Veins and Lymphatics

Question 1

Varicose veins

Answer 1

abnormally, dilated tortuous veins subjected to prolonged, increased intravascular pressures

Question 2

where do varicose veins usually occur

Answer 2

in the superficial veins of lower extremities

Question 3

What increases your risk for varicose veins?

Answer 3

> 50 years old; obesity; female; pregnancy; anything that increases pressure in lower legs

Question 4

Varicose veins are occupationally associated with

Answer 4

prolonged standing or sitting in one position; pedal edema and venous stasis

Question 5

Pathology of varicose veins

Answer 5

dilated, tortuous, elongated and scarred; marked variation in thicknes sin wall; areas of thinning and areas or thickening due to hypertrophy of the wall and subintimal fibrosis

Question 6

Varicose veins result in

Answer 6

intraluminal thrombosis and valvular deformities

Question 7

Clinical associations with varicose veins

Answer 7

venous stasis and edema; may result in thrombosis

Question 8

persistent edema is associated with

Answer 8

stasis dermatitis, ulcerations, and impaired healing

Question 9

Etiology of superficial venous thrombosis

Answer 9

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

Question 10

Where do superficial thrombosis go?

Answer 10

NOT TO THE LUNGS

Question 11

Deep venous thrombosis

Answer 11

thrombosis of deep veins results in local inflammation (phlebitis) and potentially lethal thrombomembolic disease

Question 12

Stasis/hypercoaguable states

Answer 12

cardiac faliure, neoplasia, pregnancy, postoperative state, prolonged bed rest, immobilization

Question 13

Muscle activity following thrombosis results in

Answer 13

“milking” of thrombus from attachment to inflamed venous wall

Question 14

Local manifestations of DVTs

Answer 14

edema, cyanosis, and dilatation of superficial veins

Question 15

Local inflammatory signs of DVTs

Answer 15

heat, tenderness, redness, swelling and pain

Question 16

Homan’s sign

Answer 16

dorsiflexion of the foot elicits pain behind the knee or calf

Question 17

Often first manifestation of DVT

Answer 17

embolism

Question 18

Patient populations particularly at risk for pulmonary embolisms

Answer 18

all cardiac, post partum, and postoperative patients
pregnancy, obesity, and age increase the risk
hypercoagulable states such as polycythemia

Question 19

Phelgmasia alba dolens

Answer 19

iliofemoral venous thrombosis occuring usually in pregnant women just prior or post delivery; due to both pelvic stasis and hypercoagulable state

Question 20

Migratory thrombophlebitis

Answer 20

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

Question 21

Lymphangitis

Answer 21

acute inflammation associated with red, painful, subcutaneous streaks; usually associated with lymphadenitits

Question 22

Most common cause of lymphangitis

Answer 22

group A beta-hemolytic strep and sporotrichosis

Question 23

Lymphedema

Answer 23

usually due to obstruction; collection of interstitial edema

Question 24

Causes of lymphedema

Answer 24

1. malignant tumors
2. radical surgery for cancer
3. postirradiation fibrosis
4. filariasis
5. postinflammatory and scarring of lymphatic channels

Question 25

Persistent edema leads to

Answer 25

interstitial fibrosis and edema

Question 26

Lymphedema results in

Answer 26

brawny induration and Peau d’orange changes in the skin

Question 27

chronic lymphedema also results in

Answer 27

vascular stasis and skin ulcers

Question 28

Chylous ascites, chylothorax, chylopericardium

Answer 28

lymph with high amounts of fat globules; associated with obstruction and rupture of lymphatics infiltrated by tumors