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PHTH 536 - Body Systems > Venous Disorders - PVD > Flashcards

Venous Disorders - PVD Flashcards

1
Q

What are the risk factors for venous disorders?

A
  • hx of blood clots
  • family hx
  • obesity
  • pregnant
  • prolonged standing
  • hx of ankle injury or immobility
  • trauma, illness, surgery
  • lifestyle
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2
Q

What is the clincal presentation of venous disorders?

A
  • edema generally in LE’s
  • fatigue
  • heaviness feeling in LE’s
  • hemosiderin staining
  • warm on palpation
  • ulcers/wounds are common (above ankle)
  • frequent infections
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3
Q

Varicose Veins

What is the cause?

A

dulated tortuous superficial veins
- the most common are the saphenous and tributaries
- possibilty of hemorrhoids

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4
Q

Varicose veins

Intrinsic weakness of the vessel walls will lead to?

A
  • increased intralumal pressure
  • congenital weakness
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5
Q

Varicose veins

What are the risk factors?

A
  • females more likely
  • pregnant
  • obese
  • family hx
  • prolonged standing
  • hx of infection
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6
Q

Varicose veins

What are the sx?

A
  • heaviness
  • dull ache
  • bulging veins
  • local hematomas (small venuoles rupture)
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7
Q

Varicose veins

Stage 1

A

Reticular veins or spider veins

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8
Q

Varicose veins

Stage 2

A

Vericose veins or venous nodules

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9
Q

Varicose veins

stage 3

A

edema of lower leg

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10
Q

Varicose veins

Stage 4

A

varicose eczema or trophic ulcer

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11
Q

Varicose veins

What are the management strategies?

A
  • conservative
  • sclerotherapy (local iv shot)
  • endovenous thermal ablation (bring heat to obliterate varicous saph veins)
  • surgical
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12
Q

Varicose veins

What are the conservative management techniques?

A
  • compression hose
  • feet elevation
  • edema managemenet
  • avoid prolonged standing
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13
Q

VTE

What are the different categories?

A

DVT - blood clot found in deep vein of UE or LE

PE - blood clot that traveled to the lung

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14
Q

VTE

What is used to calculate the probability of VTE?

A

clinical preduction rule and based on risk factors and physical findings
- helps to predict the next steps in medical testing to rile in/out DVT/PE

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15
Q

VTE Pathogenesis

What is apart of the virchow’s triad?

A

venous stasis
vascular injury
hypercoagulability

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16
Q

VTE Pathogenesis

What is secondary hemostasis?

A

a trigger of the coagulation cascade
- a series of steps in response to a bleed which is caused by tissue injury
- stays active for 5-6 weeks

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17
Q

VTE Pathogenesis

Where do VTE’s usually occur?

A

where there’s areas of decreased or mechanically altered blood flow
- VTE can develop weeks after D/C

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18
Q

DVT

What are the risk factors?

A
  • post-op
  • obesity
  • pregnant and post-partum period
  • heart failure or respiratory fail
  • tobacco use
  • oral contraceptives
  • cancer and chemo
  • prolonged travel
  • trauma
  • diabetes, HTN, CVA, SCI
  • varicose veins
  • increased age
  • UE DVT = CVC, PICC lines and pacemakers
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19
Q

DVT

What are the signs and sx?

A
  • unilateral edema
  • tenderness and pain in the leg
  • warmth and erythema
  • low-grade fever
  • cognitive changes in elderly
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20
Q

DVT

Where does it usually occur?

A

Most common in veins of the calves but can happen in the popliteal, femoral or iliac

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21
Q

DVT

Who are most commonly affected by DVT?

A

women are more likely to develop especially in pregnancy and early post-partum

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22
Q

DVT

What are some diagnosis tools?

A
  • serum d-Dimer (measuring fibrin)
  • doppler US
  • MRI
  • contrast venography
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23
Q

DVT

What is the score interpretation of Wells Clinical Prediction Rule?

A

greater than 3 = high risk
1-2 = mod risk
lower than 1 = low risk

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24
Q

DVT

What is the simplified score interpretation for the Well’s Criteria score?

A

DVT likely = 2 or more points

DVT unlikely = less than 2 points

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25
Q

DVT

What is the clinical features needed for DVT?

A
  • venous materail in subclavian or jugular vein
  • localized arm pain
  • unilateral pitting edema
  • alternative diagnosis
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26
Q

DVT

What should not be relied upon?

A

Homan’s sign
- treat or refer based on the probability of DVT

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27
Q

DVT

What are the treatment indications?

A
  • compression stockings
  • anti-coagulation
  • 1st DVT dx (usually on rx for 3 mos)
  • if can’t anti-coagulate patient then IVC filter is considered
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28
Q

DVT

When should you check with the medical team?

A

if the patient is not on anticoagulants and has a known DVT and does not have an IVC filter

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29
Q

DVT

if on warfarin, what is normal INR levels?

A

less than 1.1 in healthy normal NOT on warfarin

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30
Q

DVT

if on warfarin, what is the INR levels of therapeutic range?

A

2-4 therapeutic range when ON warfarin

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31
Q

DVT

When on warfarin, what is the INR levels for risk of hemorrhage?

A

greater than 4.5

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32
Q

DVT

When on warfarin, what is the INR levels for increased risk of clot?

A

less than 2

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33
Q

DVT

What is recommended to avoid eating?

A
  • large amounts of green leafy vegetables with vitamin K
  • green tea
  • cranberry juice
  • alcohol
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34
Q

DVT

What is the guideline for unfractionated heparin?

A

< 24 hours: no mobility
24-48 hours: consult medical team

.>48 hours: mobilize

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35
Q

DVT

What is the guideline for heparin?

A

< 3 hours: no mobility

3-5 hours: check with physician

.> 5 hours: mobilize

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36
Q

DVT

What is the purpose of an IVC filter?

A

placed in the inferior vena cava above the level of diagnosed clot
- to help prevent DVT from going to the lungs

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37
Q

VTE

What score is indicative for a high risk of VTE on the Padua Prediction Score?

A

greater than or equal to 4

38
Q

What is the khorana risk score?

A

low risk = 0 points
intermediate risk = 1-2 points
high risk = > 3 points

39
Q

what is the score needed to stop anticoagulation?

A

If the HASBLED score is greater than or equal to 4

40
Q

HAS-BLED

Condition for H

A

Hypertension
- uncontrolled
- greater than 160 mmHg

41
Q

HAS-BLED

Condition for A

A

abnormal renal function: dialysis, transplant, Cr > 2.26 mg/dL or > 200 umol/L
abnormal liver function: cirrhosis or bilirubin > 2 x normal or AST/ALT/AP > 3 x normal

42
Q

HAS-BLED

Condition for S

A

prior hx of stroke

43
Q

HAS-BLED

Condition for B

A

Bleeding
- prior major bleeding or predisposition to bleeding

44
Q

HAS-BLED

Condition for L

A

Labile INR (unstable/high INR)
- time in therapeutic range < 60%

45
Q

HAS-BLED

Condition for E

A

Elderly
- age 65 and older

46
Q

HAS-BLED

Condition for D

A

Drug or alchol usage hx (greater 8 drinks/wk)
medication usage predisposing to bleeding

47
Q

Post thrombotic syndrome

What is the prevalence of development?

A
  • develops in 20-50% with an LE DVT even with anticoagulation
  • 8-28% UE DVT
48
Q

Post thrombotic syndrome

What is the cause?

A

permanent damage to the valves of the veins and reflex of the blood in the venous system

49
Q

Post thrombotic syndrome

What does it lead to?

A

leads to venous hypertension = reduces muscle perfusion which increases tissue permeability

50
Q

Post thrombotic syndrome

What are the signs and sx?

A
  • chronic aching arm or leg pain
  • intractable edema
  • limb heabiness
  • leg ulcers
  • skin changes
  • heaviness of the limb affected by DVT
51
Q

Post thrombotic syndrome

What is disease associated with?

A

high morbidity and lower QoL

52
Q

Pulmonary embolism

What is a PE?

A

clot, most often from DVT
- it breaks off then dislodges and travels through the vena cava
- right heart to the lungs and lodges in a part of the pulmonary vasculature

53
Q

Pulmonary embolism

What is the prevalence?

A

common, especially after surgery and trauma prolonged immobility
- can be fatal (40% fatality rate if left untreated)

54
Q

Pulmonary embolism

What is the presentation?

A
  • dyspnea
  • pleutritic chest pain
  • hemoptysis
  • cough
  • syncope
  • tachypnea
55
Q

Pulmonary embolism

How is it diagnosed?

A

same as for DVT but also EKG, CTA, v/q scans

56
Q

Pulmonary embolism

How is it treated?

A

anticoagulation and thrombolytic therapy

57
Q

Pulmonary embolism

What is the risk score interpretation for Wells Clinical Prediction Rule?

A

high risk: > 6
mod risk: 2-6
low risk: < 2

58
Q

What does chronic valve incompetence or venous obstruction leads to?

A

to extravasion (leaking) of edema into surrounding tissues

59
Q

What is chronic venous insufficiency?

A

associated with variscose veins, edema, skin inflammations and hyperpigementations and ulcerations

60
Q

Chronic venous insufficiency

What are the treatments?

A
  • Treating the edema
  • diuretics
  • antibiotics (when infection is present)
  • compression
  • dressing changes
61
Q

Chronic venous insufficiency

What do most chronic wounds most likely lead to?

A

lead to an amputation
- one of the most difficult to treat

62
Q

Chronic venous insufficiency

What are some of the types of compression?

A

bandage pressure
spiral wrap of LE (50% overlap provides 2 layers)
figure 8 (50% overlap provides 4 layers)
compression garments

63
Q

Chronic venous insufficiency

What are the options for compression garments?

A
  • graded compression stockings
  • Unna boot (zinc oxide paste and gauze boots)
  • multilayer bandaging
64
Q

What do we take into account for venous insufficiency hx?

A
  • can report chronic edema issues
  • slow healing
  • h/o infections
  • h/o varicose veins
65
Q

What do we take into account for arterial insufficiency hx?

A
  • aching or cramping of distal limbs
  • poor wound healing
  • limited mobility
66
Q

What are the special tests for vascular examination?

A
  • capillary refill time
  • ABI
  • venous filling time / rubor of dependency test
  • intermittent claudication test
  • Wells’ clinical prediction rules
  • DVT clinical practive guidelines
  • response to exercise
67
Q

Difference in vascular wounds

Skin characteristics - arterial

A
  • shiny
  • dry
  • cool/cold
  • loss of hair
  • rubor with dependent positioning
  • pallor in elevation
68
Q

Difference in vascular wounds

Skin characteristics - venous

A
  • warm
  • pigmentation
  • mottling
  • thickened
  • rough skin
  • changes in appearance of skin after wound healing
69
Q

Difference in vascular wounds

Pain - arterial

A

positive for pain due to ischemia

70
Q

Difference in vascular wounds

pain - venous

A

wounds generally minimally painful

71
Q

Difference in vascular wounds

Exudate - arterial

A

Not observable, dry

72
Q

Difference in vascular wounds

Exudate - venous

A

commonly seen, oozing

73
Q

Difference in vascular wounds

Pulses - arterial

A

can be absent or dimished

74
Q

Difference in vascular wounds

Pulses - venous

A

normal

75
Q

Difference in vascular wounds

Common sites - arterial

A

toes, feet, distal to malleoli

76
Q

Difference in vascular wounds

Common sites - venous

A

above malleoli, distal 1/3 lower leg

77
Q

Difference in vascular wounds

Wound characteristics - arterial

A
  • small
  • defined borders
  • punched out
  • deep
  • tunneling
  • dry
  • necrotic tissue
78
Q

Difference in vascular wounds

Wound characteristics - venous

A
  • uneven borders
  • shallow
  • drainage
  • can be large
79
Q

Cellulitis

What is cellulitis?

A

bacterial (staphylococcus aureus or streptococcus) skin infection of dermis or subcutaneous tissue
- breaks in skin, splinters, bug bites, incisions, IV sites
- not a vascular disorder but can be confused for a developing venous wound

80
Q

Cellulitis

What are the sx?

A
  • red area of the skin that tends to expand
  • swelling
  • tenderness
  • pain
  • warmth
  • occasional open wounds
  • fever
  • red spots
  • blisters
  • skin dimpling
81
Q

Cellulitis

What are the treatment?

A
  • long term antibiotics
  • wound care
  • reduction of edema
82
Q

Cellulitis

What can it progress to?

A

osteomyelitis - infection of the bone

83
Q

Raynaud’s Disease

What is Raynaud’s disease?

A

Intermittently affects small arteries and arterioles = decreased blood supply to distal extremity

84
Q

Raynaud’s Disease

What are the sx?

A
  • cold fingers/toes
  • color changes to skin in response to cold or stress
  • numbness/tingling in fingers or toes
  • stinging/throbbing pain when warming or stress relieved
  • ulcers can occur on tips of fingers/toes (severe cases)
85
Q

Raynaud’s Disease

What are the causes?

A
  1. Atherosclerosis
  2. drugs that cause narrowing of the arteries
  3. certain autoimmune conditions
  4. smoking
  5. repeated injury or usage
86
Q

Raynaud’s Disease

What are the treatments?

A
  1. no smoking
  2. avoid caffeine
  3. avoid medications that cause tightening of the blood vessels
  4. keep the body warm, stop going to the cold, wearing mittens or warmers
  5. wear comfortable, roomy shoes and wool socks
87
Q

Buerger’s Disease

What is burger disease?

I mean Buerger’s Disease

A

inflammation and thrombosis of small and medium sized veins and arteries
- onset is distal to proximal in extremities

88
Q

Buerger’s Disease

What is the cause?

A

unknown but possibly smoking

89
Q

Buerger’s Disease

What is the prevalence?

A

common in males aged 20-40s

90
Q

Buerger’s Disease

What are the sx?

A
  • temp and color variance in hands/feet
  • pain in hands/feet can be severe (arch of foot)
  • painful sores or ulcers hands/feet
  • pain during walking in LEs
91
Q

Buerger’s Disease

What are the treatments?

A
  • no cure for disorder
  • stop smoking
  • pain management
  • improve circulation thru surgery that restores blood flow
92
Q
A

PHTH 536 - Body Systems (28 decks)

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