Unit 1 - Peripheral Vascular Disease Flashcards
Edema is defined as
either a generalized or local swelling in which there is an excessive amount of fluid in tissue
This can involve any of the tissues in the body, for example;
cerebral edema or pulmonary edema
Localized edema may occur as part of the body’s normal
normal response to injury or trauma in a lower limb.
Localized edema may occur as part of the body’s normal response to injury or trauma in a lower limb. This type of edema resolves when?
as the injury resolves
dependent edema
Is characterized by…?
3 causes
Characterized by being
Temporary/transient
prolonged standing,
prolonged lack of motion to stimulate venous and lymphatic fluid return
the effects of gravity
Someone may have swollen legs after standing for an unusually long period, but the swelling will abate after the legs are elevated.
When does dependent edema resolve?
when the conditions that brought it on are removed
dependent edema
Someone may have swollen legs after…
But…
Typically…
Someone may have swollen legs after standing for an unusually long period,
but the swelling will abate after the legs are elevated.
Typically, the person sleeps and the edema is gone in the morning.
Dependent edema is usually not cause for concern as…
it may be attributed to a particular set of circumstances and resolves easily
Lower limb edema that develops without a visible cause and does not resolve easily with leg elevation may be due to?
a systemic disease
5 Systemic Diseases
that can lead to lower limb edema
Cardiac Disease Heart Failure Hepatic Disease Renal Disease Inflammatory Disease Malnutrition or Starvation
Cardiac Disease Heart Failure is a condition where…
the heart no longer exerts the strength necessary to effectively return all the blood from the extremities
Cardiac Disease Heart Failure is a condition where the heart no longer exerts the strength necessary to effectively return all the blood from the extremities.
This results in…
excess pooling of blood in the lower limbs assisted by gravity
Cardiac Disease Heart Failure
Excess pooling of blood in the lower limbs assisted by gravity does what?
increases the pressure in the veins and capillaries of the legs
Cardiac Disease Heart Failure
Excess pooling of blood in the lower limbs assisted by gravity increases the pressure in the veins and capillaries of the legs.
This increased pressure…
makes it more difficult for fluid to move from the interstitial compartment into the capillaries and so it remains in the interstitial space causing edema
Hepatic or Liver Disease may effect the production of?
plasma proteins
Hepatic or Liver Disease may effect the production of plasma proteins.
These large plasma proteins do what?
provide a large part of the osmotic pressure that draws fluid from the interstitial space into the capillaries and bloodstream
Hepatic or Liver Disease may effect the production of plasma proteins.
These large plasma proteins provide a large part of the osmotic pressure that draws fluid from the interstitial space into the capillaries and bloodstream.
When the number of these proteins is decreased, what happens?
the osmotic pressure of the blood is decreased and more fluid is left behind in the interstitial space
Renal Disease results in?
fluid and electrolyte imbalances
Renal Disease results in fluid and electrolyte imbalances, particularly?
sodium retention
Renal Disease results in fluid and electrolyte imbalances, particularly sodium retention.
Sodium retention may result in? (2)
edema
excessive loss of protein from the body through proteinuria
Malnutrition or starvation results in?
inadequate protein intake
Malnutrition or starvation results in inadequate protein intake.
Inadequate protein intake will result in?
fewer plasma proteins being produced
Malnutrition or starvation could include? (2)
any malabsorption disease
such as
Celiac Disease
or
Inflammatory Bowel Disease
Inflammatory Disease may cause edema when?
example?
an immune response triggers
the release of chemical toxins,
increased local blood flow
and
influx of white blood cells mistakenly against the body’s own tissue
E.g. = RA
Inflammatory edema is usually? (4)
Red
Warm
Tender
Non-pitting
When inflammatory edema is chronic there may be evidence of?
simultaneous tissue destruction and repair
Diagnosis of the underlying systemic disease causing the edema is made by the client’s physician and may include…
bloodwork
EKG
x-rays
ultrasonography of the heart, liver, kidneys
Referral to specialists for further testing with
CT
MRI
nuclear scanning
Clinical Symptoms of Systemic Edema:
Systemic causes of edema will usually result in?
a symmetrical distribution of edema
for example; both legs, both eyes with periorbital edema, or both hands or feet
Clinical Symptoms of Systemic Edema:
Edema may? (3)
be pitting or non-pitting
be indurated
(Hardened, usually used with reference to soft tissues becoming extremely firm but not as hard as bone.)
extend from the toes to knees or start at the ankles and extend upwards
Clinical Symptoms of Systemic Edema:
Onset may be…
slow and gradual over many months
or
relatively sudden over hours, days or several weeks
Clinical Symptoms of Systemic Edema:
The more rapid the onset…
the more cause for serious concern
and
the more pressing the need for treatment
Goals and Treatments for Systemic Edema:
Goals and treatment for edema from systemic disease needs to focus on…?
edema caused by systemic disease will not resolve until the underlying cause is specifically treated.
Treatment with compression stockings does not begin until diagnosis.
accurate and timely diagnosis of the underlying cause
Goals and Treatments for Systemic Edema:
Once cause is established…?
a medical plan of treatment can be pursued by the client and doctor to treat and manage the symptoms of the underlying disease
Goals and Treatments for Systemic Edema:
Once cause is established, a medical plan of treatment can be pursued by the client and doctor to treat and manage the symptoms of the underlying disease; this will prevent…?
further complications of skin damage and/or infection
Lymphatic Disorders causing Edema
The Lymphatic System:
Describe.
lymphatic system is a web-like system of lymph capillaries, vessels, valves and nodes
that transport lymph fluid containing water, proteins, nutrients and white blood cells throughout our body tissues
Lymphatic Disorders causing Edema
The Lymphatic System is a web-like system of lymph capillaries, vessels, valves and nodes that transport lymph fluid containing water, proteins, nutrients and white blood cells throughout our body tissues.
It then…?
returns the lymph fluid to our vascular system
via
the thoracic duct into the left subclavian vein
and
the right lymphatic duct into the right subclavian vein
Lymphatic Disorders causing Edema
What is the function of the lymphatic system? (2)
to remove foreign material from our tissues after delivering fluid and nutrients to those tissues
to work with the circulatory system to absorb digested fats from the small intestine
Lymphedema etiology: (5)
anything that results in injury, destruction or blockage of the lymphatic system can lead to lymphedema by blocking or impeding the return of lymph fluid to the vascular system
injury to lymphatic vessels from trauma, surgery or radiation
chronic hereditary disease called Milroy’s disease
parasitic infection found in tropical climates called lymphatic filariasis
venous obstruction results in an increase in capillary pressure and this in turn leads to the increased production of tissue fluid
Medical Diagnosis of Lymphedema:
Usually diagnosed by?
What else may be used and why?
What is rarely used and why?
history and physical exam alone
lab tests
to exclude other systemic causes
lymphangiography
due to risk of complications
Clinical Symptoms and Complications of Lymphedema:
In the early stage?
But with time?
Eventually?
there is pitting edema that relieves with elevation
the edema becomes non-pitting and does not relieve with elevation
Eventually the swollen tissue becomes hardened and fibrotic and may have and “orange peel” appearance to the skin
Clinical Symptoms and Complications of Lymphedema:
With prolonged lymph stasis, what happens?
toxins remain in the tissue and inflammation (called lymphangitis) and infection are common complications
Lymph stasis - A stoppage or slowdown in the flow of blood or other body fluid, such as lymph.
lymphangitis
an infection of the lymph vessels that carry lymphatic fluid throughout the body
Signs of lymphangitis
the appearance of pain, warmth and red streaking along the track of the lymph vessels
There is no cure for lymphedema
Treatment is aimed at?
the prevention of complications of skin breakdown and infection
There is no cure for lymphedema
Treatment is aimed at the prevention of complications of skin breakdown and infection.
Through? (3)
reduction of swelling
containment of swelling
additional support measures
Lymphedema treatment
Reduction of swelling (2)
pneumatic extremity pumps
manual lymph drainage or complete decongestive therapy
Lymphedema treatment
Containment of swelling (3)
short stretch bandages (e.g. Comprilan)
reusable fabric devices with adjustable straps (e.g. Circ-Aid, Reid Sleeves)
custom compression garments (e.g. Jobst)
Lymphedema treatment
Additional support measures (4)
healthy diet and weight control
exercise is important in stimulating lymphatic fluid return
careful skin and nail care
drugs may be used to control infection
diuretics are rarely used
Thrombophlebitis
Deep vein thrombosis
Thrombophlebitis (throm-boe-fluh-BY-tis) is an inflammatory process that causes a blood clot to form and block one or more veins, usually in your legs. The affected vein might be near the surface of your skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT).
Deep vein thrombosis (DVT) is a blood clot (thrombus) in a deep vein, usually in the legs. Clots can form in superficial veins and in deep veins. Blood clots with inflammation in superficial veins (called superficial thrombophlebitis or phlebitis) rarely cause serious problems.
