leg edema

Question 1

why synthroid (levothyroxin for hypothyroidism) be an issue?

Answer 1

is it controlled?

if too high dose, induce hyperthyroidism
if too low: swelling

Question 2

another med an issue for cramping

Answer 2

amlodipine: Ca2+ channel blocker

Question 3

ddx

Answer 3

DVT
PAD
CHF

Question 4

if start to see dark coloration around ankle implies blood leakage

Answer 4

venous inflammation
happens with allergies
may also have streaking

Question 5

if skin turns white then black implies

Answer 5

arterial blockage

Question 6

normal venous pressure

Answer 6

80mm Hg in deep veins

20-30mm Hg in superficial veins

Question 7

cephalad venous blood flow

Answer 7

Biscuspid venous valves
Effective muscle contractions
Normal respirations

Question 8

LE edema occurs in response to

Answer 8

Increased venous or lymphatic pressures
Decreased intravascular oncotic pressure
Increased capillary leak (mastectomy)
Local injury or infection

Question 9

most common cause of LE edema

Answer 9

chronic venous insufficiency

Question 10

LE edema ddx

Answer 10

DVT* (acute)
Cellulitis* (acute)
Lymphedema* (chronic)
Heart failure* (chronic)
Musculoskeletal disorder (baker cyst, gastrocnemius tear/rupture)
Cirrhosis
Nephrotic syndrome
Medications (CCB, minoxidil, pioglitazone)* (chronic unless med change)

Question 11

brawny fibrotic skin caused by

Answer 11

Chronic exposure of elevated venous pressures by postcapillary venues
-prone to getting ulcers

Question 12

chronic exposure of elevated venous pressures causes

Answer 12

Leakage of fibrinogen and growth factors into interstitial space
Leukocyte aggregation and activation
Obliterations of cutaneous lymphatic network

Question 13

LE cramping always check….

Answer 13

*K+ and Mg+ levels!!

Question 14

LE cramping ddx

Answer 14

Arterial disease
Hypokalemia
Deconditioning
Dehydration
Medication

Question 15

DVT: need to find cause

Answer 15

Malignancy, esp untreated
Recent limb immobilization or paralysis (ortho sx)
Bedridden >3 days due to surgery in past 4wk (month)
Localized tenderness along deep veins (homan sign)
Swelling of entire leg
Swelling of one calf >3cm
Ipsilateral pitting edema
Collateral superficial veins
Previous DVT
pregnancy, OCTs >35 yo

Question 16

DVT ppx

Answer 16

heparin and lovenox

compression stockings

Question 17

Bilateral involvement with improvement after awakening

Answer 17

Systemic (heart failure, cirrhosis)

Question 18

heavy legs or itching

Answer 18

Chronic venous insufficiency

Question 19

LE swelling or inflammation with recent DVT

Answer 19

Postphlebetic syndrome

Question 20

dx testing

Answer 20

Ultrasound – arterial or venous depending on cause
D-dimer (not typ. done outside ER)
Ankle brachial pressure index
Kidney function/urine analysis
CT (if no clue what's going on)

Question 21

what looking for in UA

Answer 21

proteinuria
RBC/WBC casts (nephritis)
*kidney etiology

Question 22

in chronic liver cirrhosis

Answer 22

LFTs will not be elevated: “killed off” liver, will not put out enzymes

Question 23

CT will find

Answer 23

muscle tears, etc

Question 24

leg edema tx

Answer 24

Treat underlying cause
Compression stockings (for venous issues)
OMM (better for benign, venous causes, not arterial)
Aspirin and walking if PAD

Question 25

compression stockings do what

Answer 25

force more blood thru clogged vessels-breaks it up
new vessels are formed
(less pain in end)
bring blood back to heart

Question 26

Asians, Afr. Americans at higher risk for

Answer 26

compartment syndrome, etc if cellulitis not tx properly
have thin-walled vessels
don’t miss emboli, PAD
note absent pulses

Question 27

life threatening leg edema

Answer 27

High risk for DVT
Compartment syndrome
Acute edema that impairs ability to function