Obliterans affects blood vessels where?
Peripheral blood vessels
Vasospasm occluding and eventually obliterating small and medium sized vessels of the hands and feet can result from
Thromboangiitis obliterans
Thromboangiitis obliterans is most common in what population
Smoker men younger than 40
Clinical manifestations of Thromboangiitis obliterans
Pain/tenderness
Reduced blood flow and O2
Intermittent claudication of arch and foot or palm of hand (may be asymmetrical)
Other: edema, cold sensitivity, rub or, cyanosis, thin shiny hairless skin, parenthesias, diminished pulse
Ulceration and gangrene
Management of Thromboangiitis obliterans
Cessation of smoking, vasodilators and pain reliever (surgery can be required)
Arterial occlusive diseases usually occur as a result of
Atherosclerosis
(Other causes: trauma, thrombus, embolism, vasculitis, spasms)
Arterial occlusive diseases manifestation depends on
Location
Arterial occlusive diseases in the brain results in ______ and in the intensities result in _____
Brain -> Hemiplegia, weakness, blurred vision
Intestines -> Ischemic colitis
Diminished distal pulses, pain, numbness, cold, tingling or sensation changes, skin color changes and hair loss, pallor, venous filling delayed following foot elevation (>30 sec), weakness and muscle spasm in the extremity distal to block, intermittent claudication, death of tissue from gangrene.
These are signs and symptoms of what
Arterial occlusive diseases: arterial insufficiency
Treatment for arterial occlusive diseases
Anticoagulation therapy
Protection of limb
Embolectomy
What is Arteriosclerosis Obliterans
(Peripheral Arterial Disease (PAD))
Proliferation of intima causes obliteration of lumen of artery
What is most common arterial occlusive disease? (95%)
Arteriosclerosis Obliterans
(Peripheral Arterial Disease (PAD))
Risk factors for Arteriosclerosis Obliterans
“Same as coronary atherosclerosis”
Common in elderly
Develops earlier in DM and smokers
Bilateral, progressive, intermittent claudication
Present in calf muscles (exacerbated by walking and relieved by rest
Clinical manifestations of Arteriosclerosis Obliterans
Diameter of vessels narrows by 50%
Large and medium sized arteries with some branches
Symptoms occur distal to narrowing
Acute ischemia (pain, pallor, paresthesia, paralysis, pulselessness)
Occlusive Disease of LE arteries arteries. What areas can it affect
Distal aorta and iliac
Femoral and pop literal
Tibial and common peroneal
Arteriosclerosis Obliterans (PAD) usually develops over how much time?
Years
Treatment for Arteriosclerosis
Smoking cessation, dietary management, daily walking, prevent skin breakdown and injury, medications, surgical interventions
What is a potentially life threatening complication of any vascular condition?
Thrombus developing and turning into an embolism (breaking off and carried into heart, brain, lungs)
What is Thrombophlebitis
Partial or complete occlusion of a vein by thrombus with secondary inflammatory reaction in the wall of the vein
Where is thrombophlebitis most common
Lower extremity
What is it called when thrombophlebitis is in deep veins?
DVT
Thrombophlebitis can dislodge and travel where?
Lungs, creating pulmonary embolism
Risk factors for thrombophlebitis
Immobility (Venous blood stasis)
Trauma (venous damage)
Venous stasis is
Slow blood flow (in leg) usually caused from immobility (prolonged bed rest)
Risk factors of thrombophlebitis
Lifestyle - Hormone status, oral contraceptive, meds, pregnancy, IVF, smoking
Hypercoagulation - genetics or neoplasms
Clinical manifestations of thrombophlebitis
Early stages pain is a dull ache, a tight feeling
Signs are often absent. When present may be a variable and inconsistent
Unilateral tenderness of leg pain, unilateral swelling, leg is relatively warmer than the other side, discoloration (cyanotic), varicose vein and ulcers
Treatment for thrombophlebitis
Pharmacology: Anticoagulants
Symptomatic: Bed rest, elevation of legs, swelling/tenderness -> subsided ambulation and wear compression, avoid prolonged standing
Prognosis of thrombophlebitis
Return to prior function usually occur
Varicose veins is what
Abnormal dilation of veins (usually saphenous) (LE)
Varicose veins leads to
twisting and turning of vessels, incompetence of the valves and a tendency to thrombosis
Risk factors for varicose veins
Periods of high venous pressure
Hormonal changes
Obesity
Heart failure
Constipation, hemorrhoids, cirrhosis
Treatment for varicose veins
Periodic rests with elevation
Promote circulation, massage
Limited prolonged activity
Elastic stockings
Surgical intervention can be required (sclerotherpay or surface laser treatment)
Chronic venous insufficiency is
Inadequate venous return over a long period of time
What occurs when damaged veins or valves prevent venous return, increased venous pressure produces venous stasis
Chronic venous insufficiency
Treatment for chronic venous insufficiency
Compression stockings
Exercise
Weight control
Wearing apparel
Elevation above the level of heart
Avoiding long periods of sitting or standing
Vasomotor disorders of blood vessels include…
Raynaud’s Disease/Phenomenon and Complex Regional Pain Syndrome
Raynaud’s Disease is
Vasospastic disorder - Hyperactivation of the sympathetic vasomotor response
Intermittent episodes of small artery constriction of extremities…
- are more common in…
- causes ___ and ____ of digits
- occur in response to what 2 scenarios?
- Fingers and toes, but more in fingers
- Cyanosis and pallor
- cold or strong emotion
Raynaud’s disease occurs in how much of the population, what sex more commonly, and can it be a sign for other pathologies?
10-20% population
More in women
Yes, can be sign of other pathologies
Raynaud’s disease is ______ etiology while phenomenon is ____ etiology
Disease = unknown
Phenomenon = Secondary to other disease
Treatment of Raynaud’s is _____ or ____
Prevention: (temp, emotional stress, nicotine)
Alleviation: Education (stress management, relaxation, exercise) or pharmacological (vasodilators and analgesics)
Complex Regional Pain Syndrome is
Severe chronically painful condition usually involving one limb (arm or leg)
CRPS is thought to be what kind of disorder, but not completely understood
Vasospastic motor
Characterized by…
severe, constant burning pain in the affected limb
CRPS usually starts after a precipitating event such as…
The original event is usually…
Trauma, crush injury, fracture, plaster cast wear or stroke.
Mild compared to following pain
CRPS is triggered by
Nerve fiber damage in the injured tissue : nerves then become hypersensitive to incoming sensory signalsls
CRPS results in 2 types of peripheral sensitization. Name and explain them
Allodynia: Inc in pain due to non painful stimulus (not supposed to be painful)
Hyperalgesia: More pain with painful stimulus (should be painful but now heightened)
CRPS Types: I and II. Explain differences
I: No specific nerve is identified. Most common.
II: A specific nerve is injured. Has 3 overlapping but identifiable stages. Not everyone goes through every stage.
Stages of CRPS (Type II); what are they called/main process
I: Acute inflammation
II: Dystrophic
III: Atrophic
Describe in depth stage I of CRPS (Type II)
(Time, Pain, Edema, Vasomotor/thermal changes, Skin)
-Time: Earliest stage; beings up to 10 days, lasts 3-6 months
-Limb may become dry, hot, red, painful
-Pain: More severe than expected, burning or aching. Increased by dependent position and physical contact. Hyperalgesia and allodynia
- Edema: Soft and localized
-Vasomotor/thermal changes: Affected limb is warmer.
- Skin: Hyperthermia and dry. Increased hair and nail growth
Describe in depth stage II of CRPS (Type II)
(Time, Pain, Edema, Vasomotor/thermal changes, Skin)
Paradoxic Sympathetic Hyperactivity
-Occurs 3-6 months after onset
-Pain: Worsens, constant, burning, aching. Allodynia and Hyperalgesia always present
-Edema: Becomes thicker/fibrotic, causing joint stiffness.
Vasomotor/thermal changes: Neither warm, nor cold
Skin: Thin, glossy, cool (vasoconstriction) and sweaty
Describe in depth stage III of CRPS (Type II)
(Time, Pain, Edema, Vasomotor/thermal changes, Skin)
Atrophic
- Time: 6-12 months after onset, may last for years or may resolve and reoccur
- Pain: Spreads proximal, joint stiffness progresses
- Edema: Continues to harden
- Vasomotor/thermal changes: Affected limb is color
- Skin: Thin, shiny, cyanotic, dry fingertips and toes on involved extremity are Atrophic. Fascia is thickened, contractures may occur.
Clinical manifestations of CRPS
Pain, edema, movement disorders (inability to initiate movement, weakness, tremor, muscle spasm, atrophy), abnormal vasomotor changes (temperature, color)
Diagnosis and treatment of CRPS
All symptoms are required to make diagnosis
X-rays, bone scan, thermography, EMG, NCS.
Treatment: Pain management +PT + psychotherapy
Prognosis of CRPS:
The earlier the condition is diagnosed, the better the prognosis
The overall response rate to treatment is poor: >50% of patients reporting significant pain and sometimes disability years later
