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CNIH > Vasc- pathologies and collateral circulation > Flashcards

Vasc- pathologies and collateral circulation Flashcards

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1
Q

what does phlegmsia mean?

A
  • inflammation

- used in reference to extreame cases of lower extremity DVT that cause critical limb ischemia and possible limb loss

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2
Q

Phlegmasia alba dolens (PAD) describes?

A

parient with swollen and white leg bevause of early compromise of arterial flow secondary to extensive DVT

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3
Q

What is milk leg? who does it mainly affect?

A
  • milk leg is white leg associated with Phlegmasia albe dolens
  • affects women in 3rd tri of pregnancy or post partum
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4
Q

Phlegmasia cerulea dolens is more advanced and considered a persursor for what?

A

frank venous gangrene

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5
Q

what is Phlegmasia cerulea dolens charaterized by? (3)

A
  • severe swelling
  • cyanosis
  • blue discoloration of the extremity
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6
Q

Phlegmasia alba dolens 4 clinical presentations?

A
  1. milk leg/ white leg
  2. edema and discomfort
  3. leg pale and cool
  4. diminished arterial pulse due to spasm
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7
Q

Phlegmasia cerulen dolens clinical presentation?

A
  • painful blue adema
  • pain
  • cyanosis
  • irreversible ischemia
  • necrosis
  • gangrene
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8
Q

Phlegmasia cerulen dolens vs. Phlegmasia alba dolens?

A

cerulen- affects deep veins, superficial veins, and collaterals (more severe) (medical emergency)

alba- affects deep veins only

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9
Q

Phlegmasia cerulen dolens extends into capillaries in what % of cases?

A

40-60%

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10
Q

what is trousseau’s sign?

A
  • concerns hypercoagulability associated with cancer

- based on spontaneous venous thrombosis in patients with underlying malignancy

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11
Q

When patients present with DVT and have no known risk factors, what is the underlying concern?

A

they may have an occult malignancy

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12
Q

T or F- DVT associated with malignancy tends to be much more extensive and aggressive than DVT in the nonmalignant setting?

A

true

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13
Q

clinical presentation of DVT in occult malignancy?

A

very swollen and painful extremity

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14
Q

Patients with DVT related to Trousseau’s syndrome usually clinically manifest cancer within how many years?

A

1-2 years

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15
Q

Malignancies associated with venous thrombosis typically arise in? (5)

A
  1. breast
  2. GI tract
  3. GU tract
  4. lung
  5. brain
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16
Q

SCV obstruction is difficult to diagnose due to a lack of visualization and location of clavicle so diagnosis relies on what?

A
  • secondary signs of obstruction
  • pressure fluctuation in the atrium are readily transmitted into the vein producing a pulsatile waveform
  • when pulsatility is absent SVC obstruction is present
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17
Q

many cases of SCV thrombosis involve?

A

IJV thrombosis- therefore should be part of the examination

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18
Q

if the SVC is the site of obstruction what may occur?

A
  • collateral flow in the internal mammary veins may occur (flow appears reversed)
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19
Q

What is Lemierre’s syndrome also known as?

A
  • jugular vein thrombosis
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20
Q

what is lemierres syndrome?

A
  • patient with a neck infection and enlarged lymph nodes
  • IJV compression results in thrombus formation due to stasis
  • bacteria from throat can spread to major blood vessels and poison blood stream leading to patient becoming septic
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21
Q

what is Behcet’s disease?

A
  • inflammation in blood vessels
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22
Q

what does Behcet’s disease cause?

A
  • redness
  • pain
  • swelling in arms and legs
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23
Q

Behcet’s disease in large arteries?

A
  • inflammation that can lead to complications such as aneurysms or blockage of vessel
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24
Q

Behcet’s disease can affect? (7)

A
  1. mouth
  2. genitals
  3. eyes
  4. joints
  5. digestive system
  6. brain
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25
What is the etiology of IVC thrombus? (3)
- mirrors that of DVT in general 1. wall damage 2. hypercoagulability 3. venous stasis
26
tumors associated with IVC thrombosis? (3)
- RCC, seminomas, teratomas - extends from renal vein and can propagate to the heart - can partially or completely occlude IVC
27
Less common tumors that involve IVC? (3)
- retroperitoneal leiomyosarcoma - adrenal cortical carcinoma - renal angiomyolipoma
28
what kind of compression may cause thrombosis of the IVC?
- hepatic abscess - polycystic disease - pancreatic pseudocyst - acute pancreatitis
29
How do enlarged lymph nodes correspond with thrombus in the IVC?
- they may compress the IVC in patients with chronic lymphatic leukemia and should not be confused with thrombus in the IVC
30
What is nephrotic syndrome? symptoms?
- patients with this syndrome have urinary protein losses s/s: - massive urinary protein loss - diminished levels of antithrombin III
31
Iatrogenic IVCT may be seen in?
- patients with recent history of medical care
32
Iatrogenic IVCT- Interventions that reportedly have identifiable rates of IVCT include the following? (5)
``` Hepatic transplantation Dialysis access Femoral venous catheters Pacemaker wires Vena caval filters ```
33
Vena cava filters are placed where?
- ivs just below kidneys
34
Numerous other clinical situations have been associated with IVCT including? (4)
developmental anomalies of the IVC retroperitoneal fibrosis pregnancy oral contraceptives
35
May-Thurner syndrome occurs when?
- rare | - compression of the common venous outflow tract of the left lower extremity
36
May-Thurner syndrome clinical presentation? (4)
- discomfort - swelling - pain - blood clots
37
what might cause May-Thurner syndrome?
DVT in the iliofemoral vein
38
problem in May-Thurner syndrome?
- compression of the left common iliac vein by overlying right common iliac artery
39
May-Thurner syndrome leads to?
- pooling or stasis of blood | - formation of blood clots
40
causes of leg swelling, pain, or tenderness? (8)
``` Popliteal(Baker’s) cysts-ruptured Hematoma/muscle injury Superficial thrombophlebitis Iliac nodes/pelvic masses Arteriovenous fistula Lymphedema Knee joint effusion Rt heart failure ```
41
what is Hematoma/muscle tear?
An anechoic structure between the medial gastrocnemius and the soleus muscle
42
Hematoma/muscle tear D/D?
- A hematoma caused by a gastrocnemius muscle rupture, - A hematoma caused by a plantaris tendon rupture - A ruptured Baker's cyst
43
how to make a diagnosis of a hematoma/muscle tear
- examine fluid collection in its full length | - DVT must be ruled out
44
Baker’s cyst is located?
A cyst with a 'neck' at its deepest extent, extending into the joint space between the semimembranosus tendon and the medial head of the gastrocnemius muscle
45
what is necessary for a definitive diagnosis of a baker's cyst?
- the 'neck' between the tendons is necessary for a definitive diagnosis - usually anechoic and may contain internal debris
46
what is Groin Lymphadenopathy?
The lymph nodes in the groin (femoral or inguinal lymph nodes) may swell from an injury or infection in the foot, leg, groin, or genitals
47
what is Superficial thrombophlebitis?
- inflammation is vein with thrombus
48
thrombus at the junctions are concidered a risk for PE?
- SFJ, SPJ
49
In right heart failure what might be seen?
- bilateral leg adema | - fluid in abdo, leg, feet, causing swelling
50
What is Lymphedema?
- swelling in one or more extremities that result from impaired flow of the lymphatic system
51
what is a complication of lymphedema?
cellulitis
52
what is a risk for developing secondary deep vein thrombosis of the upper extremity?
IV drug use
53
primary DVT may be caused by?
- idiopathic or caused bu effort induced activity
54
what is cellulitis?
- infectious process in soft tissue
55
clues to diagnosing cellulitis?
- tenderness - erythema - skin thickening - edema - swelling
56
cellulitis can result from?
- break in skin from trauma - surgery - bite
57
what might be seen in an abcess? (4)
Well-circumscribed fluid collections within the soft tissues Well defined walls, simple, or complex fluid Gas bubbles appear as bright reflectors May be increased vascularity within the walls of the abscess
58
most common soft tissue tumor?
lipoma
59
soft tissue tumors examples 6?
``` Lipoma-most common Fibroma Leiomyoma Desmoid tumor Neurofibroma Hemangioma ```
60
malignant masses primary and metastatic?
primary: most common - sarcoma and lymphoma - melanoma metastatic: uncommon - lymphoma - leukemia appear hypervascular
61
Flow may bypass an aortoiliac obstruction utilizing what collateral?
Subclavian artery
62
Flow may bypass an aortoiliac obstruction utilizing what collateral?
Subclavian artery
63
Some major collateral routes are most often in the? (2)
1, abdomen | 2. pelvis

CNIH (69 decks)

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