Venous System Disorders

Question 1

Detail the saphenous venous system.

Answer 1

Superficial saphenous veins drain blood into deep veins via perforating branches (common femoral vein)

Question 2

Define varicose veins.

Answer 2

Veins that are abnormally distended + tortuous

Question 3

What is the most common site of varicose veins?

Answer 3

Superficial saphenous veins

Question 4

Aside from the superficial saphenous veins, what other locations are common sites of varicose veins?

Answer 4

Distal esophagus (portal hypertension)
Anorectal region (internal hemorrhoids)
Left scrotal sack (varicocele)

Question 5

What is the most common clinical manifestation of chronic venous insufficiency?

Answer 5

Varicose veins

Question 6

Detail the pathogenesis of superficial varicosities in the lower extremities.

Answer 6

Valve incompetence in perforating branches- retrograde blood flow from high P deep venous system into superficial veins (may be secondary to DVT)

Question 7

What treatment is available for varicose veins?

Answer 7

Compression stockings

Question 8

Aside from compression stockings, what are other treatment options for varicose veins?

Answer 8

Sclerotherapy, ligation

Question 9

What are 2 broad classes of causes of venous thromboses?

Answer 9

Stasis of blood flow

Hypercoagulability

Question 10

What is the most common site of venous thrombosis?

Answer 10

Lower extremity- veins in calf, popliteal vein, femoral vein

Question 11

What are the acute signs of DVT in the calf?

Answer 11

Swelling of the affected leg (relative to other leg)
Pain with dorsiflextion of foot (Homan sign) and compression of calf
Pitting edema distal to the thrombosis (increased hydrostatic pressure)

Question 12

What dermatitis is associated with DVT?

Answer 12

Stasis dermatitis- hemorrhagic or orange discoloration of the skin and ulcers (medial malleolus)

Question 13

What causes stasis dermatitis?

Answer 13

Rupture of perforating vessels due to pressure backup

Question 14

What is the treatment of stasis dermatitis?

Answer 14

Corticosteroids, antibiotics of infection present

Question 15

How do you diagnose a DVT?

Answer 15

US, serum D-dimer

Question 16

How do you treat a DVT?

Answer 16

LMWH, compression stockings

Long term therapy is warfarin

Question 17

Define thrombophlebitis.

Answer 17

Inflammation of the wall of a vein with associated thrombosis

Question 18

What are the clinical findings for a patient with superficial thrombophlebitis?

Answer 18

Pain and tenderness along the course of a superficial vein, erythema, edema

Question 19

Define superior vena cava syndrome.

Answer 19

Obstruction of blood flow through the superior vena cava

Question 20

What is the most common cause of superior vena cava syndrome?

Answer 20

Primary lung cancer- small cell carcinoma

Question 21

What is the cell of origin for small cell carcinoma?

Answer 21

Kulchitsky cell (Enterochromaffin cell)

Question 22

What are clinical signs of superior vena cava syndrome?

Answer 22

“Puffiness”
Blue/purple face, arms, and shoulders
Retinal hemorrhage
Stroke

Question 23

A patient presents and says their arm “falls asleep” when they sleep, they also say that they have numbness in their arm. You note diminished pulses and order a CXR which shows an extra rib. What is your diagnosis?

Answer 23

Thoracic outlet syndrome

cervical rib