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Flashcards in leg edema Deck (27):
1

why synthroid (levothyroxin for hypothyroidism) be an issue?

is it controlled?

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

2

another med an issue for cramping

amlodipine: Ca2+ channel blocker

3

ddx

DVT
PAD
CHF

4

if start to see dark coloration around ankle implies blood leakage

venous inflammation
happens with allergies
may also have streaking

5

if skin turns white then black implies

arterial blockage

6

normal venous pressure

80mm Hg in deep veins
20-30mm Hg in superficial veins

7

cephalad venous blood flow

Biscuspid venous valves
Effective muscle contractions
Normal respirations

8

LE edema occurs in response to

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

9

most common cause of LE edema

chronic venous insufficiency

10

LE edema ddx

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)

11

brawny fibrotic skin caused by

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

12

chronic exposure of elevated venous pressures causes

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

13

LE cramping always check....

*K+ and Mg+ levels!!

14

LE cramping ddx

Arterial disease
Hypokalemia
Deconditioning
Dehydration
Medication

15

DVT: need to find cause

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

16

DVT ppx

heparin and lovenox
compression stockings

17

Bilateral involvement with improvement after awakening

Systemic (heart failure, cirrhosis)

18

heavy legs or itching

Chronic venous insufficiency

19

LE swelling or inflammation with recent DVT

Postphlebetic syndrome

20

dx testing

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)

21

what looking for in UA

proteinuria
RBC/WBC casts (nephritis)
*kidney etiology

22

in chronic liver cirrhosis

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

23

CT will find

muscle tears, etc

24

leg edema tx

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

25

compression stockings do what

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

26

Asians, Afr. Americans at higher risk for

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

27

life threatening leg edema

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