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Integument Test 2 > Venous Ulcers > Flashcards

Venous Ulcers Flashcards

1
Q

What veins have the most valves?

A

Deep veins

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2
Q

What accompanies the deep veins?

A

Arteries

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3
Q

What are all the deep veins in the leg?

A
  • posterior tibial v.
  • anterior tibial v.
  • fibular v.
  • popliteal v.
  • femoral v.
  • deep femoral v.
  • external iliac v.
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4
Q

What is the superficial veins also known as?

A

Saphenous system

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5
Q

What are the two major vessels in the superficial vein system?

A

Greater saphenous vein and lesser saphenous vein

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6
Q

What is the longest vein in the body?

A

Greater saphenous vein (most problems and where DVT in medial malleolus is)

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7
Q

True/False: the superficial veins are located just below the superficial fascia?

A

True

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8
Q

Where are superficial vein valves more abundant and why?

A

Lower leg (versus the thigh) because it doesn’t have the force from the heart to move it and gravity creates more pressure distally

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9
Q

What connects the superficial and deep vein systems?

A

Perforator veins

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10
Q

How many perforator veins are there?

A

Varies!
200 below the knee
20 above the knee

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11
Q

What do perforators pass through and what do they join to?

A

Pass through openings in deep fascia to join directly with deep veins of the calf or thigh

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12
Q

What plays a vital role in normal blood flow?

A

Valves

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13
Q

What do valves prevent specifically?

A

Valves prevent back flow of blood from high-pressure deep system to the low-pressure superficial system

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14
Q

Where are there more valves?

A

Deep veins

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15
Q

What kind of valves are found in 50-60% of patients with venous ulcers?

A

Incompetent venous valves in perforating and superficial vessels

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16
Q

What do healthy vein valves do?

A

Close with pressure and prevent blood from reflexing or pooling

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17
Q

What are the 3 major mechanisms to help return blood to the heart through the venous system?

A
  1. Smooth muscle tone in vessel walls
  2. Contraction of calf muscle
  3. Negative intrathoracic pressure created during inspiration
18
Q

What is the most important mechanism in returning venous blood?

A

Muscle pump, pushes blood out of the deep veins and into central circulation

19
Q

What does respiration cause?

A

Negative pressure in the chest that assists the return of blood from the legs to the heart

20
Q

What is it called when there sustained high pressure in low pressure veins caused by retrograde flow from incompetent veins?

A

ambulatory venous hypertension

-causes a vicious cycle of distended veins and damaged valve leaflets

21
Q

What happens to unidirectional blood flow during ambulatory venous hypertension?

A

Becomes bidirectional

22
Q

Why does edema build up during ambulatory venous hypertension?

A

Congested superficial veins and capillaries

23
Q

When ambulatory venous hypertension happens and the deep veins are not completely emptied out, what happens next?

A

Increased pressure within the deep system that creates a resistance to blood draining from superficial veins.
-this creates more congestion and distention in superficial and perforating veins causing more valves to be compromised

24
Q

What does improper functioning of the venous system lead to?

A

Chronic venous insufficiency (CVI)

25
Q

What does chronic venous insufficiency impair and cause?

A
  • impairs nutrient and oxygen supply to involved tissue of lower leg
  • lack of nutrients cause tissue damage
  • tissue damage worsens and the dies
26
Q

What are the 2 possible mechanisms for chronic venous insufficiency?

A
  1. Fibrin cuff theory

2. White blood cell trapping hypothesis

27
Q

Veins in the lower leg include what?

A

Deep veins, superficial veins and perforator veins

28
Q

What else escapes into the interstitial space with large macromolecules during the fibrin cuff theory?

A

Fibrinogens

29
Q

In the fibrin cuff theory what causes widening of the capillary pores?

A

Venous hypertension that is transmitted to the superficial veins in the subcutaneous tissue and overlying skin (dilated long saphenous vein)

30
Q

What happens in the fibrin cuff theory after large macromolecules escape into the interstitial space?

A
  • edema forms in the leg because of pooling of fluid in dermis
  • fibrin accumulates in dermis and cause “fibrin cuff” of hard, non-pitting edema
  • the fibrin cuff forms a mechanical border and lessens the delivery of oxygen and other nutrients to the skin
31
Q

Describe the white blood cell-trapping hypothesis

A
  • transient elevation in venous pressures decrease capillary blood flow, resulting in trapping of WBC at the capillary level
  • the trapping plugs the capillary loops which results in areas of localized ischemia
32
Q

What does ischemia and possible WBC release that aid in? (During WBC-trapping hypothesis)

A

Release proteolytic enzymes that aid in cell death

33
Q

Where are the tissue problems most frequently at and why?

A

Medial malleolus because the great saphenous vein is most superficial and has its greatest curvature there

34
Q

Why else can someone get an ulcer by the medial malleolus?

A
  • trauma to involved area

- infection

35
Q

What are the clinical indicators for CVI? (9)

A
  1. Localized limb pain (dec pain with elevation and inc with leg dependency)
  2. Pain with deep pressure or palpation
  3. Pedal pulse are present
  4. Inc temp around wound
  5. Indistinct, irregular wound edges
  6. Lower extremity edema
  7. Shallow, fibrous covered wound bed
  8. Hemosiderin staining
  9. Lipodermatosclerotic changes
36
Q

What are the risk factors for CVI? (19…..)

A
  • obesity
  • Prego
  • leg trauma
  • sedentary lifestyle
  • advanced age
  • altered/shuffling gait
  • dec AROM of ankle
  • tobacco use
  • malnutrition
  • diabetes
  • unplanned weight loss
  • meds
  • thrombophlebitis (DVT, PE)
  • cardiac disease
  • prolonged sitting
  • heart failure
  • previous ulcer
  • response to txt of previous ulcers
37
Q

What is used as a clinical prediction rule to assess the probability of a DVT in patients?

A

Wells Score

38
Q

What are the different scores for the Wells Score and what do they tell you?

A

> 1 = indicates high clinical probability of DVT (28% chance of DVT)

39
Q

What is hemosiderin staining?

A

Red blood cells can lead out of dilated vessels, then iron-containing hemosiderin and stimulated melanin get trapped in the skin around the problematic areas
-this causes a darkening of surrounding tissues

40
Q

What is the result of inflammation of subcutaneous adipose tissue called?

A

Lipodermatosclerosis

41
Q

How does the skin look when lipodermatosclerosis happens?

A

Thick, hard and contracted with the inverted champagne-bottle appearance
-the tissue becomes sclerotic over time

Integument Test 2 (2 decks)

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