the last part of cardiac pathology that we covered in CPD II was that of the various peripheral venous disorders. perhaps most prominent is deep vein thrombosis, which is a blood clot in the deep veins, usually in the calf muscle. one important complication of DVT is an increased risk of pulmonary emboli from the thrombus dislodging. chronic venous insufficiency is like DVT but without the thrombus (although can result from DVT damage to vessel walls), and can be ameliorated with exercise. superficial venous thrombosis is thrombus of the superficial veins most commonly caused by IV catheterization and is usually self limiting, dissolving in a couple of weeks. varicose veins are tortuous, dilated superficial veins due to incompetent valves. idiopathic telangectasias are achy dilated intracutaneous veins. arteriovenous fistula is an abnormal shunt of blood between arteries and veins that can result in swollen, warm areas over which thrills are palpable. lymphedema is the abnormal accumulation of lymph from destruction of lymph vessels. it is usually primary and affects mostly women, but can also be secondary due to surgery, trauma, chemotherapy, tumors, or infection. one important complication of lymphedema is the possibility of lymphangitis, bacterial infiltration through the skin.
questions
DVT...
1. what is deep vein thrombosis? √
2. what are the risk factors for DVT? †X
3. most dangerous complication of DVT is... √
4. what are the signs/symptoms of DVT? X√
5. what are some PE signs that might lead one to the diagnosis of DVT? †√
6. what is a Homan's sign and how does it relate to DVT? √
7. what is the imaging test used to diagnose DVT? √
8. what are the blood tests that can aid in the diagnosis of DVT? X†
9. what are the differential diagnoses for DVT? †
chronic venous insufficiency...
10. what is chronic venous insufficiency? what is it caused by? √
11. what occurs in the tissues afflicted with chronic venous insufficiency? †
12. what are the signs and symptoms of CVI? √
13. what ameliorates and aggravates CVI? √
14. what is post-phlebitic syndrome? √
15. if edema appears in CVI, is it more likely unilateral or bilateral? √
16. what is the treatment strategy for CVI patients? √
superficial venous thrombosis...
17. what is SVT?
18. what is the most common cause of SVT?
19. what is the prognosis for patients with SVT?
20. what are the PE findings for SVT?
21. SVT may look like what other condition?
22. what is the treatment strategy of SVT?
varicose veins...
23. what are varicose veins are what are they due to?
24. what are the symptoms of VV?
25. what are some complications of VV?
various venous disorders...
26. what are idiopathic telangectasias?
27. what is an arteriovenous fistula?
28. what is the result of an arteriovenous fistula?
29. what is some PE findings for arteriovenous fistulas?
30. what is lymphedema?
31. primary lymphedema is more common in...
32. secondary lymphedema is usually the result of...
33. what are the symptoms of lymphedema?
34. what is a complication of lymphedema?
answers
1. clotting of blood in a deep vein of the leg or the pelvis.
2. age, smoking, heart failure, hypercoagulability, immobility, catheters, limb trauma, obesity, etc. [old fat smoker in a wheelchair covered in cat hair has a heart attack]
3. pulmonary emboli.
4. may be asymptomatic, or pain in affected area accompanied by edema, erythema, bluish discoloration, prominence of veins.
5. pain on deep leg palpation, erythema, pitting edema, enlarged calf on one side.
6. pressing deeply on the backside of the calf- positive homan's is eliciting pain, but test is not diagnostic for DVT.
7. doppler echo.
8. elevated D-dimer, fibrinogen, bleeding times.
9. venous insufficiency, superficial phlebitis, lymphatic obstruction, cellulitis, ruptured baker's cyst, muscle/tendon tears.
10. impaired venous return without a clot. caused by DVT, valve insufficiency, decreased muscular contraction, obesity, old age.
11. hypoxia, edema, inflammation.
12. usually asymptomatic, but might feel sense of fullness, heaviness, aching, cramps, tiredness, paresthesias.
13. worse with standing and walking, better with rest and elevation (opposite of peripheral artery disease).
14. venous insufficiency that results from venous damage from DVT.
15. more often unilateral.
16. lifestyle modification, exercise! anticoagulation and compression stockings after DVT.
17. thrombosis of a superficial vein.
18. IV catherization.
19. the condition is self limiting and usually dissolves in a couple weeks.
20. hard, indurated vein, local inflammation, tenderness, erythema.
21. lymphedema.
22. warm compresses, NSAIDS, anesthetic injection.
23. dilated superficial veins in the lower extremities from incompetent valves.
24. aching, heat, fatigue, better on elevation.
25. may lead to edema, ulcerations (not common), pigmentations, eczema.
26. achy dilated intracutaneous veins.
27. abnormal shunting of blood between arteries and veins.
28. arterial or venous insufficiency, ulceration, emboli, ischemia.
29. swollen, warm area with distended veins. can feel thrill over fistula.
30. destruction of lymph vessels leading to abnormal accumulation of lymph and tissue swelling.
31. women.
32. surgery, trauma, radiation therapy, tumors, infection.
33. aching discomfort and a sense of heaviness / fullness. unilateral swelling made worse with heat.
34. lymphangitis due to bacterial infiltration through skin.
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