Week 7 - Peripheral Vascular System Flashcards
Where is the location of epitrochlear lymph nodes? Which areas do they drain?
Epitrochlear lymph nodes are located on the medial surface of the arm approximately 3 cm above the elbow. Lymphatics from the ulnar surface of the forearm and hand, the little and ring fingers, and the adjacent surface of the middle finger drain into them.
What are the 2 groups of superficial inguinal lymph nodes? What is the location of each?
The horizontal group lies in a chain high in the anterior thigh below the inguinal ligament. The vertical group clusters near the upper part of the saphenous vein.
Define intermittent claudication. What is its cause? How intermittent claudication can be distinguished from the leg pain due to spinal stenosis?
Intermittent claudication is pain or cramping in the legs during exertion that is relieved by rest within 10 minutes.
Chronic arterial occlusion, usually from atherosclerosis, causes intermittent claudication, postural color changes, and trophic changes in the skin.
This can be distinguished from spinal stenosis if the leg pain with exertion is reduced by leaning forward and stretching the spinal cord in the narrowed vertebral canal (spinal stenosis) versus being reduced by rest.
Ischemia of which artery can cause abdominal pain after meals and associated food fear?
Celiac or superior or inferior mesenteric arteries.
What are the causes of asymmetric BP in the two arms?
Coarctation of the aorta and dissecting aortic aneurysm.
What are the causes of lymphedema of the arm and hand?
Axillary lymph node dissection and radiation therapy.
Know the 4 grades of pulses and the character of each. What is the cause of asymmetric diminished pulses?
▪ 3+ Bounding ▪ 2+ Brisk, expected (normal) ▪ 1+ Diminished, weaker than expected ▪ 0 Absent, unable to palpate Asymmetric diminished pulses may be due to arterial occlusion from atherosclerosis or embolism.
What is the common cause of a decreased or absent pedal pulse?
Occlusive disease in the lower popliteal artery or its branches, often seen in diabetes mellitus.
What are the signs of superficial thrombophlebitis? What are the signs of chronic venous insufficiency in the leg? What are the causes of thickened brawny skin?
Local swelling, redness, warmth, and a subcutaneous cord suggest superficial thrombophlebitis.
Brownish discoloration or ulcers just above the malleolus suggest chronic venous insufficiency.
Thickened brawny skin suggests lymphedema and advanced venous insufficiency.
What are the causes of absent or diminished wrist pulses? What is the purpose of Allen test?
Absent or diminished wrist pulse found in Buerger’s disease (thromboangiitis obliterans).
The Allen Test assesses the patency of the ulnar and radial arteries.
Define Raynaud’s disease. What are the location and timing of pain? What are the aggravating and relieving factors?
Raynaud’s Disease: episodic spasm of the small arteries and arterioles with no vascular occlusion.
Aggravating Factors: exposure to cold; emotional upset.
Alleviating Factors: warm environment.
What are the differences between chronic arterial and chronic venous insufficiency?
(1)CHRONIC ARTERIAL INSUFFICIENCY (2)CHRONIC VENOUS INSUFFICIENCY
PAIN (1) Intermittent claudication, progressing to pain at rest (2) Often painful
MECHANISM (1) Tissue ischemia (2)Venous hypertension
PULSES (1) Decreased or absent (2) Normal, though hard to feel through edema
COLOR (1) Pale, esp. on elevation; dusky red on dependency (2) Normal, or cyanotic on dependency. Petechiae and then brown with chronicity.
TEMPERATURE (1) Cool (2) Normal
EDEMA (1) Absent or mild if patient lowers leg to relieve rest pain (2) Present, often marked
SKIN CHANGES (1) Trophic changes: thin, shiny, atrophic skin; loss of hair over the foot and toes; nails thickened and ridged (2) Often brown around ankle, stasis dermatitis, and possible thickening of skin and narrowing of the leg as scarring develops
ULCERATION (1) If present involves toes or point of trauma on feet (2) If present, develops at sides of ankle, esp. medially
GANGRENE (1) May develop (2) Does not develop
What are the features of chronic venous insufficiency ulcers, arterial insufficiency ulcers, and neuropathic ulcers?
Venous Insufficiency Ulcers
▪ This condition usually appears over the medial and sometimes the lateral malleolus. The ulcer contains small, painful granulation tissue and fibrin; necrosis or exposed tendons are rare. Borders are irregular, flat, or slightly steep. Pain affects quality of life in 75% of patients. Associated findings include edema, reddish pigmentation and purpura, venous varicosities, the eczematous changes of stasis dermatitis, and at times cyanosis of the foot when dependent. Gangrene is rare.
Arterial Insufficiency Ulcers
▪ This condition occurs in the toes, feet, or possibly areas of trauma (shins). Surrounding skin shows no callus or excess pigment, although it may be atrophic. Pain often is severe unless neuropathy masks it. Gangrene may be associated along with decreased pulses, trophic changes, foot pallor on elevation, and dusky rubor on dependency.
Neuropathic Ulcers
▪ This condition develops in the pressure points of areas with diminished sensation; seen in diabetic neuropathy, neurologic disorders, and Hansen disease. Surrounding skin is calloused. There is no pain, so the ulcer may go unnoticed. In uncomplicated cases, there is no gangrene. Associated signs include decreased sensation and absent ankle jerks.
What are the differences between pitting edema, chronic venous insufficiency edema, and lymphedema?
Pitting Edema
▪ Edema is soft, bilateral, with pitting on pressure, on the anterior tibiae and feet. There is no skin thickening, ulceration, or pigmentation.
▪ Pitting edema results from several conditions: when legs are dependent from prolonged standing or sitting, which leads to increased hydrostatic pressure in the veins and capillaries; congestive heart failure leading to decreased cardiac output; nephrotic syndrome, cirrhosis, or malnutrition leading to low albumin and decreased intravascular colloid oncotic pressure; and drug use.
Chronic Venous Insufficiency
▪ Edema is soft, with pitting on pressure, and occasionally bilateral. Look for brawny changes and skin thickening, especially near the ankle. Ulceration, brownish pigmentation, and edema in the feet are common.
▪ Arises from chronic obstruction and from incompetent valves in the deep venous system.
Lymphedema
▪ Edema is soft in the early stages, then becomes indurated, hard, and non-pitting. Skin is markedly thickened; ulceration is rare. There is no pigmentation. Edema is found in the feet and toes, often bilaterally.
▪ Lymphedema develops when lymph channels are obstructed by tumor, fibrosis, or inflammation, and in cases of axillary node dissection and radiation.
