Vascular - Testing consider, pt hx, mechanisms of disease & physical exam - Ch 26

swelling and pooling is generally related to venous or arterial issue

venous

elevation of limb helps in arterial or venous issues

venous

limb being ‘down’ helps with arterial or venous issues

arterial

signs of acute deep venous thrombosis

swelling, pain, erythema (skin redness), warmth

why are acute DVT’s more dangerous

they are not solidly adhered to wall and may emboli

what are signs of chronic DVT

swelling, erythema, heaviness/aching, discoloration or ulcers, varicosities

why do ulcers happen

pooling of blood causes skin to breadown from inside out

what is cobblestone appearance related to

cellulitis

what is virchow’s triad

the 3 risk factors DVT is based on - trauma, venous stasis, hypercoagulability

what are two types of trauma to vessel

intrinsic (catheter, IV drugs, PICC), extrinsic (result of accident)

what may cause venous stasis

bed ridden, heart issues, hypotension, COPD, obesity, prenancy, previous DVT

what may be the cause of hypercoagulability

pregnancy, cancer, hormones taken, genetic

what makes up thrombosis

intralumen RBC’s trapped in fibrin web

where is thrombosis most common

valves, soleal sinuses

what is paget schroetters syndrome

intense repetitive activity of upper extremity (Stallone bulging veins), could be cause of thrombosis

what is may-thurner syndrome

common left iliac vein compression from right iliac artery, could be cause of thrombosis

what is nutcracker syndrome

compression of LRV as it courses between Ao and SMA (blood flow backs into kidney)

incompetent valves allow blood to move —-

antegrade and retrograde

does valvular incompetence increase or decrease venous pressure

increases, creating venous hypertension

what is a common location for valvular incompetence

in gaiter zone

what are signs of gaiter zone valvular incompetence

brawny discoloration of skin (due to RBC breakdown), ulcerations

what is most common renal mass in adult and causes thrombosis of renal vein as well as being the most common cause of IVC tumor

renal cell carcinoma

what are primary vericose veins

dilated veins secondary to valvular incompetence of superfiical system; superficial valves not working, deep system normal

what are secondary vericose veins

dilated veins caused by incompetence of superficial system; superficial and deep system not intact

where are venous ulcers found

near medial and lateral malleolus (ankle bone); shallow and irregular shape

where are arterial ulcers found

toes, tibial area, bony prominences - deep and “punched out” shape

what are skin changes seen w/DVTs

brawny discoloration, lipodermatosclerosis, phlegmasia alba dolens (palor), phlegmasia cerulean dolens (cyanosis)

what is lipodermatosclerosis

thickening and hardening of skin usually w/chronic venous insufficiency