Week 7 Part 3 Venous Disorders Flashcards
Thrombophlebitis
Partial or complete occlusion of a vein by thrombus with secondary inflammatory reaction in the wall of the vein
swelling in vein due to clot
Thrombophlebitis
Most common in ______
in deep veins, referred to as ____
LE
DVT
Thrombophlebitis can dislodge (embolize) and travel to lungs to become a
life – threatening pulmonary embolism (PE) (can lead to death)
Thrombophlebitis
Risk Factors
Immobility
- e.g., hospitalization, prolonged bed rest or air travel,
neurological disorders (SCI or stroke),
absence of ankle ms pump
Trauma
- venous damage
Lifestyle
- hormonal status, medications, pregnancy, smoking
Hypercoagulation
- genetics or neoplasms
Thrombophlebitis Clincal Manifestations
- Early stages pain is a dull ache, a tight feeling
- Signs are often absent. When present may be variable & inconsistent
- Unilateral swelling, tenderness of leg pain
- Leg is relatively warmer than the other side
- Discoloration- cyanotic
- Varicose vein and ulcers
Thrombophlebitis Treatment
Bed rest (up to 24 hours)
elevation of legs w/ knees flexed
Avoid prolonged standing
- When swelling and tenderness have subsided ambulation and wearing compression is permitted
Embolism symptoms
chest pain, hemoptysis
sweating profusely, dyspnea
Varicose Veins. ususally affects
saphenous vein
Varicose Veins common among
older women
Varicose Veins risk factors
Periods of high venous pressure, e.g., heavy lifting, prolonged standing or sitting
Hormonal changes, e.g., pregnancy
Obesity (increase intra-abdominal pressure)
Heart failure
Constipation, hemorrhoids, and cirrhosis
Varicose Veins Treatment
periodic rests with elevation
Promote circulation, message
Limited prolonged activity sitting/standing
Elastic stockings
Surgical Intervention can be required
- sclerotherapy or surface laser treatment
Chronic Venous Insufficiency Occurs when
damaged veins or valves prevent venous return, increased venous pressure produces venous stasis (slowness in blood flow inside the vein)
Chronic Venous Insufficiency leads to
Inadequatecellular oxygenation and removal of waste products
Cell death
- Venous stasis ulcers
- can lead to gangrene —> loss of limb
Poor wound healing
Impaired immune and inflammatory responses
Chronic Venous Insufficiency treatment
Compression Stockings
- The stockings are tighter at the ankle and looser as they progress up the leg
- They promote circulation and help limit gravity’s downward pull
- Daily wear is important
- The stockings are sold over-the-counter
- elevation is good
Chronic Venous Insufficiency Lifestyle Recommendations
Exercise
Weight control
dont wear tight clothes, especially around popliteal fossa
Elevation above the level of heart
Avoiding long periods of sitting or standing
Vasomotor Disorders of Blood Vessels effect blood vessels ability to
constrict and relax
Raynaud’s Disease or Phenomenon
Vasospastic disorder - Hyper activation of the sympathetic vasomotor response
Raynaud’s Disease or Phenomenon
intermittent episodes of small artery constriction of extremities
Commonly _______
Causes _______
fingers > toes
pallor and cyanosis of digits
Raynaud’s Disease or Phenomenon
Occur in response to
cold or strong emotion
Raynauds Disease
happens by itself
Age: 20-49 y
Unknown etiology
Account for 65% of all people affected by this condition
Raynauds Phenomenon
happens with other pathologies
Age: 15-40 y
Secondary to other diseases, e.g., Burger’s disease, RA, SLE
Raynaud’s Disease or Phenomenon may produce
numbness, stiffness, diminished sensation, and aching pain
Raynaud’s Disease or Phenomenon May damage _____
Rarely ________
vessels and digits
necrosis, ulceration or gangrene
Raynaud’s Disease or Phenomenon treatment
avoid stimuli that trigger attack
- Temperature (stay warm) , emotional stress, and nicotine (vasoconstriction)
Avoid AC
Dress warm for winter
aquatic therapy
stress management, relaxation, and exercise
Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome/Causalgia is a
- severe, chronically painful condition usually involving one limb (arm or leg)
Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome/Causalgia characterized by
severe, constant, burning pain in the affected limb
- The lightest touch over the limb, even a brush of clothing or a breeze, can be excruciatingly painful
Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome/Causalgia results in peripheral sensitization resulting in
allodynia and hyperalgesia
CRPS Type I
- No specific nerve is identified
- Most common
- usually following a fracture
CRPS Type II
- A specific nerve that has been injured
- Has 3 overlapping but identifiable stages
- Not everyone goes through every stage
CRPS Type II Stage I
limb may become dry, hot and painful
Pain: more severe than expected, burning or aching
Edema: soft and localized
Vasomotor/thermal changes: affected limb is warmer
Skin: Hyperthermia and dry. Increased hair and nail growth
Stage II (Dystrophic) Paradoxic Sympathetic Hyperactivity
3-6 months after onset
Pain: worsens - constant, burning and aching
Allodynia and hyperalgesia almost always present
Edema: becomes thicker/fibrotic causing joint stiffness
Vasomotor/Thermal Changes: neither warm, nor cold
Skin: thin, glossy, cool and sweaty
Stage III (Atrophic)
6-12 months
Pain: spreads proximally, joint stiffness progresses
Edema: continues to harden
Vasomotor/thermal changes: affected limb is cooler
Skin: thin, shiny, cyanotic, and dry fingertips and toes on involved extremity are atrophic. Fascia is thickened; contractures (decrease in PROM) may occur
Complex Regional Pain Syndrome
Clinical Manifestations
- Pain
- Edema
- Movement disorders
- Inability to initiate movement
- Weakness
- Tremor
- Muscle spasm
- Atrophy
- Abnormal vasomotor changes
- Temperature
- Color
