Venous Diseases Flashcards
Varicose Veins
Risk Factors
5
- pregnancy
- advanced age
- obesity
- family hx
- prolonged standing
Varicose Veins
clinical presentation
6
- ache/fatigue in limb that progresses throughout the day
- edema
- abnormal pigmentation
- dilated tortous veins
- spider veins
- telangiectasias
Varicose Veins
work up
2
- physical exam
- doppler studies
Varicose Veins
tx
6
- compression socks
- exercise
- elevation
- treatment of ulceration w wound care PRN
- refer to vascular/vein specialist
- surgery
Varicose Veins
what surgical options are there?
3
- endovenous abaltion
- sclerotherapy
- vein stripping
Venous insufficiency
Loss of wall tension/elasticity in veins leading to stasis of blood in the vein
Is a progression of varicose veins or trauma
Chronic Venous Insufficiency
stages
6
- C1: spider veins
- C2: varicose veins
- C3: swelling
- C4: skin changes
- C5: healed ulcers
- C6: venous stasis
Chronic Venous Insufficiency
risk factors
- hx of DVT
- hx of varicose veins
Chronic Venous Insufficiency
presentation
7
- progressive edema
- dull pain, esp with standing
- itching
- skin ulcerations
- shiny, thing, atrophic skin
- darkened pigment
- ulcerations (usually above the ankle)
Arterial vs Venous insufficiencies
Arterial
1. end of toes/top of feet/lateral ankle region
2. very little drainage from ulcer
3. little tissue granulatoin
4. deep, punched out margins
Venous
1. medial parts of lower legs/medial ankle region
2. swollen ulcer w/ drainage, shallow, irregular edges
3. granulation present (pink to red)
Chronic Venous Insufficiency
treatment
6
- prevention
- treatment of varicose veins
- elevating legs
- compression socks
- avoid excessive sitting/standing
- wound care
Thrombophlebitis
Virchow’s Triad (risk factors)
- Hypercoagulability
- Vascular Damage
- Circulatory Statis
Virchow’s triad: stasis, hypercoagulopathy, vascular injury
Thrombophlebitis
Key hypercoag risk factors
3
- estrogen therapy
- inflammation
- dehydration
Thrombophlebitis
key vascular damage risk factors
2
- physical trauma, strain, or injury
- microtrauma to vessel wall
Thrombophlebitis
key circulatory stasis risk factors
2
- congenital abnormalities
- low heart rate and bp
Thrombophlebitis
presentation
- dull pain
- erythema
- tenderness
- palpable induration or
(Most common presentation on PANCE questions will be patient post trauma, or at IV/PICC site)
Thrombophlebitis
work up
Hx component, PE components, dx component
- Hx: look for Virchow’s Triad
- PE: erythema, tenderness
- US: r/o deep vein involvement or occlusion
Thrombophlebitis
treatment
5
- rest
- warm compress, heat
- elevation
- NSAIDs
- abx if infection
Deep Vein Thrombosis (DVT)
Risk Factors
8
- Virchow’s Traid (stasis, vasc injury, hypercoag)
- post major surgery (hips)
- prolonged bedrest/sitting (travel)
- lower extremity trauma
- OCPs/hormone replacement
- tobacco
- cancer associated inflammatory states
- Protein C, Protein S, Leiden Factor V, antithrombin deficiencies
Deep Vein Thrombosis (DVT)
presentation
- edema (measure)
- heat
- erythema
- Homan’s sign
Deep Vein Thrombosis (DVT)
what is Homan’s sign?
discomfort in the calf muscles on forced dorsiflexion of the foot with the knee straight
Deep Vein Thrombosis (DVT)
Work up
- history/PE
- Doppler study
- D-dimer
- r/o PE with vq scan, CT chest)
Deep Vein Thrombosis (DVT)
Tx
- determine if the event is provoked or unprovoked
- anti-coag therapy
- “usu oaxtx” (NOAC) for 3-6mo; before discontinuing, r/o residual clot
- if pt cannot take PO anti-coags, give IVC filter
Deep Vein Thrombosis (DVT)
which meds are NOAC?
- rivaroxaban
- dabigatran
- apixaban
Deep Vein Thrombosis (DVT)
prevention
- DVT prophylaxis considered on all in-patient hosptals (give renal dose)
- intermittent compression boots
- bed exercises/ambulation
- education
what do each of these things describe?
- mild, non-pruritis pitting edema with atrophy and chronic pigmentation changes of the skin
- tender, erythematous area with palpable heat and cord
- unilateral edema with generalized heat, erythema, and tenderness with dorsiflexsion of the foot
- decreased hair growth, shiny atrophic skin, reduced pulse, reduced capillary refill
- chronic venous insufficiency
- thrombophlebitis
- DVT
- PAD
varicose veins
40 yo obese female presents work in for heaviness/ ache in legs at end of day. Works full time as a nurse- 12 hour shifts. No etoh, drugs, tobacco; 4 children. On physical exam + spider veins, no skin changes/heat/tenderness. Pulses/capillary refill intact.
The following interventions are appropriate except:
A- compression socks
B- exercise routine
C- ultrasound
D- ABIs
A treatment for chronic venous insuff/ varicose veins
B- treatment for chronic venous insuff/ varicose veins
C- work up for PVD or DVT
D- abi are work up for PAD
80 yo female presents needs ORIF R hip. PMHX: tissue valve replacement, cardiac pace maker, HTN, osteoporosis.
What pre-op rx does she need?
What post-op rx does she need?
What is most likely post op complication?
Antibiotic prophylaxis on call
Post op DVT management and poss at DC
You have a patient with a confirmed diagnosis of DVT. Which of the following is not indicated
1- rivaroxaban (VTE dosing)
2-D-Dimer
3-VQ scan
4-CT chest
D Dimer bc already confirmed
