What does the arterial system do?
carries oxygenated blood to the capillaries of the body organs
What are the different layers of an artery? Which one provides the strength?
tunica intima (endothelium, CT, basement membrane) tunica media (smooth muscle) tunica adventitia (elastic and collagenous fibers)
Media provides the strength
How do the arteries work?
Where is BP the greatest?
What happens in smaller arterioles and capillaries?
elastic fibers allow expansion during systolic phase (cxn)
recoil and drive blood through during diastolic
- BP is greatest in muscular small arteries
- BP decreases and blood flow slows to allow gas and nutrient exchange
What does the venous system do?
returns deoxygenated blood from tissue back to the heart (& moves waste products)
What are the different layers of a vein?
3 tunics, but less distinct and cannot contract
valves are formed by the inner layer of the vessel wall
How do veins work?
Veins formed by the inner layer of the vessel wall ensure one-way blood flow
Blood moves in veins via skeletal muscle pump and breathing (contraction of diaphragm insreases pressure in the abdomen and pressure differences force blood –> thoracic cavity –> heart)
What does the lymphatic system do?
transports interstitial fluid back to blood
transports absorbed fat from small intestine
has lymphocytes that provide immunological defense
What are the different layers of lymph pathways?
3 layers similar to veins, with close-ended tubes
valves formed by inner layer to prevent backflow
How is lymph moved throughout the body?
peristaltic motion and valvular closure
What are the 4 main categories of peripheral vascular disease?
- Arterial Occlusive
- Inflammatory
- Vasomotor Disorder / Vasospastic Disease
- Venous
What are some types of arterial occlusive PVD?
Aterio/Atherosclerosis
Thromboangiitis
Thrombosis/Emboli
What is a clot that commonly has a cardiac origin secondary to stasis of flow, and can migrate to peripheral arterial vessels and block it?
Emboli
Which clot is less common and usually formed in conjunction with an atherosclerotic lesion… platelets gather behind lesion and form it… severity depends on size?
Thrombus
What are the symptoms of Thrombus/Emboli?
Pain, Pallor, Paralysis, Parasthesia, and Pulselessness
What is the hardening of arterial walls?
arteriosclerosis
What is a form of arteriosclerosis that often involves plaque deposits on the endothelial lining?
atherosclerosis
What is a form of atherosclerosis that is manifested peripherally, usually in the lower extremities?
arterirosclerosis obliterans
What is a specific arterial disease with tissue ischemia in young men who smoke?
thromboangiitis obliterans (Buerger’s disease)
What will patients complain of subjectively with arterial occlusive disease?
cramping w/ walking
rest pain relieved by dependency
wounds w/o a history of trauma
What will patients display objectively with arterial occlusive disease?
trophic changes (loss of hair, abnormal cells, dry/cool skin) decreased pulses
What are some types of inflammatory disease?
vasculitis
Kawasaki disease
What is inflammation of the vessel wall resulting from immune complex deposition or cell-mediated immune reactions directed against the vessel wall
Vasculitis
What is a febrile inflammatory disease in children?
Kawasaki disease
What are some types of vasomotor/vasospastic conditions?
Primary and secondary Raynaud’s
What is temporary vasospasm in arterioles causing cyanosis, most often occurring in the fingers and caused by cold temperatures or strong emotions?
Primary Raynaud’s Disease
What is it called when vasospasm in arterioles causing cyanosis, most often occurring in the fingers and caused by cold temperatures or strong emotions occurs secondary to another disease like Buerger’s or connective tissue diseases?
Secondary Raynaud’s Disease
What are some types of venous disease?
varicose veins
deep vein thrombosis
superficial thrombophlebitis
chronic venous insufficiency
What are abnormally dilated veins resulting from intrinsic vessel wall weakness and chronic valvular insufficiency?
varicose veins
Where and in whom do varicose veins most frequently occur?
in lower extremity, women (3:1)
What is caused by a coagulation of blood collected in deep veins due to obstructed blood flow?
DVT
What is inflammation/thrombosis of a superficial vein called?
superficial thrombophlebitis
What is it called when damaged valves result in decreased venous return, reversed bloodflow that can cause venous hypertension?
Chronic venous insufficiency
What is the cause of the majority (70-80%) of LE ulcers?
chronic venous insufficiency
What do patients complain of subjectively with venous disease?
aching/heavy legs, sometimes relieved with elevation,, wounds with no history of trauma
What do patients present with objectively with venous disease?
swelling, skin changes (hemosiderin, fibrosis), pulses present, wounds with drainage
Where are arterial wounds often found?
anywhere distal to ankle, often foot/toes
Where are venous wounds often found?
most often on medial mallelous and lower leg
How do arterial wounds appear?
dry, pale, minimal drainage, blanched wound base, punched out borders
How do venous wounds appear?
lots of drainage, red granulation, hyperpigmentation, red wound base, irregular borders
Which type of wound is painful?
arterial
Which type of wound has pulses?
venous
What is primary lymphedema caused by?
failure of complete formation of lymph vessels
What is secondary lymphedema caused by?
trauma, surgery, parasitic infection, radiation, etc.
What does a patient with lymphedema complain of subjectively?
feelings of fullness and heaviness, numbness/tingling
What does a patient with lymphedema present with objectively?
swelling not improved by elevation, pitting, dermal changes (cysts, hyperkeratosis), decreased ROM, lymph leakage
What is joint breakdown marked by hypermobility in the feet with sensory/motor/autonomic issues?
Charcot’s joint
What is the ability to sense pressure at different locations in the foot with a 5.07 mm monofilament ( Semmes-Weinstein)
Protective sensation
What are the 3 phases of wound healing?
- Inflammatory Phase
- Proliferative Phase
- Maturation Phase
