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Vascular- Venous Legs > Venous Disease > Flashcards

Venous Disease Flashcards

1
Q

Varicose Veins - 2 types

A

Primary - hereditary

Secondary- prior clot causes valve damage

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2
Q

Causes of Varicose Veins

A

Failure of deep, superficial or perforator valves to close causing poor outflow!
(Results in HTN and poor perfusion)

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3
Q

Risk Factors associated with Varicose veins

A

Hereditary, Females, Occupation (sedentary lifestyle), pregnancy, obesity, and inactivity

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4
Q

Some treatments for Varicose Veins

A

Deep veins: treated with stocking and elevation, usually a DVT or phlebitis

Superficial veins: selective ablation by laser or injection

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5
Q

Symptoms of Superficial Incompetence

A

Varicose veins, pain/heavyness, swelling, ulceration, stasis dermatitis

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6
Q

DVT- Deep Vein Thrombosis

-facts of disease

A

1 in 10 million
600,000 develop PE
200,000 deaths per year

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7
Q

Thrombosis

A

Simply the formation of a clot, usually described for a clot in the artery

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8
Q

Phlebitis

A

Inflammation of the vein

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9
Q

Thrombophlebitis

A

Inflammation of a vein WITH a clot

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10
Q

Post Phlebitic Syndrome

A

Chronic Venous Insufficiency

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11
Q

Virchows Triad

A

3 main symptoms

  • venous stasis (no activity)
  • wall changes (injury from PICC example)
  • hypercoaguability
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12
Q

High risk populations for Virchows Triad

A 
Paraplegia 
Prior DVT
Lower Limb Injury
CHF/Prior MI 
Cancer 
Immobility/Obesity
Burn Patients 
Pregnancy
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13
Q

HIT - Heparin Induced Thrombocytopenia

“Factor 5”

A

Heparin givin to a patient to prevent clots…in this case the Heparin actually CAUSES clots to form

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14
Q

Symptoms of Virchows Triad

A

Swelling
Pain w/ dorsiflexion (Homan’s Sign)
Pain w/ palpitation of PTV (Neuhof Sign)

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15
Q

Criteria for Patency

A
  • Complete Coaptability: absence of intraluminal thrombus
  • Normal Venous Doppler: spontaneity, phasicity, and augmentation.
  • Visualizing blood flow: throughout lumen w/ color Doppler
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16
Q

Criteria for Venous Thrombosis

A

Lack of complete compressability
Visualize the thrombus
Distention of the vein 2-3x
*if free floating thrombus! Do no compress!
Abnormal Doppler: non-phasic flow, reduced/absent flow with augmentation, or no signal at all

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17
Q

Describe the doppler for normal and venous thrombosis

A

Normal:
Should see color filled in vessel
Should see the normal phasicity of flow with respiration or augmentation

Abnormal:
Non-phasic
Reduced or absent flow, possible even no signal

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18
Q

Spontaneous color flow in vessels occur where?

A

Above the calf veins

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19
Q

Below the knee, in order to see the calf veins what must happen

A

Not spontaneous flow! Sometimes requires augmentation!

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20
Q

Treatments of DVT

A
  • Prophylaxis (compression socks, low dose heparin)
  • Anticoagulant (heparin)
  • Thrombolytic Therepy (streptokinase/urokinase)
  • Surgical (IVC filters)
21
Q

What can you look at for a physical exam

A

Edema- pitting vs non pitting
Ulceration- tissue breakdown due to lack of O2
Skin Changes- redness/pale/blue or brown

22
Q

Iliac Vein Outflow Obstruction

A

Continuous, non-phasic flow in the CFV unilaterally! With normal phasic flow in the contralateral CFV

23
Q

Acute Conditions

A

Phelegmasia Alba / Cerula Dolens

Treuseus Syndrome

24
Q

Cerula Dolens (acute condition)

A

Severe ilio-femoral veins thrombosis

Arterial supply compromised due to swelling

25
Q

Treuseus Syndrome

A

Spontaneous ilio-femoral thrombosis

Highly associated with malignancy

26
Q

Superficial Phlebitis

A 
Involves the superficial veins of legs
Lower risk of DVT
Red & warm legs
Painful cord-like veins 
Pain is usually very specific
27
Q

Acute vs chronic clot

A

Acute- blunt end and hypoechoic, and usually not attached somewhere

Chronic ***

28
Q

Some differential dx

A

Lymphedema
Cellulitis
Lymph Nodes

29
Q

Lymphedema

A

A differential diagnosis to DVT
-it is the obstruction of lymph channels causing excess fluid
Causes: CHF, kidney failure or prior surgery
-ant farm appearance
-swelling comes and goes

30
Q

Ant-farm appearance

A

Lymphedema

31
Q

Cellulitis

A

Infection of connective/soft tissue
Skin is red and hot to the touch
Hypervascular lymph nodes
Typically treated w/ antibiotics

32
Q

Lymph nodes

A

Common to see in the groin

-swollen in presence of infection

33
Q

Bakers Cyst, aka

A

Popliteal cyst

Synovial cyst

34
Q

What is a Bakers Cyst

A 
Lining and fluid bulges into popliteal space 
May remain in popliteal space OR 
-dissect into medial calf
-rupture into calf 
-become hemorrhagic
35
Q

Hematoma, Muscle tear

A

Related to injury or trauma
Bleed can occur in the calf causing pain and swelling
-should not extend past knee joint
-may compress popliteal vein
-exacerbated if patient is taking aspirin (blood thinner)

36
Q

Venous Ulcer vs Arterial Ulcer

A

Venous- irregular shape, shallow, mild pain, ooze, stasis dermatitis

Artery- well defined, deep and dry skin

37
Q

“Gaiter Zone”

A

Venous stasis
Brown and dry skin
6 inches wide, just above ankles

38
Q

Cockett’s

A

Lower leg perforators…

39
Q

Getting a DVT is more common in what kind of veins

A

Deep

40
Q

Claudication

A

Muscle pain, spasms and cramping due to lack of oxygen to the muscles (from lack of blood flow)

41
Q

Homan’s Sign

A

Pain with dorsiflexion

42
Q

Neuhof’s Sign

A

Pain with palpatation of PTV

43
Q

Most common treatment for DVT

A

IV therepy Heparin…5-7 days

Oral Coumadin for 3-6 months

44
Q

Short description of AV fistula

A

High venous flow and low arterial resistance

45
Q

Basics of the veno-motor pump

A

Contraction of leg muscles cause proximal valves to remain open and distal valves to close to prevent reflux

Relaxation of muscles causes prox valves to shut longer and distal valves to remain open

46
Q

Cardiac Effects

A

Increase in central pressure can increase risk of DVT

  • CHF or Tricuspid Regurgitation can cause increased pressure
  • Increased pressure creates more resistance with venous blood flow
47
Q

What can cause central venous pressure increases?

A

CHF or Tricuspid Regurgitation

48
Q

Respiratory effects - inspiration

A

Inspiration drops the diaphragm down, causing increased abd pressure and decreased thoracic pressure
This slows flow from coming from the legs

49
Q

Respiratory effects- expiration

A

Breathing out brings the diaphragm back up, increasing the intra-thoracic pressure and decreasing the abd pressure
-Increased amount of blood coming up from the legs and less coming from the arms

Vascular- Venous Legs (2 decks)

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