Veins and lymphatics

Question 1

pathological conditions

Answer 1

-Varicose veins
-Superficial venous thrombosis
-Deep venous thrombosis
associated risk for pulmonary embolus

Question 2

varicose veins

Answer 2

-abnormally, dilated tortuous veins subjected to

prolonged, increased intravascular pressures

Question 3

where do varicose veins occur?

Answer 3

-usually occurs in superficial veins of lower extremities

Question 4

who gets varicose veins

Answer 4

-10-20% of population
> age 50, obesity, female, pregnancy
-familial tendency (defective development of
venous wall)

Question 5

occupations prone to varicose veins

Answer 5

-occupationally associated with prolonged standing
or sitting in one position; pedal edema and venous
stasis

Question 6

pathology of varicose veins

Answer 6

-dilated, tortuous, elongated and scarred
-marked variation in thickness in wall; areas of thinning
and areas of thickening due to hypertrophy of the wall
and subintimal fibrosis
-results in intraluminal thrombosis, valvular deformities

Question 7

clinical associations of varicose veins

Answer 7

-venous stasis and edema; may result in superficial
thrombosis (see below)
-persistent edema is associated with stasis dermatitis,
ulcerations, and impaired healing

Question 8

esophageal varices

Answer 8

• increased intrahepatic vascular obstruction

(cirrhosis) with decreased venous drainage

Question 9

why do esophageal varices occur?

Answer 9

-increased portal pressures and decreased
vascular flow through liver results in increased
pressure in collateral venous circulation
-dilatation of venous plexus of esophageal veins
and rectal veins
*esophageal varices
*hemorrhoids

Question 10

superficial venous thrombosis

Answer 10

-stasis can result in thrombosis of superficial veins,
particularly in the presence of pre-existing
varicosities
-rarely associated with venous distension and pain

Question 11

difference between superficial venous thrombosis and deep venous thrombosis

Answer 11

-IN MARKED CONTRAST TO DEEP VENOUS
THROMBOSIS, SUPERFICIAL THROMBOSIS RARELY
RESULTS IN THROMBOEMBOLI

Question 12

Deep venous thrombosis (thrombophlebitis)

Answer 12

-Thrombosis of deep veins results in local
inflammation (phlebitis) and potentially lethal
thromboembolic disease

Question 13

DVT occurrence

Answer 13

-DVT account for >90% cases of thrombophlebitis

Question 14

Results from stasis and/or hypercoaguable states

Answer 14

• cardiac failure
• neoplasia
• pregnancy
• postoperative state (release of tissue factor)
• prolonged bed rest
• Immobilization

Question 15

Postulated that muscle activity following thrombosis

Answer 15

• “milking” of thrombus from attachment to inflamed venous wall
• Sometimes results from inflammation of venous channels (bacterial infections of meninges, middle ears, mastoids, peritonitis, acute appendicitis, acute salpingitis, pelvic abscesses)
• Results in pulmonary embolism

Question 16

DVT pathology

Answer 16

-thrombosis with associated inflammation of
the venous wall
-may result in scarring of venous wall and
dysfunction of venous valves

Question 17

DVT most common

Answer 17

found in deep veins of legs

Question 18

DVT prevalent in

Answer 18

periprostatic venous plexus in men;

pelvic veins of women

Question 19

clinical associations with DVT

Answer 19

1. Homan’s sign
2. in more than half of the cases, no symptoms or
   signs occur until thromboembolism takes place
3. local manifestations include edema, cyanosis and
   dilatation of superficial veins; local inflammation
4. embolism

Question 20

Homan’s sign

Answer 20

• pain behind knee or in calf with dorsiflexion of foot

- deep venous thrombosis of leg veins

Question 21

embolism associations?

Answer 21

• often first manifestation of DVT

- pulmonary embolism most serious problem

Question 22

prevention of DVT

Answer 22

-Anticoagulation
-Pneumatic stockings, elastic stockings after
surgery
-Early ambulation after surgery
-Exercises or walking during periods of
immobilization (prolonged flights)

Question 23

Clinical Variants

Answer 23

1. phelgmasia alba dolens

2. migratory thrombophlebitis

Question 24

phelgmasia alba dolens

Answer 24

-(painful white leg) -iliofemoral venous thrombosis occuring
usually in pregnant women just prior or post
delivery; due to both pelvic stasis and
hypercoagulable state

Question 25

migratory thrombophlebitis

Answer 25

appear and then disappear; associated with
paraneoplastic syndromes (pancreatic, lung,
colon cancer)
*pancreatic cancer

Question 26

Lymphangitis

Answer 26

-acute inflammation associated with red,
painful, subcutaneous streaks
-most common: group A beta-hemolytic strep
-usually associated with lymphadenitis

Question 27

Lymphedema

Answer 27

-usually due to obstruction
-collection of interstitial edema (lymphedema)
-fluid milky white; may contain fat globules
(chylomicrons)
-chylous effusions

Question 28

lymphedema causes

Answer 28

1. malignant tumors – obstruction of lymphatic
   channels directly or lymph node infiltration
   (carcinomas)
2. radical surgery for cancer (i.e. breast cancer)
3. postirradiation fibrosis
4. filariasis (Wuchereriathrombosis and bandrofti,
   Brugia malayi; p. 373)
5. postinflammatory and scarring of lymphatic
   channels

Question 29

Clinical Features of lymphedema

Answer 29

-persistent edema leads to interstitial fibrosis,
edema
-Lymphedema results in “brawny induration” and
“Peau d’orange” changes in the skin
-chronic lymphedema also results in vascular stasis,
and skin ulcers
-chylous ascites, chylothorax, chylopericardium –