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PVD > Intro to PVD > Flashcards

Intro to PVD Flashcards

(111 cards)

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1
Q

What is PVD?

A

Any disease of the blood vessels or lymph system outside the heart circulation

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2
Q

What are types of PVD?

A

Arterial
Venous
Lymph

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3
Q

What is the main cause of arterial disease ?

A

Ischemia/insufficiency

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4
Q

What are 2 types of ischemia/insufficiency?

A

Acute

Chronic

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5
Q

What are some examples of acute type of ischemia?

A

Embolism

Arterial spasm

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6
Q

What are some exampled of chronic type of ischemia?

A

Arteriosclerosis obliterans
Athersclerosis
Thromboangiitis obliterans

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7
Q

What are some examples of acute venous insufficiency?

A

swelling
prominent superficial veins
DVT
thrombophelebitis

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8
Q

What are the precursors for chronic venous insufficiency?

A

varicose veins

dermatitis

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9
Q

What are some diagnostic features for Arteritis?

A

Dull ache
Tenderness
Pressure

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10
Q

What are some diagnostic features for phlebitis ?

A

pain with pressure to a vein

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11
Q

What are some diagnostic features for lymphangiitis?

A

red line seen on skin from infection

tender/sore

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12
Q

constriction of a vein

A

venospasm

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13
Q

constriction of any vessel

A

vasospasm

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14
Q

Lymphedema

A

a condition of localized fluid retention and tissue swelling caused by a compromised lymphatic system.

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15
Q

What is milroys?

A

inherited disorder that begins in infancy and causes your lymph nodes to form abnormally, leading to lymphedema.

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16
Q

milroys is what kind of lymphedema?

A

congenital

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17
Q

What is praecox?

A

Hreditary disorder often causes lymphedema in childhood or around puberty, though it can occur in your 20s or early 30s. It causes your lymph vessels to form without the valves that keep lymph fluid from flowing backward, making it difficult for your body to properly drain the lymph fluid from your limbs.( it is mostly in female)

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18
Q

Secondary lymphedema can be due to?

A

malignant obstruction
surgical removal of lymph nodes
Pressure
Radiation Treatment

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19
Q

Inflammatory lymphedema can be due to?

A

Recurrent cellulitis
Filariasis ( a parasitic disease )
Secondary to injury

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20
Q

what are some clinical manifestations of lymphedema ?

A 
intermittent claudication
pain
Numbness/stiffness
trophic changes 
Delayed capillary filling time
Absent/diminished pulses
color changes 
ulcerations
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21
Q

What are some associated presenting symptoms with PVD?

A 
medications
tobacco
alcohol
leg cramps, varicose veins , ulcers 
DM
cardiac disease 
HTN, stroke , rhematic fever
prior surgeries
collagen vascular disease 
vasospastic disease , Raynauds phenomenon
Nocturnal pain
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22
Q

Vascular exam is consisted of

A

Skin exam

Pulses

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23
Q

What should you pay attention to in skin exam portion of vascular exam?

A

color
texture
appearance

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24
Q

what pulses should you take ?

A 
femoral
popliteal
posterior tibial
dorsalis pedis 
Perforating peroneal
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25
Grading of pulses
``` 0-absent 1-diminished 2-normal 3-accentuated 4-aneurysmal ```
26
What do you do if you are not sure about pulses ?
you Auscultate ( manual or doppler )
27
What artery is occuled in Allen's test
Radial artery
28
What do you see in podiatric vascular exam in PVD?
pallor with elevation | Rubor with dependency
29
with elevation normal color should return in
10 s
30
In diseased feet with elevation normal color will return in
40-60 s
31
How is the skin texture in arteriosclerosis obliterans?
atrophic or thin skin
32
How is the skin texture in lymphedema?
Thick skin
33
How is the skin texture in scleroderma?
smooth and shiny
34
What is the normal CFT?
2-4 sec
35
What does delayed in CFT mean?
decrease in flow due to obstruction/spasm
36
What does Smith-Wick test measure?
Subpapillary venous plexus filling time
37
arterial system is directly connected to the venous system through
capillary network
38
Lymphatic system consist of what type of vessels ?
blind ended
39
vascular system is consisted of
``` Endothelial cells BM Elastic tissue Collagen Smooth muscle ```
40
Arterial histology
mostly smooth muscle and endothelium | Largely tunica media
41
Veins histology
larger than aa thiner walls few smooth muscles for small amount of dilation and contraction
42
what is degenerative artheriopathies
interference of the flow of blood through the arteries
43
What are some diseases asoociated with degenerative artheriopathies ?
``` Atherosclerosis Arterioslerosis Monckeberg's sclerosis Fibromuscular dysplasia Thromoangiitis onliterans ```
44
Atherosclerosis
Increased thickinening of the tunica intima layer Accumulation of lipids, CHO deposits and blood products increase in intra-arterial pressure
45
Atherosclerosis occurs in conjunction with
Arteriosclerosis
46
plaques are unique to
arteries
47
What appears first in atherosclerotic lesions ?
Fatty streak
48
What replace the smooth muscle cells in atherosclerotic lesions ?
Complicated lesions
49
What is the first sign of atherosclerosis ?
Fatty streak
50
Where do you see fatty streak in atherosclerosis ?
arterial wall just beneath the endothelium
51
What are fatty streak?
lipid containing foam cells
52
Where do fatty streak occur?
in coronary aa
53
What is the fate of fatty streak?
Can evolve into atherosclerotic plaques can remain stable can regress
54
H-H theory
Thrombosis leads to plaque development
55
lipoprotein oxidation theory?
lipid and protein oxidation products are responsible for lesion formation/ development
56
what is the major target for oxidation ?
intimal low density lipoprotein
57
What are some pro-atherogenic properties of in vitro oxidized lipoprotein ?
chemotaxis Sterol accumulation in macrophages Adhesion molecule expression on endothelial cells Apoptosis of several cell types
58
what happens in arteriosclerosis obliterans?
``` Increased thickening of the intima Increased calcium Increased diameter Loss of elasticity hardening of the arteries occurs throughout the arterial system ```
59
What are some major risk factors for Arteriosclerosis obliterans (ASO)
``` Stress HTN DM Sicke cell Hyperlipidemia obesity hereditary diet tobacco use ```
60
Pathology of ASO?
obstruction of blood flow through large arteries and therefore ischemia Ischema causes collateral circulation to increase Less pressure and less blood flow in small vessels since large arteries are occluded.--> ischemia to tissues poiseuille's law
61
what is poiseuille's law?
Flow is proportional to the 4th power of radius of the vessel
62
What are some clinical findings of Arteriosclerosis?
pain due to build up of lactic Acid ( product of anaerobid glycolysis) and ischemic pain begins
63
What are the symptoms of ASO?
Intermittent claudication Exercise and pain begins rest and there is relief of pain
64
What is the first sypmtom in ASO
Intermittent claudication and pain
65
ABI in ASO is uaually
< 0.7
66
What are symptoms of PVD?
rest pain Ulcerations Gangerene Disuse atrophy
67
Differential diagnosis for pseudo-claudication?
``` non vascular caudication neurologic herniated disc or spinal stenosis Arthriditis DJD deformities multiple hereditary exostoses usually bilateral variable walking distances ```
68
Caudication -onset
walking
69
Caudication -character
cramp/pain
70
Caudication bilateral
yes and no
71
Caudication -distance
fairly consistent
72
Caudication -cause
ASO
73
Caudication -relief
rest
74
Pseudo-claudication-onset
standing /walking
75
Pseudo-claudication-character
paresthesias
76
Pseudo-claudication-bilateral
yes
77
Pseudo-claudication-distance
variable
78
Pseudo-claudication-cause
spinal stenosis
79
Pseudo-claudication-relief
sit
80
Monckeberg sclerosis
senile medical calcinosis scar tissue and fibrous tissue replaces muscle mostly in middle age men doesnt indicate arterial occlusive disease or arterial wall weakness doesnt get into adventitia or lumen
81
juvenile and presenile calcinosis
Rare Extensive calcinosis No evidence of lumen obstruction
82
Fibromuscular dysplasia
non-atherosclerotic, non-inflammatory vascular disease that causes abnormal growth within the wall of an artery intermediate sized arteries leading cause for renal vascular HTN strings of beads on arteriogram
83
cystic degeneration of popliteal artery
sudden onset | distal pulses present at rest, absent on exercise
84
doppler exam can be
audible | visual
85
what is a doppler shift?
change in frequency and is proportional to blood flow velocity
86
When plaques are present they are
bi or monophasic
87
triphasic form is
``` ventricular systole Diastole ( deflection) elastic recoil ( dichrotic notch ) ```
88
What is ABI
ankle brachial index | compare ankle pressure to arm pressure
89
ABI is difficult to analyze in
calcified vessels | will be falsely elevated
90
Normal ABI
1
91
moderate ABI
0.8-1.0
92
intermittent claudication
0.6-0.8
93
Rest pain
0.4-0.6
94
ulcerations
<0.4
95
success for healing ABI for non DM
0.35
96
Success for healing ABI for DM
0.45
97
How to measure segmental pressue
``` put 4 cuffs in high thigh above the knee below the knee ankle ```
98
how to read segmental pressure
a drop between segments of over 30mmHg shows disease in the vessel above
99
what is the normal value for segmental pressure
70-120
100
What is photoelectric plethysmography? PPG
indirect summation of blood in microcirculation of the toe | Intensity of light reflected by cutaneous microcirculation
101
what is the normal value for PPG?
50mmHg
102
What is transcutaneous oxygen pressure ?
quantifies skin oxygenation useful in advanced stages of arteriopathy for evaluation of cutaneous ischemia indicator of amputation level
103
What does TCPO2 above 30mmhg mean
predictive of spontaneous healing
104
What does TCPO2 below TCPO2 below 10mmHg mean?
it is unfavorable
105
What is the treatment for PVD?
Walking program D/C smoking Decreased Bp Lose weight
106
Pharmacologic treatment for arteriosclerosis
Pentoxyfylline (Trental) 400 mg I tab PO TID | Ciostazol (Pletal) 100 mg 1 tab PO BID
107
Pentoxyfylline (Trental)
increase erythrocyte flexibility must take at least 1 month to see a result inhibit platelet agregation interferes with caffeine and theophylline
108
Ciostazol (Pletal)
vasodilatory and antiplatelet acticity | inhibity type III phosphodiasterase activity
109
What are some surgical treatment options for PVD?
Bypass Thromectomy/Endarterectomy Angioplasty
110
what are some podiatric treatment options for PVD?
once blood flow is established Amputatate at appropriate level Flap Graft
111
Goals of therapy for critical limb ischemia
Restoration of continuous in-line flow to the foot Pulsatile flow equals wound healing Expert wound care/debridement /amputation at appropriate level

PVD (5 decks)

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