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Gen Med Unit 7: Cardio > Venous Disorders > Flashcards

Venous Disorders Flashcards

1
Q

What conditions are included in venous disorders?

A
  1. Varicose veins
  2. Superficial venous thrombophlebitis
  3. Chronic venous insufficiency
  4. Venous thromboembolic disease
    A. DVT
    B. PE
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2
Q

What is the etiology of varicose veins?

A
  1. Dilated tortuous veins engorged with blood
  2. Results from incompetent venous valves
  3. Greater saphenous vein and its tributaries are most commonly involved
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3
Q

What are the risk factors for varicose veins?

A 
F>M
Pregnancy
Highest incidence is in women after pregnancy
Heavy lifting
Prolonged sitting/standing
Obesity
Hormonal changes (puberty, OCP, HRT)
(+) FH
Aging
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4
Q

What is the pathophysiology of varicose veins?

A
  1. Veins are thin walled distensible vessels with valves that keep blood flowing in one direction
  2. Any condition that weakens, distends or destroys these valves allows backflow of blood
  3. Valves become incompetent from increased pressure  pooling of blood occurs
  4. As veins are stretched, they lose elasticity and become tortuous
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5
Q

What are the sxs of mild-moderate varicose veins?

A
  1. Fullness, heaviness, aching
  2. Visible,swollen veins
  3. Mild swelling of feet or ankles
  4. Itching
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6
Q

What are the sxs of severe varicose veins?

A
  1. Leg pain after prolonged sitting/standing
  2. Edema
  3. Dry, scaly skin
  4. Brownish pigmentation (stasis dermatitis)
  5. Stasis ulcers of skin may develop
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7
Q

Why are imaging studies used to visualize varicose veins?

A
  1. Clinical diagnosis but imaging helpful in determining surgical treatment
  2. Used to identify source of venous reflux
    A. Greater saphenous vein is the most common source
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8
Q

What are the imaging studies used to visualize varicose veins?

A
  1. Duplex ultrasonography is test of choice for planning treatment
    A. USN to visualize the structure or architecture of the vessel
    B. Color-doppler ultrasound to visualize the flow within the vessel
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9
Q

What non-surgical treatments are available for varicose veins?

A 
1. Compression stockings
A. Thromboembolic deterrent stockings
B. Give external support to veins
2. Elevating the legs
3. Exercise
4. Compression sclerotherapy
A. Sclerosing agent injected into vein
B. Leg wrapped with ace x few days
C. Agent causes irritation that fibroses and occludes vein
D. Obliterates vein
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10
Q

What surgical treatments are available for varicose veins?

A
  1. Vein ligation & stripping
    A. Excise symptomatic portion of vein
  2. Endovenous ablation w/ radiofrequency or laser
    A. Laser inserted into catheter that’s directed inside the vein
    B. Heat generated from the laser seals the vein, redirecting blood flow to surrounding healthy veins
    C. Slowly destroys vein over 1 yr post Tx
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11
Q

Define scerlotherapy. When is it used?

A
  1. Inject vein with a sclerosing solution causing vein to shrink, then dissolve over a period of weeks as the body naturally absorbs the treated vein
  2. “Gold standard” & preferred over laser for treating large spider veins (telangiectasiae) & smaller varicose veins
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12
Q

Define foam scerlotherapy. When is it indicated?

A
  1. “Foamed sclerosant drugs” sclerosant drugs (sodium tetradecyl sulfate or polidocanol) mixed with air or CO2
  2. More efficacious than the liquid in sclerosing
  3. Used for longer and larger veins
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13
Q

What is the prognosis for varicose veins?

A
  1. Surgical correction of reflux provides excellent results

2. 5 year success rate as defined by lack of pain and recurrent viscosities is 85-90%

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14
Q

define Superficial Venous Thrombophlebitis. What is it asst with?

A
  1. Inflammation of superficial vein
  2. May occur spontaneously
    A. Pregnancy or post partum
  3. May occur secondary to trauma
  4. May occur as manifestation of systemic hypercoagulability
    A. Cancer
  5. Approximately 20% of cases may have co-existing DVT
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15
Q

What is the etiology of Superficial Venous Thrombophlebitis?

A
  1. Most common cause
    A. IV catheter
    B. PICC line: Peripherally Inserted Central Catheter
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16
Q

What veins is most commonly involved in spontaneous superficial venous thrombophlebitis?

A

Long saphenous vein

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17
Q

What are the sxs of superficial venous thrombophlebitis?

A
  1. (+) Homan’s sign
  2. Often spontaneous
  3. Palpable, sometimes nodular cord if thrombus
  4. Dull ache in involved area
  5. If co-existing fever & chills, consider septic phlebitis (rare)
  6. Induration, redness & tenderness along superficial vein
  7. Usually saphenous vein
  8. Secondary to trauma
  9. Induration at site of recent IV line or trauma
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18
Q

How is superficial venous thrombophlebitis diagnosed? When is imaging indicated?

A
  1. Usually clinical diagnosis
  2. Duplex USN indicated if
    A. Superficial phlebitis involves or extends into the proximal 1/3 of the medial thigh
    B. LE edema > than would be expected from a superficial phlebitis alone
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19
Q

How is superficial venous thrombophlebitis treated non surgically?

A
  1. Local heat
  2. NSAIDs: 1st: Indomethacin, 2nd: ASA
  3. Compression stockings
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20
Q

When is superficial venous thrombophlebitis treated surgically?

A
  1. Surgery may be warranted if:
    A. Extensive induration
    B. Near saphenofemoral junction
    C. Near cephalo-axillary junction
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21
Q

What is the prognosis for Spontaneous superficial thrombophlebitis
secondary to varicose veins?

A

Recurrent episodes likely unless correction of underlying venous reflux is done

22
Q

What is the prognosis for Spontaneous superficial thrombophlebitis
secondary to trauma?

A

Recurrent episodes unlikely

23
Q

What is the etiology of Chronic Venous Insufficiency?

A
  1. Changes secondary to superficial venous reflux & varicose veins
    A. Often secondary to leg trauma
  2. Changes secondary to DVT
  3. Neoplastic obstruction of pelvic veins
  4. Congenital arteriovenous fistula
24
Q

What is the pathophys of Chronic Venous Insufficiency?

A
  1. Valve leaflets not functional
    A. Due to thickening or scarring (post thrombosis)
    B. Due to dilated vein
  2. Results in high hydrostatic pressure in lower leg
  3. Leads to edema
25
Q

What are the sxs of Chronic Venous Insufficiency?

A
  1. Hx of prior DVT or leg injury
  2. Pitting edema
    A. Usually first symptom
  3. Itching
  4. Dry cracked skin
  5. Dull aching of lower extremity
    A. Worse with standing
  6. Stasis (brawny) skin pigmentation
    A. Hemosiderin
  7. Thin shiny skin
  8. Stasis ulcers
26
Q

When is duplex US indicated in Chronic Venous Insufficiency?

A

Imaging is done to evaluate degree of reflux and obstruction

27
Q

How is Chronic Venous Insufficiency treated?

A
  1. Compression stockings during day and evening
  2. Avoid long periods of standing or sitting
  3. Elevation of lower extremities
28
Q

How is Chronic Venous Insufficiency treated if ulcers are present?

A
  1. Unna boot
    A. Applied after edema is reduced by elevation of LE
    B. Semi rigid gauze boot made with Unna paste
    C. Enhances pumping action of calf muscles on blood flow out of LE
    D. Boot changed q 2-3 days
    E. Ulcer and tendons must be adequately padded
29
Q

define correction of reflux treatment. When it used for chronic venous insufficiency?

A
  1. Radiofrequency ablation or endovenous laser treatment
    A. Treats incompetent veins that feed the area of ulceration
    B. Decreases venous pressure in area of ulceration
    C. Promotes healing of ulcer
30
Q

Define Venous Thromboembolic Disease (VTE)

A

Includes DVT and PE

31
Q

What are the high risk factors for Venous Thromboembolic Disease in the in pt setting?

A
  1. Recent orthopedic surgery
  2. Abdominal or pelvic cancer
  3. Recent spinal cord injury
  4. > 3 intermediate risk factors
32
Q

What are the intermediate risk factors for Venous Thromboembolic Disease in the in pt setting?

A
  1. Not ambulating
  2. Acute infectious or inflammatory process
  3. Active malignancy
  4. Hx VTE
  5. Hx stroke
  6. Hormone replacement
    A. OCT, estrogen replacement
  7. CHF
33
Q

Define Virchow’s triad asst with DVT

A
  1. Stasis
  2. Vascular injury
  3. Hypercoaguability
    A. Factor V Leiden mutation
    Polycythemia vera or essential thrombocythemia
34
Q

What are the most common sites of DVTs?

A
  1. Superficial femoral vein
  2. Popliteal vein
  3. Posterior tibial vein
35
Q

What are the sxs of dvts?

A
  1. Pain/aching/heaviness
  2. Swelling
  3. +/-Redness
  4. ↑ Warmth over area
  5. Palpable tender cord in calf
  6. Swelling of whole calf
    A. > 3 cm difference of calf size
  7. Homan’s sign unreliable
    A. Pain with dorsiflexion of foot
36
Q

What are the diagnostic studies for dvt?

A
  1. D-Dimer (Degradation product of fibrin)
  2. Venous doppler USN
  3. Contrast venography “gold standard” but invasive
37
Q

What is a normal D dimer test? What is its specificity and sensitivity?

A 
1. ↑ In presence of thrombus
A. < or =250 ng/mL D-Dimer Units (DDU)
B. < or =0.5 mcg/mL Fibrinogen Equivalent Units (FEU)
2. Sensitivity 95-97%, specificity 45%
3. Can be used as a screen to R/O DVT
38
Q

When is contrast venography used?

A

Used for high index patients w/ negative or inconclusive ultrasounds

39
Q

What are the sxs of PE?

A
  1. Pleuritic chest pain
  2. Dyspnea*
  3. Apprehension
  4. Cough
  5. Hemoptysis
  6. Tachycardia
  7. Tachypnea
  8. Crackles
  9. Low grade fever
40
Q

What are the diagnostic studies for PE?

A 
1. D-Dimer
A. ↑ In presence of thrombus
B. Can be used as a screen to R/O PE
2. Pulse Oximetry
3. ABG
4. EKG
41
Q

What are the EKG results in PE?

A
  1. Sinus tachycardia
  2. Non specific ST-T wave abnormalities
  3. S1Q3T3
    A. Seen in < 20% patients
42
Q

What are the dx studies for PE?

A
  1. CXR
  2. Ventilation/Perfusion Scan
  3. Spiral CT Chest
  4. Pulmonary angiography
43
Q

What are the results of the cxr in a pt with a PE?

A
  1. May be normal or may show non specific abnormalities
    A. Areas of atelectasis
    B. Prominent PA
44
Q

What are the results of the V/Q scan in a pt with a PE?

A

Demonstrates perfusion defect with normal ventilation

45
Q

What are the results of the spiral CT Chest in a pt with a PE?

A

Initial method for identifying PE

46
Q

Why is a pulmonary angiography used in a pt with a PE?

A
  1. Definitive test for diagnosis

2. Rarely used unless non-invasive testing leaves uncertainty of diagnosis

47
Q

How is a DVT treated?

A
  1. Anticoagulation
    A. Prevent recurrence, extension and embolization of thrombus
    B. Reduce risk of post thrombotic syndrome
  2. Most patients with DVT treated as outpatient w/ LMWH
    A. If their risk of bleeding is low
  3. IVC filters
  4. Thrombolytic therapy
48
Q

What are the DVT treatment guidelines for a pt with a reversible risk factor?

A 
1. Pt who had a reversible risk factor contributing to DVT, Tx 3 months or until the risk factor is resolved
Trauma
Surgery 
Cancer 
Confined to bed for a prolonged period
49
Q

What are the DVT treatment guidelines for a pt with no known risk factors?

A

Pt w/DVT and no known risk factor for thrombosis Tx for an indefinite period of time (minimum 6 mo-optional)

50
Q

What are the DVT treatment guidelines for a pt with an underlying medical risk factor?

A

Pt w/underlying medical risk factor for thrombosis advised to continue Tx indefinitely after a 1st spontaneous DVT or PE

51
Q

Describe an inferior vena cava filter. When is it used?

A
  1. Blocks the circulation of clots in the bloodstream
  2. Used in DVT pt who cannot use anticoagulants because of a very high bleeding risk
  3. Recommended in pt w/recurrent DVT despite anticoagulation
  4. Used in pt w/pulmonary problems due to chronic recurrent PE
52
Q

Describe the indications of thrombolytic therapy

A

Reserved for pt’s w/ serious complications related to PE or DVT, & low risk of serious bleeding as a side effect of the therapy

Gen Med Unit 7: Cardio (13 decks)

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