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Clinical Medicine II > Vascular disorders (venous) > Flashcards

Vascular disorders (venous) Flashcards

1
Q

What is:
Dilated, tortuous superficial veins – severity NOT correlated w/ number/size
Dull, aching heaviness, fatigue (worse with standing), itching from eczema above ankle or overlying large varicosities
Chronic venous insufficiency (ankle edema, hyperpigmentation, chronic skin induration or fibrosis), restless legs

A

varicose veins

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2
Q

What are risk factors for varicose veins?

A

Prolonged standing or heavy lifting, pregnancy
>20% adults

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3
Q

What can help diagnose varicose veins?

A

duplex US

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4
Q

How can you treat varicose veins?

A

Compression stockings! Leg elevation, pain control

Sclerotherapy - permanent fibrous + obliteration of target veins

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5
Q

What’s more invasive treatment of varicose veins?

A

Surgical - vein stripping, endovenous treatments (thermal devices, cyanoacrylate glue injection, foam sclerosant injection)

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6
Q

What does this indicate:
Dull pain, induration, redness, hard, tenderness of vein, firm cord, edema UNCOMMON, proximal extension of induration + pain w/ chills and high fever

A

superficial venous thrombophlebitis

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7
Q

What can put someone at risk for superficial venous thrombophlebitis?

A

Pregnancy, postpartum, varicose veins, trauma, malignancy, hypercoagulability

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8
Q

What is the Troausseu sign?

A

superficial venous thrombophlebitis – could be an early sign of of systemic hypercoaguability second to to abdominal cancer

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9
Q

What causes superficial venous thrombophlebitis?

A

Inflammation of vein just below surface of the skin from blood clot – short term IV, long term PICC, or spontaneous
S. aureus

NOT a thrombus

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10
Q

How do you diagnose superficial venous thrombophlebitis?

A

US to rule out DVT

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11
Q

How do you treat superficial venous thrombophlebitis?

A

Focal/spontaneous - local heat + NSAIDS

5cm or longer of saphenous vein = prophylaxis w/ fondaparinux or rivaroxaban

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12
Q

When do you give full anticoagulation in superficial venous thrombophlebitis?

A

for rapidly progressing disease or concern for extension (active malignancy, Hx of venous thromboembolism, known thrombophilia)

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13
Q

What is treatment for extensive superficial venous thrombophlebitis?

A

Ligation and division of vein for extensive
If septic, consider intravascular abscess
Heparin or fondaparinux, remove catheter
Abx - vancomycin + ceftriaxone
Surgical excision

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14
Q

What could this indicate:
Progressive pitting edema
Secondary skin changes, itching, dull discomfort worse w/ standing, better if elevated, pain if ulceration is present, skin swelling, shiny, brownish, varicosities, cellulitis

A

chronic venous insufficiency

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15
Q

What can cause chronic venous insufficiency?

A

Severe venous HTN, prior DVT or
Leg trauma/surgery, obesity, progressive superficial venous reflux, congenital or neoplastic obstruction of pelvic veins, congenital or acquired arteriovenous fistula

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16
Q

What can help diagnosis chronic venous insufficiency?

A

US
ulcers, medially
NO redness disappears upon raising

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17
Q

How can you prevent chronic venous insufficiency?

A

early + aggressive anticoag of acute DVT

18
Q

How do you treat chronic venous insufficiency?

A

Compression stockings, avoid prolonged standing/sitting, intermittent elevations of leg, exercise, sleep with legs above heart

19
Q

How do you treat complications of chronic venous insufficiency?

A

Cellulitis treatment (cephalexin, clindamycin)
Ulcer treatment (debridement)
Vein treatment (reflux or obstruction)

20
Q

What are these symptoms associated w/:
Legs – asymptomatic or pain, swelling, warmth, redness of lower extremity unilaterally

Areas of: Distal, proximal (majority), iliofemoral ass w/ most severe symptoms

A

deep vein thrombosis

21
Q

What are the risk factors for deep vein thrombosis?

A

Virchow’s triad

22
Q

What does this cause:
Blood clot obstructing blood flow in deep venous system from

Can be from recent surgery or trauma, hospitalization w/ prolonged bed rest, use of birth control
OR idiopathic, inherited or acquired hypercoagulable states like cancer or pregnancy

A

deep vein thrombosis

23
Q

How long should you treat a deep vein thrombosis if provoked by major transient risk factor?

A

3-6 months if major event + bleeding risk allows

24
Q

How long should you treat a deep vein thrombosis if unprovoked?

A

at least 3 months or indefinitely if allows

25
Q

How long should you treat a deep vein thrombosis if recurrent unprovoked?

A

indefinite

26
Q

How long should you treat a deep vein thrombosis if cancer related?

A

> 3-6 months as long as cancer is active, whichever is longer

27
Q

How long should you treat a deep vein thrombosis if underlying significant thrombophilia?

A

indefinite

28
Q

What is your first step in DVT?

A

D dimer

29
Q

If the d dimer is +, what do you do in DVT?

A

US

30
Q

If the d dimer is -, what do you do in DVT?

A

nothing. DVT unlikely.

31
Q

What are other Dx techniques for DVT?

A

contrast venography and CT+MRI venography

32
Q

What criteria is best for DVT and PE?

A

Wells

33
Q

What’s key in DVT management?

A

Prevent reoccurence or development of complications

34
Q

How do you treat non-severe isolated distal DVT (unlikely to reoccur)?

A

serial imaging of deep veins x2 weeks

35
Q

How do you treat severe isolated distal DVT (unlikely to reoccur)?

A

consider anticoagulation x 3 months

36
Q

How do you treat proximal DVT?

A

Anticoagulation for 3+ months
Dabigatran, rivaroxaban, apixaban, edoxaban

37
Q

How do you treat iliofemoral DVT?

A

Anticoagulation for 3+ months
No resolution = catheter directed thrombectomy

38
Q

What does this indicate:
Neurological symptoms if in brain/spinal cord (seizures, headaches, neurological deficits, vision changes, weakness, difficulty speaking, speech)
Bleeding or hemorrhage (severe headache, N/V, dizziness, loss of consciousness
Pain and swelling (visible bulging of veins)

A

arteriovenous malformation

39
Q

What cause arteriovenous malformation?

A

Abnormal tangle of blood vessels that connect arteries to veins

MC in brain, spinal cord, lungs

High pressure → low pressure

AVMS = congenital, genetic conditions, vascular disorders or trauma

40
Q

What does this indicate:
Neurological deficits, signs of hemorrhage (increased ICP), tortuous blood vessels

PE: assess motor, sensory, cognitive impairments, auscultation (bruit), palpation (thrill or pulsations)

DX: MRI/CT scan, angiography, EEG if seizures are present

A

arteriovenous malformation

41
Q

What’s gold standard for ateriovenous malformation?

A

angiography

42
Q

How do you treat arteriovenous malformation?

A

Observation

Surgical resection (if symptoms such as bleeding or neuro deficits)
Endovascular embolization
Radiosurgery
Medical management

Clinical Medicine II (15 decks)

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