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yr4s1: pm5 > wk 2- peripheral vascular disorders > Flashcards

wk 2- peripheral vascular disorders Flashcards

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1
Q

what is the lymphatic system and how does it operate

A

vessels that move fluid from interstital spaces to the venous circulation via hydrostatic pressure, lymphangion and muscle contractions, arterial pulsation.
Theres no central pump

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2
Q

functions of lymphatic system

A
  1. returns filtrate and proteins from the tissues to the blood circulation - 8 litres/day
  2. absorbs fat and fat soluable vitamins
  3. immune defence and surveillance - lymph nodes
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3
Q

what is the revised starling principle

A

hydrostatic pressure drives filtration (fluid into the interstital space)
but theres no venous reabsorption, it is the lymphatic system that returns it to the venous circulation

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4
Q

what system is responsible for returning all of the interstitial fluid?

A

lymphatic system

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5
Q

whats a watershed

A

division of lymph territoriees in the body

deep lymphatic system do not cross these but superficial can

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6
Q

what is a lymphosome

A

area of superficial skin that drain to a specific lymph node basin

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7
Q

what lymphosomes drains the legs

A

popliteal - posterior calf
superficial inguinal (inferior, superior and lateral) other areas of the legs

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8
Q

what active and passive forces move lymphatics

A

active- lymphangion contractions

passive- arterial pulsation, contraction of muscles, respiration, negative pressure in veins, external compression (stockings/massage), lymph formation

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9
Q

lymphatic transport is dependent on

A

-lymphatic load (hyperaemia, hypoproteinemia influences this)
-lymph time volume
-transport capacity

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10
Q

what are the underlying causes of oedema in the legs

A
  1. filtration increased beyond capacity of lymmphatics- unable to drain/filtrate excessive fluid
  2. filtration is normal but lymphatic system isnt functioning to clear enough- unable to filtrate due to impaired lymphatics
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11
Q

chronic limb swelling (oedema) makes patients more prone to

A
  1. wounds
  2. infection
  3. loss of function
  4. pain
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12
Q

Ddx of leg oedema if unilateral and acute onset

A

-DVT
-ruptured bakers cyst
-cellulitis
-compartment syndrome
-ruptured leg muscle

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13
Q

how to differentiate different Dx

A
  1. site of swelling (unilateral/symmetrical?)
  2. pattern of severity (better or worse after things?)
  3. symptoms
  4. onset (acute or chronic)
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14
Q

Dx of unilateral and chronic leg oedema

A

-primary venous disease / insufficency
-lymphoedema
-iliac vein compression

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15
Q

dx of bilateral acute leg oedema

A

-bilateral DVT
-medications
-bilateral infection
-heart failure, liver/renal failure

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16
Q

dx of chronic bilateral leg oedema

A

-Chronic venous disease
-obesity
-pulmonary hypertension
-medications
-lymphoedema
-heart/renal/liver failure
-hypothyroidism
-lipedema

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17
Q

drugs that cause leg swelling

A

calcium channel blockers
beta blockers
corticosteroids
sex hormones
chemotherapy treatments
NSAIDs

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18
Q

what is lipedema

A

excess fat in the lower body

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19
Q

primary lymphoedema

A

congenital
caused by alterations in genes that are responsible for lymphatic system

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20
Q

secondary lymphoedema

A

due to damage/injury to the lymphatic system

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21
Q

clinical assessments for lymphoedema

A
  1. pitting test- pressure to area for 60 seconds to see how easy the fluid is to move
  2. stemmers sign
  3. skin assessment
  4. photographs
  5. limb volume measurement
  6. interntional society of lymphology staging
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22
Q

skin assessment what are you observing in lymphoedema

A
  1. fibrosis (stasis of interstital fluid leads to cell changes)
  2. hyperkeratosis
  3. dry/flaky skin (inflammation leads to overgrowth of skin)
  4. skin folds (thickening of epidermis and reduction in elasticity)
  5. lymphorrhea - fluid leaking through skin
  6. papillomatosis (warty appearance)
    7.infection/cellulitis (low immunity)
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23
Q

stemmers sign

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A

inability to pick up the skin between the 2nd and 3rd met

24
Q

international society of lymphology

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A

stage 0-impaired lymphatics but swelling not evident
stage 1- fluid that subsides with limb elevation, pitting oedem
stage 2- limb elevation alone rarely subsides fluid, may not be pitting
stage 3- non pitting oedema due to fibrosis, skin changes occur

25
circumference measurements
pt to stand, measure from the ground to 2cm above the medial mall and mark it as starting point pt to sit with straight leg, mark limb up the medial side every 4cm to below the popliteal fossa for swelling below the knee, or continue to the gluteal crease for above the knee with the leg in a relaxed position, measure each points circumference
26
what difference in limb volume measurement indicates lymphoedema
a difference of 10% or 200ml volume between limbs to diagnose cant be used in bilateral oedema or if there is limb dominance
27
what is the gold standard for testing limb volume measurement and other equipment you can use
water displacement but rarely used or -perometry -bioimpedance spectroscopy
28
what difference is indicative of oedema on a bioimpednce spectroscopy
L-dex score of greater than 6.5
29
imaging assessments you can conduct to diagnose lymphoedema
1. ICG 2.lymphoscintigraphy 3. MRI 4. US
30
ICG
dye is used to visualise superficial lymphatic vessels, it helps to diagnoses, stages and aids management
31
lymphoscintigraphy
visulaises depper lymphatics and used in determining suitability for lymph node transfer
32
MRI
looks at tissue changes (fibrosis and fatty tissue disposited) and helps determine what treatment method is most appropriate (liposuction, etc)
33
US
used to assess tissue changes
34
lymphoedema management 2 options for conservative and 3 for surgery
1. conservative -decongestive therapy (manual drainage massage by professional, layered compression bandaging, eduation) -maintenance therapy (self massage, compression garment, exercise, skin care, education) 2. surgical -lymph node transfer -liposuction -lymphovenous anastomosis
35
does surgery cure lymphoedema
no
36
complex lymphoedema therapy involves what
2 phases- both conservative treatment options 1. intensive phase - reduces volume of limb -compressive therapy -layered bandages -manual lymphatic drainage massage -skin care -exercise 2. maintenance phase -maintains volume -compression therapy - garments -lymphatic drainage massage -skin care -exercise -compression pumps
37
PROM for lymphoedema
lymphoedema symptoms intensity and distress survery- lower limb- quality of life lower extremeity functional scale- functional impact
38
lipedema
condition that occurs in women causing disproportionate distribution of fat in lower body
39
signs and symptoms of lipedema
bilateral fatty legs with normal feet pain and tenderness on pressure bruising thin skin minimal pitting oedema stemmers negative
40
CVD risk factors (non modifiable and modifiable)
age- 45 for men, 55 for women sex-male, post menopausal women genetic family history - CVD ethnicity- aboriginal, torres strait, pacific islander, middle eastern hypertension dyslipidaemia diabetes/hyperglycemia inactvity smoking poor nutrition alcohol consumption obesity
41
diabetic over 80 is what risk for CVD
HIGH
42
how often do garment need to be replaced
every 3-6months
43
considerations with compression therapy
1. is compression contraindicated (infection, PAD below 0.5, severe neuropathy, uncontrolled heart failure, poor skin integrity/ulceration) 2. what class is appropriate for the patients diagnosis 3. are there any barriers to donning and doffing- grip strength, mobility 4. are there any barriers to compression compliance (weather, education, appearance, religious, exercise)
44
what doppler probe is appropriate for measuring ABI for compression therapy
4MHZ better than 8MHZ due to oedema and skin changes make it hard to detect blood flow
45
can you use TBI instead of ABI
yes, if ABI is too painful
46
ABI <0.5
compression contraindicated. refer to gp for vascular referral.
47
class 1 compression, what is it and who is it good for
20-30mmHg ABI range of 0.5-0.8: mod PAD and/or -heavy, tired legs -prevention of thrombosis/embolism/DVT -superficial varicose veins (without oedema/pregnancy)
48
class 2 compression
30-40mmHg -varicose veins with mild oedema -after varicose surgery treatment -DVT -after healing Venous ulcers in CVI -severe varicose veins in pregnancy
49
compression 3
40-50mmHg -venous leg ulcer (active/recurrent) -lymphoedema, lipoedema (reversible)
50
compression 4
50-60mmHg -irreversible lymphoedema
51
class 3/4 should be prescribed by who
medical specialists
52
different styles of compression
1. calf 2.thigh 3. panty 4. panty malema 5. closed toe/open toe
53
skin care in compression/oedema
1. wash daily - using pH neurtal soap or natural soap and dry thoroughly 2. skin folds are clean and dry 3. monitor areas for skin breaks 4. apply emollients
54
barriers to compliance
heat education of condition (irreversible manifestations) donning and doffing aesthetics restriction of footwear choice and showering
55
what type of stockings are appropriate for summer
thin, cotton, open toed stockings
56
local providers for OTC compression
1. morris medical 2. super pharmacy plus
57
how to measure for compression
measure while pt is standing, barefoot and in the morning. 1. narrowest part of ankle, just above mall 2. calf, widest point 3. thigh, widest point 4. length - for knee high from floor to knee fold. for thigh high from floor to top of thigh (glute fold)

yr4s1: pm5 (12 decks)

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