Peripheral Venous Disease and Lymphatic Disease - Exam 3

Question 1

Combination of progressive _____ and _____ is the hallmark of chronic venous disease

Answer 1

venous reflux

venous hypertension

Question 2

What are varicose veins due to? What are the 3 contributing factors?

Answer 2

high venous pressure

postpartum women
prolonged standing
heavy lifting

Question 3

______ venous valve does not close appropriately leading to backward blood flow into lower extremities

Answer 3

venous reflux

Question 4

________ increased venous pressure as a result of reflux

Answer 4

venous hypertension

Question 5

______ vein and its tributaries may be affected in varicose veins. Name one additional vein

Answer 5

great saphenous

and short saphenous veins may also be affected

Question 6

Give 3 causes of secondary varicosities

Answer 6

thrombophlebitis

proximal venous occlusion

congenital or acquired AV fistulas

Question 7

What is the MC symptom of varicose veins? give one additional symptom

Answer 7

dull, aching, heaviness of legs following a period of standing

itching

Question 8

Is s/s severity correlated with extent of varicose veins dz?

Answer 8

Symptom severity is not correlated with the number and size of the varicosities

Some patients may have no pain but numerous varicosities

Question 9

What can varicose veins progress to?

Answer 9

Long standing varicose veins may progress to chronic venous insufficiency

Associated with the development of ankle edema, brownish skin hyperpigmentation, and chronic skin induration or fibrosis

Question 10

What is the dx testing needed in varicose veins?

Answer 10

No diagnostic testing is needed

would need duplex US if planning for therapy

Question 11

What is the non-sx tx for varicose veins?

Answer 11

compression stockings (20–30 mm Hg pressure)

leg elevation, especially at night

Question 12

What is the pt education with regards to varicose veins?

Answer 12

worn while awake and taken off at night

prefer the stockings that go up past the thigh

Question 13

What are the sx therapy options for varicose veins? Which one is the last resort?

Answer 13

Sclerotherapy

Endovenous Laser Therapy (EVLA)

Endovenous Radiofrequency Ablation (EVRFA)

Vein stripping is last resort

Question 14

**What are the complications for sclerotherapy?

Answer 14

Complications such as phlebitis, tissue necrosis, or infection may occur

Question 15

** What are the complications of Endovenous Laser Therapy (EVLA)?

Answer 15

Could result in heat-induced thrombosis, requiring prolonged anticoagulation

Question 16

chronic venous insufficiency is a severe manifestation of ______. What is the MC etiology? ______ is a complicating factor

Answer 16

venous hypertension

prior deep venous thrombophlebitis

obesity

Question 17

What is the etiology of chronic venous insufficiency? Chronic thrombus/scarring causes ______, worsening the problem

Answer 17

valve leaflets do not close because they are thickened and scarred (post-thrombotic syndrome) or are functionally inadequate due to vein dilation

proximal venous obstruction

Question 18

following proximal venous obstruction, ______ ensues leading to blood back up in the lower leg/foot. The leg develops _______ and an abnormally ______ is transmitted to the subcutaneous veins and tissues of the lower leg
The result is _____

Answer 18

venous reflux

venous hypertension

high hydrostatic force

edema

Question 19

What is the primary symptom of chronic venous insufficiency? What does the skin look like? secondary ____ can occur

Answer 19

progressive pitting edema of the lower leg

Stasis dermatitis, taut, shiny skin at the ankle due to edema, hemosiderin staining, can develop ulcers, secondary cellulitis and eventually relative fixation of the ankle joint secondary to tissue fibrosis

lymphedema

Question 20

Skin induration
Increased pigmentation
Swelling
Redness
“Inverted champagne bottle” or “bowling pin” appearance

What am I?
This is a type of _____

Answer 20

Lipodermatosclerosis

panniculitis

Question 21

**“Inverted champagne bottle” or “bowling pin” appearance should instantly think ______

Answer 21

Lipodermatosclerosis

Question 22

What is this? Describe it in words

Answer 22

Atrophie Blanche

Star-shaped or polyangular, ivory-white depressed atrophic plaques
Prominent red dots within the scar due to enlarged capillary blood vessels
Surrounding hyperpigmentatio

Question 23

What is this?

Answer 23

stasis dermatitis

Question 24

What is this?

Answer 24

stasis dermatitis

Question 25

What is this?

Answer 25

hemosiderin staining

Question 26

What is this?

Answer 26

lipodermatosclerosis

Question 27

What is the dx testing needed in chronic venous insufficiency? What is the pt is planning therapy?

Answer 27

nothing! duplex US

Question 28

What is the management for Chronic Venous Insufficiency? What is used in refractory cases?

Answer 28

compression stockings 20-30mm hg pressure pneumatic compression

Question 29

What is superficial venous thrombophlebitis? What is the MC cause?

Answer 29

Defined as inflammation of a superficial vein (think infection) MC a result of a recent venous catheter placement (IV)

Question 29

What is an Unna boot? What is the goal? What is the major challenge when using?

Answer 29

paste gauze compression dressing provides both compression and topical therapy compliance!! have to be changed weekly!!

Question 29

**What is the pt education for compression stockings?

Answer 29

Avoidance of long periods of sitting or standing Intermittent elevations of the involved leg Sleeping with the legs elevated **only wear during waking hours and need to remove them at night

Question 30

Besides IV placement, what are some additional causes of Superficial Venous Thrombophlebitis? Where do they commonly occur?

Answer 30

Varicose veins Spontaneous in pregnant or postpartum women Trauma Hypercoagulable states lower extremities Typical pt from lecture: think pregnant women who has an IV

Question 31

What is the presentation of Superficial Venous Thrombophlebitis? **describe the timing. ** What vein is commonly involved?

Answer 31

Localized redness, induration, and tenderness along a superficial vein **spontaneous **most commonly involves the great saphenous vein

Question 32

in Superficial Venous Thrombophlebitis, a _______ may be present for several weeks, even after initial inflammatory reaction is past

Answer 32

palpable cord

Question 33

What are some complications of Superficial Venous Thrombophlebitis?

Answer 33

can extend into deep venous system hyperpigmentation over the affected vein persistent, firm nodule at the site of the affected vein conversion to suppurative thrombophlebitis

Question 34

What 3 things can suppurative thrombophlebitis lead to?

Answer 34

Metastatic abscess formation Septicemia Septic emboli

Question 35

What is the dx needed in Superficial Venous Thrombophlebitis? What 2 things do you need to consider?

Answer 35

clinical dx, no testing is required! WBC may be elevated due to inflammation or infection venous doppler US: if it involves the proximal lower extremity or pt is a mixed picture aka concerned about a possible DVT

Question 36

What is the tx for mild, localized Superficial Venous Thrombophlebitis?

Answer 36

mild analgesics, such as aspirin or NSAIDs, and the use of some type of elastic support usually are sufficient continue ADLs as normal

Question 37

What is the tx for more severe, larger Superficial Venous Thrombophlebitis? When would you need to add on anticoag?

Answer 37

elevate the extremity and apply massive, hot, wet compresses 5 cm or longer → prophylactic dose Fondaparinux (Arixtra), LMWH, or Rivaroxaban (Xarelto) x 45 days OR Rapidly progressing disease or extension into deep system → full dose anticoagulation

Question 38

What is the tx for sepsis due to Superficial Venous Thrombophlebitis?

Answer 38

Vancomycin 15mg/kb Q12 hrs PLUS Ceftriaxone 1g Q24 hrs empirically Urgent treatment with Heparin or Arixtra

Question 39

What is Lymphangitis? What is the underlying cause? What are the 2 MC pathogens?

Answer 39

Infectious or noninfectious inflammation of the lymphatic channels MC develops after cutaneous inoculation of microorganisms that invade the lymphatic vessels and spread toward the regional lymph nodes Often caused by hemolytic streptococci or S. aureus

Question 40

What is nodular lymphangitis? Name 6 causes

Answer 40

painful or painless nodular subcutaneous swellings along the course of the lymphatic channels Sporothrix schenckii, Nocardia (most often N. brasiliensis), Mycobacterium marinum, leishmaniasis, tularemia, and systemic mycoses

Question 41

What are the common cancers that lead to Lymphangitis?

Answer 41

Breast, lung, stomach, pancreas, rectal, and prostate cancers are the most common tumors

Question 42

_____ is the infectious cause in dog and cat bites that can lead to lymphangitis

Answer 42

Pasteurella multocida

Question 43

_______ can contaminate wounds that occur in freshwater and can lead to lymphangitis

Answer 43

Aeromonas hydrophila

Question 44

** _______ filarial nematode that is a major cause of acute lymphangitis worldwide; leads to a chronic Filariasis resulting in subsequent lymphedema with thickening of skin and subcutaneous tissue

Answer 44

Wuchereria bancrofti

Question 45

A history of abrasion or trauma distal to the site of infection Fever, chills, myalgias, and malaise may be reported, especially in children Nausea, anorexia, and headache may also be present erythematous and irregular linear streaks What am I? What direction does it tend to spread?

Answer 45

lymphangitis extending from the primary infection site toward draining regional nodes

Question 46

What lab must be obtained in lymphagitis?

Answer 46

CBC w/ diff and blood cultures must be obtained

Question 47

What is the tx for lymphangitis? What do you need to cover for? When would you consider sx?

Answer 47

-Dicloxacillin, Cephalexin, Cefazolin, Cefuroxime, Ceftriaxone, Clindamycin, Nafcillin, Trimethoprim and sulfamethoxazole (TMP/SMZ) are all good options -analgesics/NSAIDs for pain -hot, moist compresses -elevate and immobilize affected areas covering for GABHS Nodular lymphangitis often require surgical intervention

Question 48

What are the 2 different types of lymphedema? What does each mean?

Answer 48

Primary form and secondary form primary: congenital hypoplastic or hyperplastic proximal or distal lymphatics Pelvic or lumbar lymph channel and node obstruction present when the disease is extensive and progressive secondary: involves inflammatory or mechanical lymphatic obstruction from trauma, regional lymph node resection/irradiation, or malignant disease or filariasis. May occur following surgical removal of the lymph nodes in the groin or axilla

Question 49

________ can occur in both form of lymphedema and leads to incompetence of the valve system, poor lymphatic fluid flow, and results in progressive stasis of a protein-rich fluid. What does it result in?

Answer 49

Secondary dilation of the lymphatics Can result in episodes of acute and chronic inflammation, worsening the edema

Question 50

Painless limb hypertrophy Markedly thickened and fibrotic skin and subcutaneous tissue Pt typically w/o ulceration, varicosities, or stasis pigmentation What am I? How do you dx?

Answer 50

lymphedema clincial dx: can use MRI to confirm no lymphatic or proximal obstructing masses

Question 51

What is the tx for lymphedema? What is RARELY helpful and should NOT be used in lymphedema?

Answer 51

No cure for lymphedema! Treatment is aimed at controlling edema and restoring patient function leg elevation compression stockings massages refer to wound care goody hygiene to reduce chances of infection **DO NOT USE DIURETICS!! not helpful