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Clin Med - Cardio Exam #2 > Peripheral Vein Disease > Flashcards

Peripheral Vein Disease Flashcards

(69 cards)

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1
Q

What structures within the vein assist in pushing blood back towards the heart?

A

Valves

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2
Q

Define VV (varicose veins)

A

Dilated, tortuous superficial veins in lower extremeties

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3
Q

What veins are most commonly affected by VV?

A

Greater saphenous and its branches

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4
Q

what does distention of the vein lead to in VV?

A

weakened/incompetent valves and dilation along the vein

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5
Q

What does dilation in VV lead to?

A

Increased pressure and distention of the vein segment below the valve and progressive failure of the next lower level

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6
Q

r/f for VV?

A

genetics
prolonged standing
pregnancy
congenital or acquired AV fistula

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7
Q

Primary VV orginate in the ______ system?

A

superficial

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8
Q

VV are more common in ____ than ____

A

females than males

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9
Q

Secondary VV originate in the _______ system and _______?

A

deep system and perforating veins

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10
Q

Signs and symptoms of VV

A

can be asymptomatic
doesn’t correlate to number and size
if present develops after long periods of standing - dull ache/heaviness or fatigue of legs
may be palpablee in obese
Venous stasis dermatitis
brownish pigmentation and thinning of the skin above the ankle

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11
Q

W/u

A

Duplex imaging is best

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12
Q

DDX of VV

A 
Chronic venous insufficiency
Leg pain d/t 2nd cause
-arthritis
-radiculopathy
-arterial insufficiency
congenital malformation/atresia of deep vein in adolescent patients
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13
Q

Complications of VV

A

Superfician Venous thrombosis (rare)

Bleeding (secondary to trauma)

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14
Q

Non-surgical TX for VV

A 
avoid prolonged standing
compression stockings (med-heavy) when standing
Leg elevation when possible
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15
Q

Surgical Tx for VV

A

Radio frequency ablation
Greater saphenous vein stripping
Phlebectomy
compression sclerotherapy

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16
Q

When to refer to a vascular surgeon

A

Bleeding from VV
Superficial VV
Pain
cosmetic concerns

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17
Q

define superficial venous thrombosis

A

Clot that develops in superficial vein

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18
Q

Signs and symptoms of svt?

A

indurated warm red tender cord extending along superficial vein

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19
Q

T/f SVT can develop into PE?

A

F

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20
Q

R/f of SVT?

A 
Pregnancy 
varicose veins
 thromboangitis obliterates 
trama 
systemic hypercoagulability
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21
Q

DDx for SVT?

A 
cellulits
erythema nodosum
erythema induratum
lymphangitis
DVT
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22
Q

Supportive TX for SVT

A

Supportive:

elevation, warm compress, NSAID

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23
Q

When is anticoag used in the event of an SVT?

A

only when a thrombus has developed in thigh/arm and is exteding toward the saphenofemoral junction or cephalon-axillary junction (could potentially migrate to the deep system)

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24
Q

Definition of CVI

A

condition that occurs when wall and/or valves aren’t working effectively. Blood can’t return to heart

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25
How are CVI and VV different
VV is dilation and malfunctioning CVI is when the walls and valves aren't working properly CVI is a complication of VV but not everyone with VV will develop CVI
26
CVI is mc in _____ than _____
females than males
27
Causes of CVI
``` Secondary to DVT Hx of leg trauma VV Pelvic tumor Vaslcular malformation ```
28
with CVI the ______ ______ are either thickened or scarred, or functionaly inadequate. This causes abnormally high hydrostatic forces that are transmitted to the ______ and _____ of the lower leg.
Valve leaflets | subcutaneous veins and tissues
29
What secondary changes can occur from chronic edema?
fibrosis of subcu tissue and skin pigmentation of skin ulceration that are slow to heal Varicosities if d/t post-thrombotic event
30
R/f for CVI
``` DVT VV Obestiy Pregnancy inactivity smoking extended periods of sitting/standint female age over 50 ```
31
What is primary sign/symp of CVI
Progressing pitting edema of leg!!
32
What are some of the secondary symp/signs for CVI?
itching dull ache in leg worse with prolonged standing/sitting skin at ankle tight and shiny w/ brown pigment subcu tissue becomes thick and fibrous ulceration may occur near medial and lateral malleolus cellulitis
33
w/u for CVI?
US
34
TX for CVI
compression stocking-mainstay! Avoid long periods of sitting/standing intermittent elevations of leg above level of heart
35
Tx for wounds that develop as result of CVI
Ulcers-wound care specialist referral Unna's boot Once healed compression
36
Surgical tx for CVI
for pt's with chronic/recurrent ulcers | RFA (radiofrequency ablation) or laser to area of ulceration to promote healing
37
Define DVT
blood clot that develops in deep vein system, and may partially/completely block flow through the vein
38
Where are DVT's MC found?
lower extremity (but can develop elsewhere)
39
Define Virchow's Triad?
Venous stasis injury to vessel wall hypercoagulable state
40
Etiology of DVT?
Venous stasis D/t -immobilization -reduced blood flow to heart (polycythemia) Reduced flow through legs (abd. mass, pregnancy) Mechanic injury to vein wall-trauma/surgery Hyper coagulable state -genetic mutation -secondary-surgery malignancy
41
Complications of DVT
PE post thrombotic syndrome (CVI_ Phlegmasia alba dolens phlegmasia cerulea dolens
42
Defile phlegmasia alba dolens
Edema in the leg puts pressure on arteries which decreases blood flow to area-causes a white leg
43
Define phlegmasia cerulea dolens
progression of white leg-complete occulsion of not only venous system but also arterial system as well. Prognossi is very poor
44
Symptoms of DVT
often asymptomatic leg swelling leg pain unilateral leg tenderness
45
signs of DVT
unilateral pitting edema increased calf circumference calf tenderness Homan's sign
46
DDX for DVT
``` ruptured bakers cyst cellulitis lymphedema thrombophlebitis post-thrombotic syndrome trauma CVI bone neoplasm Heart failure Nephrotic syndrome cirrhosis ```
47
w/u for DVT
Well's criteria D dimer (non-specific) US MR venography (when US is non-specific and there is still a high probability)
48
what is the high risk score for well's criteria in DVT?
3 points- 75%
49
What is moderate risk score for well's criteria for DVT?
1-2 points 17%
50
What is low risk score of well's criteria for DVT?
less than 1 point 3%
51
What factor does US depend on being present to rule in DVT?
non-compressible veins
52
TX for DVT?
Preventing complications is primary Mainstay of TX: -Immediate anticoag w/ UFH, LMWH or fondaparinux followed by conversion to coumadin or thrombolytics
53
How long does a pt need to be bridged for warfarin tx?
5-10 days
54
what is coumadin INR target for pts with DVT?
2.5 (range of 2.0-3.0)
55
What is more commonly used for tx of DVT and why?
LMWH - lovenox, (vs. UFH), this is because it has a greater bioavailability and is more predictable
56
Other than LMWH and UFH what can be used for immediate anticoag?
Fondaparinux
57
What is used for long term DVT oral anticoag?
Warfarin
58
How many days does it take for warfarin to become therapeutic?
minimum of 5 days
59
what must be monitored while taking warfarin?
INR
60
What is typical starting dose of WarfarN
/5mg
61
How do thrombolytics work to tx pt with DVT?
Directly attacks the clot
62
When are thrombolytics indicated in DVT?
very select extensive DVT, of recent origin, in pt with low bleeding risk
63
When is an IVC filter indicated?
Active bleeding that contraindicates anticoag | recurrect DVT despite intensive anticoag.
64
t/f DVT is tx as an outpatient?
T
65
How long should duration of tx be for pt's with provoked DVT in arm/calf
3 months
66
How long should duration of tx be for pt's with provoked proximal leg DVT?
3-6 mos
67
How long should duration of tx be for pt's with cancer?
3-6 most of LMWH w/o warfarin and continue anticoag indefinitely unless pt become cancer free
68
How long should duration of tx be for pt's with unprovoked DVT?
Consider indefinite tx d/t high rate of recurrence
69
In patient with a genetic d/o how long should they be treated for DVT?
indefinite tx

Clin Med - Cardio Exam #2 (12 decks)

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