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PVD > Chronic Venous Insufficiency, Deep Vein Thrombosis & edema > Flashcards

Chronic Venous Insufficiency, Deep Vein Thrombosis & edema Flashcards

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1
Q

Vein have high complience, what does that mean?

A

can store considerable volume of blood

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2
Q

valves

A

ensure unidirectional flow

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3
Q

Thin walls

A

pressure exceeding blood pressure can easily collapse vein

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4
Q

3 types of veins

A

Deep
Perforating
Superficial

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5
Q

deep veins are found in

A

Muscular layer

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6
Q

Perforating veins are found in

A

Commuicating

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7
Q

Superficial veins are found in

A

between skin and deep fascia

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8
Q

Chronic venous insufficiency causes

A

Illiofemoral thrombophlebitis
incompetent valves
Primary varicose vein
Obstruction due to neoplasm or AV fistula

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9
Q

what is the 1st manifestation on chronic venous insufficiency ?

A

Edema

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10
Q

Edema due to chronic venous insufficiency starts in and disappears at?

A

latter part of the day

at night due ti recumbent position

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11
Q

Edema due to chronic venous insufficiency is mainly in

A

the foot and the ankle

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12
Q

Edema due to chronic venous insufficiency is

A

subcutaneous and not deep

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13
Q

Chronic Venous insufficiency can lead to

A
  • Edema
  • Venous dermatitis
  • Induration (hardenning)
  • ulcerations
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14
Q

Venous dermatitis can lead to

A

Eczema
id reaction
Hemosiderin deposits

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15
Q

id reaction is due to

A

Autosensitization reaction

Immune response to original dermatitis

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16
Q

Induration

A

Subcutaneous fibrosis

Hard and brawny skin

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17
Q

Ulcerations

A

Irritated areas of skin that lose vital nutrients secondary to edema

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18
Q

Ulcerations usually happen in

A

medial aspect of the ankle ( gaiter area)

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19
Q

theories of ulceration formation

A

Fibrin cuff theory
GF trapping theory
WBC trapping theory

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20
Q

fibrin cuff theory

A 
fibrin accumulates in pericapillary space 
This cuff has impaired fibrinolysis 
increases diffusion barrier
inhibit repair process 
maintains inflammatory process
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21
Q

GF trapping theory

A

GF are trapped by fibrin

GF become unavailable to facilitate healing

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22
Q

WBC trapping theory

A

WBC trapped in capillaries
Releases inflammatory mediators & proteolytic enzymes
May increase permeability or impede blood flow to skin

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23
Q

Differential diagnosis for chronic venous insufficiency

A 
CHF
Chronic glomerulonephritis
Lymphedema
AV fistula
Neoplasm
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24
Q

treatment foe chronic venous insufficiency

A 
Elevate legs 
Pressure stockings and dressings
kendell pumps 
Corticosterioud cream for dermatitis 
Skin grafting for ulcers
Vein stripping ( need venogram,It is used to remove a damaged vein and prevent complications of vein damage )
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25
DVT
Blood clot forming in a deep vein, usually in the legs
26
Causes of DVT
From periods of immobilization Due to blood dyscrasia Anything that causes blood not to circulate or clot normally
27
Virchow's triad
Venous stasis Vascular injury Hypercoagulability Presence of 1 of 3 of the above can alter hemostatic balance and can lead to thrombosis
28
Risk factors for DVT
Immoblization | Inheritable blood clotting disorders
29
Inheritable blood clotting disorders
Deficiencies in antithrombin, protein C or Protein S | Mutations of Factor V (Leiden) or factor II
30
Factor V leiden
Autosomal dominant mutation | Leiden variant cannot be inactivated by protein C leading to hypercoagulable state
31
Factor II mutation
Autosomal dominant mutation | Body produces too much prothrombin
32
Risk factors for DVT
- Surgery - Pregnancy (increase pressure in LE veins ) - over weight/obsese (increase pressure in LE veins) - Heart failure - BCP/HRT (Birth control pills, hormone replacemet therapy ) - Cancer - Histology of DVT/PE in self or family - Smoking
33
General anesthetics can cause 22-38% venous dilation due to
loss of muscle tone
34
signs and symptoms of DVT
``` Erythema Edema Leg pain Warmth Tenderness Homan's sign Pratt's sign & test ```
35
Differential diagnosis of DVT
``` Cellulitis Baker's cyst Heart failure Superficial thrombophlebitis Varicose vein Edema Lymphedema Achilles ruptuture ```
36
Caprini
Uses individual risk factors to place pts in 1of 4 categories low , moderate , high & highest
37
DVT prophylaxis
Mechanical | Pharmacological
38
Compression device
prevents swelling and reduces pooling of blood
39
Coumarin
Interfere with vitamin K dependant coagulation factors (II,VII,IX,X) Warfarin requires 36-72 hrs to reach stable loading dose Reversed by vitamin k or FFP
40
Heparin
In the presence of antithrombin III it inactivates factors IIa, Xa, IXa, XIIa prevents fibrin formation by deactivating thrombin aPPT monitors heparin OD REVERSIBLE WITH PROTAMINE SULFATE
41
low molecular weight heparin (LMWH)
70-80% risk reduction for DVT Enoxaprin (Lovenox) starting 12-24 hrs post-op Requires no monitoring
42
What are some tests for DVT?
US CT/MRI blood tests ( D-dimer) Venography
43
What are goals of DVT treatment
Stop clot from increasing in size Prevent clot from breaking loose Prevent recurrent DVT
44
thrombolytics
tPA through IV to break up existing clots
45
IVC filter aka
Greenfield filter
46
IVC filter prevent
clots that break loose from becoming PE | Used in pts who are unable to take medications
47
complications of DVT
Post phlebitic syndrome (25-50% withing 2 years) PE Paradoxical stroke (Ischemic )
48
Post phlebitic syndrome
Edema Leg pain Skin discoloration
49
Paradoxical stroke (Ischemic )
Thrombus passes through patent foramen ovale
50
Symptoms of Pulmonary Embolism
``` unexplained sudden SOB Chest pain (CP ) that worsens with coughing or deep respirations Lightheadedness sense of anxiety Hemoptysis (blood in sputum ) ```
51
Edema
abnormal accumulation of fluid in interstitial tissues eithe rby increases secretion of fluid or impaired removal of fluid
52
Etiology of edema
``` Increased salt intake sun burn Heart failure Renal disease liver disease Pregnancy Medications ```
53
Generalized edama is due to
Hypoalbuminemia Burns Infections
54
CHF
``` Heart weakness Pumping blood less effectively Accumulation of fluid Decrease CO Kidney sense low blood volume from decreased CO and retain salt and water ```
55
IN CHF if fluid builds up rapidly
Pulmonary edema
56
Nephrotic Syndrome
Increased permeability of glomerulus capillary walls --> Proteinuria, Hypoalbuminemia, Edema
57
Low protein levels in blood results in
fluid accumulation
58
Localized edema
Chronic insufficiency | Increased back pressure
59
What is the most common form of edema?
pitting
60
pitting edema typically occurs in
Chronic situations
61
Non pitting edema typically occurs in
Acute situations
62
lead to Pitting edema
Cirrhosis of liver CHF Lymphedema Myexedema (severe hypothyroidism.)
63
Lead to non pitting edema
Injury Infection DVT
64
treatment for Edema
``` Address underlying cause of edema Can prescribe diuretic medications to reduce fluid Reduce sodium intake LE elevation Compression therapy ```
65
Lymphedema
stasis of lymph resulting in swelling
66
Hereditary form of lymphedema
Milroy's
67
Praecox
Lymphedema praecox is a condition characterized by swelling of the soft tissues in which an excessive amount of lymph has accumulated, and generally develops in females Present sppntaneously without cause
68
Secondary lymphedema
Obstructive | Inflammatory
69
Examples of obstructive lymphedema
Malignant obstruction Surgical removal of lymph nodes Pressure Radiation treatment
70
Examples of Inflammatory Lymphedema
Recurrent cellulitis Filariasis ( parasitic infectious disease ) Secondary to injury

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