Venous Review ch. 26-28

Question 1

Which vein has the most valves in the lower extremity?

Answer 1

Greater saphenous vein

Question 2

What is pitting edema?

Answer 2

Indention or impression made in an extremity when compressed.
nonpitting edema: a result of Lymphedema, not a venous disease.

Question 3

What is brawny discoloration caused by?

Answer 3

The breakdown of RBCs creates a hemosiderin deposit that gives off a brownish discoloration caused by increased pressure.

Question 4

Virchow’s Triad

Answer 4

hypercoagulability, endothelial injury or trauma, venous stasis

Question 5

How is a patient tested for hypercoagulability?

Answer 5

blood test, labs and treatment would be blood thinners

Question 6

If a patient does not have a family history of DVT, no injuries or recent surgeries and their labs are normal, what could be the cause of them being positive for DVT?

Answer 6

Trousseau’s sign- hypercoagulability associated with cancer and is based on the finding of spontaneous venous thrombosis in patients with underlying malignancy

Question 7

examples of hypercoagulability

Answer 7

pregnancy, birth control, cancer, dehydration, hormone replacement therapy, Factor V Leiden, antithrombin III deficiency

Question 8

which patients should not preform the valsalva maneuver?

Answer 8

difficulty breathing, severe CAD, acute MI, or moderate to severe hypovolemia

Question 9

what are the venous sinuses in the cranium?

Answer 9

right and left transverse sinuses drain into the IJV

Question 10

Veins from distal to proximal

Answer 10

deep digital veins- metatarsal veins- deep venous arches
peroneal veins(lateral leg) and PTV (posterior) join to form the tibioperoneal trunk joins the ATV (anterior) to form the popliteal just below the knee
at the adductor canal the popliteal becomes the femoral which joins the deep femoral and becomes the common femoral becomes the external iliac just above the inguinal ligament which joins the internal iliac to become the common iliac. The left common iliac travels under the right common iliac artery to become the IVC.

Question 11

Muscular veins

Answer 11

soleal veins empty into the peroneal and PTV and the gastroc empties into the popliteal

Question 12

the confluence of the common iliac vein and the IVC forms at what level

Answer 12

the 5th lumbar vertebrae

Question 13

perforating veins form communications between

Answer 13

the superficial to deep veins

Question 14

perforating veins

Answer 14

posterior arch vein, cockett’s (calf), boyd’s (knee) and dodd’s (distal thigh)
have at least one valve

Question 15

What percentage of femoral veins are bifed?

Answer 15

30%

Question 16

posterior arch vein importance

Answer 16

communication with three of the perforators in the ankle, important fact in the development of venous ulcers

Question 17

inner layer of a vein

Answer 17

tunica intima, a single layer of endothelial cells

Question 18

middle layer of a vein

Answer 18

tunica media, a thick layer of smooth muscles and collagenous fiber

Question 19

outer layer of a vein

Answer 19

tunica adventitia, a thin fibrous layer surrounding elastic tissue containing the vasa vasorum

Question 20

number of valves: GSV

Answer 20

12, mostly below the knee

Question 21

of valves: SSV

Answer 21

6-12

Question 22

of valves: perforators

Answer 22

each contain 1 sometimes up to 3

Question 23

of valves: infrapopliteal

Answer 23

7-12

Question 24

of valves: popliteal and femoral veins

Answer 24

1-3 valves

Question 25

of valves: external iliac vein

Answer 25

contains valves approximately 25% of the time

Question 26

of valves: CFV

Answer 26

1

Question 27

of valves: IJV

Answer 27

1

Question 28

of valves: axillary vein

Answer 28

1

Question 29

of valves: cephalic

Answer 29

variable in distal segment

Question 30

of valves: basilic vein

Answer 30

variable in distal segment

Question 31

veins without valves

Answer 31

soleal sinuses, external iliac (contains valves 25% of the time), internal iliac veins, CIV, IVC, subclavian, innominate, SVC

Question 32

GSV carries what percentage of venous blood in the leg?

Answer 32

15%, 8% double systems and 25% noncontinous

Question 33

what percentage of the population has SSV that enter above the popliteal vein or join the giacomini vein?

Answer 33

20-30%

Question 34

What type of pressure determines the cross sectional shape of a vein?

Answer 34

transmural pressure

Question 35

dumbbell shape vs. circular cross sectional shape

relationship of pressure vs. resistance

Answer 35

high transmural pressure with less resistance occurs in the circular cross sectional shape
low transmural pressure with more resistance occurs in the dumbbell shape

Question 36

Hydrostatic pressure

Answer 36

in a supine individual HP is 0mmhg, standing HP at the ankles is 100mmhg
weight of a column of blood

Question 37

if standing for a long period of time, what affect does it have on lower veins?

Answer 37

increase transmural pressure distally, increase venous distention, increase venous pooling, decrease in capillary perfusion, decrease in venous return and decrease in cardiac output, hypotension

Question 38

Normal effects of muscle pump

Answer 38

with competent valves there will be a decrease in venous pressure and pooling and an increase in venous return and cardiac output

Question 39

effects of muscle pump with incompetent valves

Answer 39

increase in venous pressure and pooling and decrease in venous return and cardiac output

Question 40

During muscle contraction

Answer 40

contraction of the calf muscles forces blood cephalad toward the heart when it relaxes blood moves from the superficial veins to the deep system

Question 41

what happens during valvular incompetence?

Answer 41

control of blood flow is deficient, blood travels both antegrade and retrograde

Question 42

during muscle relaxation

Answer 42

very low pressure is created in the deep system and blood flows from the superficial to deep system
this process reduces peripheral venous pressure

Question 43

What occurs during inspiration?

Answer 43

diaphragm descends during inspiration, intrathoracic pressure decreases and intraabdominal pressure increases minimizing blood flow to the lower extremities but increasing blood flow to the head, neck, and arms

Question 44

What occurs during expiration?

Answer 44

intrathoracic pressure increases and intraabdominal pressure decreases
increasing blood flow to the lower extremities but decreasing blood flow to the upper extremities

Question 45

acute signs and symptoms of a DVT

Answer 45

swelling, pain, warmth, erythema (redness)

Question 46

scoring for probability of a DVT

Answer 46

active cancer within 6 months 1
paralysis, paresis or immobilization of lower extremities 1
recently bedridden for > 3 days or major surgery within 4 weeks 1
localized tenderness along the distribution of the deep veins 1
entire leg swollen 1
calf swelling > 3 cm compared to contralateral leg 1
pitting edema 1
collateral superficial veins 1
alternative diagnosis as likely or more likely than DVT -2

Question 47

differential diagnosis in patients with a suspected DVT

Answer 47

muscle strain, direct injury to the leg, muscle tear, baker’s cyst, cellulitis, lymphangitis, heart failure, extrinsic compression, or complications of chronic venous insufficieny

Question 48

patients with chronic venous insufficiency represent with

Answer 48

swelling, heaviness, discoloration or ulcerations, varicosities

Question 49

Venous stasis

Answer 49

bedrest or immobility, hypotension, extrinsic compression, MI, congestive heart failure, COPD, obesity, pregnancy, previous DVT, paraplegia, surgery

Question 50

congenital venous disease

Answer 50

avalvular (valveless vein), incompetent valves, arteriovenous malformations

Question 51

venous ulcers

Answer 51

near medial and lateral malleolus
mild to severe pain
shallow, irregular appearance
venous ooze
stasis changes: brawny discoloration, varicosities present, or lipodermatosclerosis

Question 52

arterial ulcers

Answer 52

location is near the tibial area or toes, bony prominences
severe pain
deep regular shape
little bleeding
Trophic changes: shiny skin, thickened toenails, loss of hair