Ch. 19 - Venous Disorders

Pathophysiology Exam 2

What is a venous disorder?

A condition that impairs the normal return of blood through the veins back to the heart

What is the primary function of veins?

To return deoxygenated blood from the body to the heart

How do veins prevent the back flow of blood?

One-way valves inside the veins prevent blood from flowing backward

Which blood vessels have one-way valves?

Veins

Why are the veins in the legs especially susceptible to disease?

They must return blood to the heart against gravity

What is venous insufficiency?

A condition in which veins cannot efficiently return blood to the heart because the valves are damaged or weakened

What happens when venous valves fail?

Blood pool in the veins, increasing venous pressure

What is chronic venous insufficiency (CVI)?

Long-term impaired venous return caused by incompetent venous valves

What causes chronic venous insufficiency?

Damaged venous valves, previous DVT, prolonged standing, obesity, pregnancy, and aging

What are common signs and symptoms of chronic venous insufficiency?

Leg swelling, aching, heaviness, varicose veins, skin discoloration, and venous ulcers

Why does edema occur with chronic venous insufficiency?

Increased venous pressure forces fluid out of the blood vessels into surrounding tissues

What skin color changes are commonly seen with chronic venous insufficiency?

Brown or reddish-brown discoloration caused by hemosiderin deposition

What is hemosiderin?

An iron-containing pigment that accumulates in tissues after red blood cells break down

Where do venous stasis ulcers most commonly occur?

Around the medial malleolus (inside of the ankle)

Why do venous ulcers develop?

Poor venous return decreased oxygen and nutrient delivery to tissues, leading to skin breakdown

What do venous ulcers typically look like?

Shallow, irregularly shaped ulcers with moderate to heavy drainage

What is a varicose vein?

An enlarged, twisted superficial vein caused by valve failure

What symptoms are commonly associated with varicose veins?

Aching, heaviness, itching, swelling, and visible enlarged veins

What factors increase the risk of varicose veins?

Pregnancy, obesity, prolonged standing, aging, female sex, and family history

What is primary treatment for chronic venous insufficiency?

Compression therapy

Why do compression stockings help chronic venous insufficiency?

They improve venous return and reduce edema

Besides compression stockings, what lifestyle changes help treat chronic venous insufficiency?

Leg elevation, walking, regular exercise, weight loss if appropriate, and avoiding prolonged standing or sitting

What is deep vein thrombosis (DVT)?

Formation of a blood clot in a deep vein, most commonly in the lower extremity

Why is DVT dangerous?

Part of the clot can break off and travel to the lungs, causing a pulmonary embolism

Which veins are most commonly affected by DVT?

The deep veins of the legs

What is the most common cause of pulmonary embolism?

A deep vein thrombosis

What is Virchow’s triad?

The three major factors that increase the risk of thrombus formation: venous stasis, endothelial injury, and hypercoaguability

What is a venous stasis?

Slowing or pooling of blood within the veins

What causes venous stasis?

Immobility, prolonged bed rest, long-distance travel, paralysis, or heart failure

Why does immobility increase the risk of DVT?

Lack of muscle contraction decreased venous return, allowing blood to pool and increasing the likelihood of clot formation

What is endothelial injury?

Damage to the inner lining of a blood vessel that promotes blood clot formation

What can cause endothelial injury?

Surgery, trauma, IV catheters, inflammation, smoking, and previous vascular injury

What is hypercoagulability?

A condition in which the blood has an increased tendency to clot

What conditions can cause hypercoagulability?

Cancer, pregnancy, oral contraceptives, inherited clotting disorders, hormone therapy, and certain autoimmune disorders

Name the three components of Virchow’s triad?

Venous stasis, endothelial injury, and hypercoagulabiity

Which patients are at greatest risk for developing a DVT?

Patients who are immobile, postoperative, pregnant, have cancer, obesity, previous DVT, inherited clotting disorders, pr prolonged travel

Why does surgery increase the risk of DVT?

Surgery can cause endothelial injury and often results in temporary immobility

Why does pregnancy increase the risk of DVT?

Pregnancy increases l=clotting factors and decreases venous return from the legs

Why does cancer increase the risk of DVT?

Many cancers create a hyper coagulable state by increasing clotting activity

Why are the classic signs and symptoms of DVT?

Unilateral leg swelling, pain, warmth, redness, tenderness, and calf discomfort

Why is swelling usually unilateral in DVT?

Because the clot typically blocks venous return in only one affected limb

What causes leg pain in DVT?

Inflammation and increased pressure caused by the obstructing clot

What is the most serious complication of DVT?

Pulmonary embolism (PE)

What is a pulmonary embolism (PE)?

A blockage of a pulmonary artery by a blood clot that usually originates from a DVT

What happens when a clot travels from the leg to the lungs?

It becomes a pulmonary embolism and obstructs blood flow through the pulmonary circulation

What are common signs and symptoms of a pulmonary embolism?

Sudden shortness of breath, pleuritic chest pain, tachypnea, tachycardia, cough, anxiety, and possible hemoptysis

What is hemoptysis?

Coughing up blood

Why does a pulmonary embolism cause shortness of breath?

Blood flor to part of the lung is blocked, reducing oxygen exchange

Why can a large pulmonary embolism be fatal?

It can severely reduce blood flow through th lungs, leading to right ventricular strain, shock, and cardiac arrest

What diagnostic test is commonly used to diagnose DVT?

Duplex venous ultrasound

What blood test may help evaluate a suspected DVT?

D-dimer

What does an elevated D-dimer suggest?

Increased clot formation and breakdown, though it is not specific for DVT

What imaging study is commonly used to diagnose a pulmonary embolism?

CT pulmonary angiography (CTPA)

What is the primary treatment for DVT?

Anticoagulation therapy

Why are anticoagulants given for DVT?

They prevent clot extension and reduce the risk of pulmonary embolism but do not directly dissolve existing clots

What medications are commonly used as anticoagulants?

Heparin, low-molecular-weight heparin, warfarin, and direct oral anticoagulants (DOACs)

What is the purpose of compression stockings after a DVT?

To reduce swelling and help prevent post-thrombosis syndrome when appropriate

What lifestyle measures can help prevent DVT?

Early ambulation, leg exercises, hydration, avoiding prolonged immobility, and compression devices for high-risk patients

Why is early ambulation encouraged after surgery?

Walking activates the calf muscles, improving venous return and reducing venous stasis

Why are sequential compression devices (SCDs) used in hospitalized patients?

They intermittently compress the legs to improve venous blood flow and decrease the risk of DVT

What is the difference between peripheral artery disease and (PAD) and chronic venous insufficiency (CVI)?

PAD is caused by decreased arterial blood flow to tissues, while CVI is caused by impaired venous return and blood pooling

Which disease commonly causes cool, pale extremities?

PAD

Which disease commonly causes warm, swollen legs with brown skin discoloration?

Chronic venous insufficiency

Where do arterial ulcers usually occur?

On the toes, feet, or pressure points, they are typically painful with well defined edges

Where do venous ulcers usually occur?

Around the medial malleolus (inside of the ankle), they are typically shallow with irregular borders and drainage

What is post-thrombotic syndrome?

Chronic pain, swelling, and skin changes that develop after a DVT because the vein and its valves have been permanently damaged

Why does post-thrombotic syndrome occur?

Damage to venous valves causes chronic venous hypertension and poor blood return

What are common symptoms of post-thrombotic syndrome?

Chronic leg swelling, aching, heaviness, skin discoloration, and venous ulcers

What is the most effective way to prevent a DVT in hospitalized patients?

Early ambulation, anticoagulants when indicated, and sequential compression devices (SCDs)

Why should hospitalized patients avoid prolonged bed rest?

Immobility increased venous stasis, one of the major causes of DVT

Why should patients on long airplane flights move their legs frequently?

Muscle contractions improve venous return and reduce venous stasis

Why is smoking a risk factor for DVT?

Smoking damages blood vessels and promotes hypercoagulability

Why does obesity increase DVT risk?

Obesity decreases venous return and increases inflammation and clotting risk

Which leg is more commonly affected by DVT?

The left leg is affected slightly more often because of its venous anatomy

Can a patient have a DVT without symptoms?

Yes, some DVTs are asymptomatic until a pulmonary embolism occurs

What is the most life-threatening complication of a DVT?

Pulmonary embolism

What is the priority assessment when a patient with DVT suddenly develops chest pain and shortness of breath?

Suspect a pulmonary embolism and seek immediate medical evaluation

What is the most common source of a pulmonary embolism?

A thrombus originating in the deep veins of the lower extremities

Why are anticoagulants called “blood thinners” even though they do not actually thin the blood?

They reduce the blood’s ability to clot, preventing new clots and clot extension

Do anticoagulants dissolve existing clots?

No, they prevent clot growth while the body’s natural fibrinolytic system gradually breaks down the clot

What patient teaching is important for someone taking anticoagulants?

Watch for signs of bleeding, take medications exactly as prescribed, and notify providers before procedures or starting new medications

What are signs of excessive bleeding while taking anticoagulants?

Easy bruising, nosebleeds, bleeding gums, blood in urine or stool, prolonged bleeding, or coughing/vomiting blood

Why is hydration important in DVT prevention?

Dehydration increases blood viscosity, making clot formation more likely

Why is walking encouraged for patients with chronic venous insufficiency?

Calf muscle contractions act as a “muscle pump” that pushes venous blood back toward the heart

What is the calf muscle pump?

Contraction of the calf muscles compresses deep veins and promotes venous return

Why is leg elevation recommended for chronic venous insufficiency?

Elevating the legs decreases venous pressure and reduces edema

Why are compression stockings effective in chronic venous insufficiency?

They improve venous blood flow, reduce swelling, and decrease venous pooling

What is the major difference between arterial and venous circulation?

Arteries carry blood away from the heart under high pressure, while veins return blood to the heart under lower pressure and rely on valves and muscle contraction

What is the key pathophysiologic problem in chronic venous insufficiency?

Incompetent venous valves lead to venous hypertension, blood pooling, edema, and tissue damage

What is the main thing to remember from ch. 19?

DVT results from clot formation due to virchows triad, while chronic venous insufficiency results from valve failure causing blood poling, edema, skin changes, and venous ulcers