Vascular Pathology: Exam 1 Flashcards
Types of vascular pathos
4
- arterial
- inflammatory
- venous
- vasomotor
Types of Vascular pathos
Arterial
-
Acute
- arterial embolism
-
PAD/Chronic
- arteriosclerosis/PAD
Types of vascular pathos
Inflammatory
- Thromboangitis obliterans
- Buerger’s dis.
- vasculitis
- Chilblains
- Covid toes
Types of vascular pathos
Venous Disorders
- Chronic venous insuff.
- DVT
types of vascular pathos
Vasomotor disorders
- Raynaud’s
- CRPS
Inflammatory disorders
Buergers/Thromboangiitis obliterans
arterial ****
- vasculitis affecting intima of periph blood vessels
-
Pathophys
- inflamm in intima + sm thrombus/platelet accum.
-
Causes
- heavy smoking
- unknown, but heavy inflamm markers
- homocysteine, SED, ESR
- age >40
-
Dx
- biopsy
- Rubor of dependency
Buerger’s Dis.
Sequelae
necrosis
can lead to amputation
Buerger’s Dis
Symptoms/Tx
- Symptoms
- cool extremities
- pain
- ulcers of digits
- intermitt claud
- Tx
- grade ex. to avoid claud
- work below claud threshold
- encourage to quit smoking
- initial cause
- grade ex. to avoid claud
Inflammatory disorders:
Vasculitis
- inflamm blood vessels
- acute OR chronic
- Sx’s
- sudden or dev over time of pain/throb
- PT involve:
- pain relief
- prevent LOF
- wound care
Venous Disorders:
Chronic venous stasis/insuff.
- == inad. venous return over long pd of time
-
pathophys:
-
damaged valves w/in veins==decd venous return
- chronic venous stasis (stuck)
-
damaged valves w/in veins==decd venous return
-
Causes
- DVT
- idiopathic
- trauma to pelvic floor
- varicose veins (females)
- neoplastic obstruct of pelvic veins—cancer
- CHF
-
Dx
-
venous trendelenberg
- if leg elevated is blood return better?
- rule out lymphedema
- ABI
- rules OUT PAD
- rules IN CVS
-
venous trendelenberg
Venous Disorders:
CVS sequelae
- chronic venous ulcers
- inad. cellular O2
- prone to infection
Venous disorders:
CVS Sx’s and Tx
- Sx’s—> very comfortable w/ leg elevated
- edema
- pulses ALWAYS norm
- pain in dep. pos
- hemosiderin staining—- HgB stains
- varicose veins
- wet wounds–uneven borders
- Tx
-
compression devices
- MAKE SURE THEY HAVE NORMAL AA PERFUSION ****
-
compression devices
Pitting Edema Scale
- 1+: barely perceptible depression
- 2mm
- 2+: easily ID’d depression
- 4mm
- skin rebounds <15s
- 3+: easily ID’d depression
- 6mm
- skin rebounds 15-30s
- 4+: easily ID’d depression
-
8mm
- skin rebounds >30s
-
8mm
Venous disorders:
DVT
ACUTE!!!
-
S/S—> UNILATERAL
- PAIN
- ipsilat. edema— only DVT leg
- palpable cords
- redness
- leg warmth
Venous disorders: DVT
risk factors
- immobility
- trauma/endothelial injury
- lifestyle
- hypercoagulation
- other
- family hx/genetics
- diabetes
- prior DVT
- Beurger’s
- idiopath
- >60yo
PT and PREVENTION OF DVT
- EARLY mobility—-aerobic act.
- Compression therapy
- TEDs
Wells Score
Dx of DVT
2 pts or more== DVT likely
Fewer than 2 pts== DVT unlikely
DVT
Dx Tests
- Wells Criteria Prediction Rules
-
If >2 on Wells
-
D-dimer
-
(+) if elevated
- >400-500
-
(-) if NORMAL
- <400
-
(+) if elevated
-
Venous Duplex Dopplers
- US veins
-
D-dimer
-
If >2 on Wells
PT implications:
UnDx’d high sus DVT
- Our fear…
- dislodge clot if move them
- limtd research
- facility protocol
- Wells, D-dimer, Homan’s
- obtain clearance from MD
Med Mgmt DVT
Anticoagulants or “Blood thinners”
- Heparin
- Warfarin
-
Function:
- inhibit synthesis of clotting factors
-
Contraindications:
- actively bleeding and high fall risk
IVC filter and DVT
used for higher risk bleeding or lg wound
PT implications DVT:
Once Dx and med tx initiated
- check lab vals to ensure pt therapeutic
- TREAT BALANCE TO LOWER RISK OF FALLS***
- Educate on protective measures to prevent falls
- Ambulation helps DEC sx’s of DVT and risk of PE
-
wound care
- careful!!!
- clearance before debridement
Labs: MD det’d Therapeutic Lvl
PT (prothrombin time) for warfarin (coumadin)
- norm== 11-15s
- anticoag. therapeutic lvl== 1.5-2.5x normal
- 15-37s
-
if >38s
- INCd risk hemorrhaging
-
if >88s
-
HIGH risk hemorrhaging
- only do ADL/safety check
-
HIGH risk hemorrhaging
Labs: MD det’d Therapeutic lvl
aPTT
activated partial thromboplastin time for Heparin
- norm== 20-35
- anticoag. therap. lvl== 2.25x normal
- 60-110s
-
if >110s
- INCd risk hemorrhaging
- NO agreed aPTT apon lvl for high risk hemorrhaging
Labs: MD det’d Therapeutic lvl
INR
International Ratio
- for Warfarin (coumadin)
- Normal== 1
- anticoag. therapeutic lvl: 2-3.5
-
if >3.6
- INCd risk hemorrhaging
-
if >5
- HIGH risk hemorrhaging
Labs: MD det’d Therapeutic lvls
Plt
platelets
Normal: 150,000-400,000/mm3
EARLY ambulation in mgmt of PE, DVT, both
early amb associated w/
- LOWER incidence of new PE
- LESS progress of dx’d DVT
- DECd mortality
Phys act in pts w/ DVT
- early walking exercise:
- is safe w/ acute DVT
- reduces acute sx’s AND chronic sx’s
- help to prevent/improve postthrombotic syndrome
LE DVT
once meds therapeutic lvls or accept. time pd been reached post admin……
Mobilization should begin!!!
- although risks assoc’d w/ mobilization….
- risk of INACTIVITY is greater!!!!
Vasomotor disorders:
Raynaud’s Syndrome====
VASOSPASMS
-
Pathophys:
- vasospasm of vessel’s in pts digits aggravated by cold temps——DEC vascular supply
-
Causes:
- unknown
- women
-
sequelae
- remains static
-
Dx Tests
- descript of sx’s
-
Sx’s
- white/cyanotic digits in cold
- Hyperemia when initially return to warm temps/recirculation
-
Tx
- wear gloves
- aquatic tx
- warm pools
