Notes in peripheral vascular system

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Published	09/08/2024	EXTREMITY {{c3::PAIN}}, {{c3::SWELLING}}, {{c3::WEAKNESS}},  {{c3::NUMBNESS}} {{c2::TEMPERATURE}} Changes, and {{c2::SKIN}}&n…
Published	09/08/2024	risk factors of PVD are (3) {{c1::smoking, diabetes, hypertension}}
Published	09/08/2024	{{c1::Atherosclerosis}} is most common bucket of PVD: inflammatory condition secondary to lipid deposition into the intima, leading to fibrous ca…
Published	09/08/2024	{{c1::Intima}}: single, continuous lining of endothelial cells. Both pro- and anti- thrombotic enzymes. Vasoconstrictor and dilator enzyme synthesis.
Published	09/08/2024	{{c1::Media}}: smooth muscle cells that aid in BP accommodation
Published	09/08/2024	{{c1::Adventitia}}: connective tissue, nerve fibers
Published	09/08/2024	{{c1::Valves}}: located only in veins, prevent regurgitation and backward flow, skeletal muscle acts as pumps
Published	09/08/2024	In regards to race, the CHS found African Americans to have an odds ratio of {{c1::2.12}} for PAD compared to Non-Hispanic whites when …
Published	09/08/2024	A socioeconomic survey study found patients with lower poverty-income ratios (PIR) to have a nearly {{c1::2}} fold increase in the risk…
Published	09/08/2024	pathophysiology of peripheral arterial disease: atherosclerosis & stenosis → {{c2::ischemia}} → {{c1::claudication}}
Published	09/08/2024	{{c1::Neurogenic}} claudication: pain as a result from compression of the spinal nerves in the lumbar spine (spinal stenosis).
Published	09/08/2024	{{c1::Vascular}} claudication: pain as a results from progressive or acute occlusion in peripheral vasculature.
Published	09/08/2024	when concerned about microvasculature ask about vision changes. Concerned for {{c1::blurry}} vision, {{c2::floaters}}, {{c3::cotton wool}} spots, and …
Published	09/08/2024	when concerned about microvasculature, ask about changes in urination and edema. Pts can have impaired {{c1::filtration}} and {{c2::excretion of waste…
Published	09/08/2024	when concerned about microvasculature, ask about changes in sensation & weakness. Pts can have defect in {{c1::sensory}}, {{c1::motor}}, and …
Published	09/08/2024	peripheral {{c1::venous}} disease is most common in lower extremities
Published	09/08/2024	peripheral venous disease is typically {{c1::bi}}lateral over {{c1::uni}}lateral
Published	09/08/2024	peripheral venous disease is typically more {{c2::painful}} than arterial
Published	09/08/2024	pain of peripheral venous disease is typically localized/{{c2::sharp}}, general/{{c3::dull}}, and improves with {{c1::elevation}}
Published	09/08/2024	ulcerations and wounds of peripheral venous disease is typically {{c1::wet}}, {{c1::oozing}}, {{c1::painful}}, and at the {{c2::medial malleolus …
Published	09/08/2024	{{c4::peripheral venous disease}} typically has {{c1::dry}}, {{c1::scaling}}, or {{c1::thickening}} skin
Published	09/08/2024	{{c1::hydrostatic}}pressure: near arterial end & forces fluid from capillary beds into interstitial space
Published	09/08/2024	•{{c1::Oncotic }} pressure: near venous end & pulls fluid back into vasculature
Published	09/08/2024	{{c1::Thrombophlebitis}}: inflammation or swelling, most commonly caused by a clot. Consider location - superficial vs deep.
Published	09/08/2024	chronic venous insufficiency lis caused by {{c1::incompetent valves}} which leads to {{c2::stasis }}
Published	09/08/2024	PVD may lead to {{c1::DVT}}s
Published	09/08/2024	{{c4::Trendelenburg}} test: evaluates competency of {{c1::communicating veins}} and {{c1::saphenous system}}the test evaluates two…
Published	09/08/2024	Postural color changes: assess for chronic {{c1::arterial}} insufficiencyWhile supine, raise legs to 60 degrees to obtain {{c2::maximal pall…
Published	09/08/2024	Ankle Brachial Index (ABI): measures systolic pressure using both {{c3::doppler US}} and {{c2::BP cuff}} to assess {{c1::arte…
Published	09/08/2024	{{c1::Infection}} lymph nodes will be tender, non-discrete borders, rubbery
Published	09/08/2024	{{c1::Malignant}} lymph nodes will be non-tender (usually), discrete borders, hard and nonmobile (fixed), asymmetrical locations
Published	09/08/2024	If new enlarged node is found, you must examine associated areas of the body such as the (4) {{c1::primary site, all associated nodes, liver, spleen}}
Published	09/08/2024	a 3+ pulse is {{c1::bounding}}
Published	09/08/2024	a 2+ pulse is {{c1::brisk, expected, normal}}
Published	09/08/2024	a 1+ pulse is {{c1::diminised, weaker than expected}}
Published	09/08/2024	a 0 pulse is {{c1::absent, unable to palpate}}
Published	09/08/2024	Dependent {{c1::Rubor }} is usually caused by dilation of the arteries in the foot as a compensatory response to poor arterial blood flow. It is…
Published	09/08/2024	•{{c1::vasculitis}} •Fever, headache, fatigue, rash ({{c2::petechiae}}), weight loss, pain, swelling, organ specific symptoms.
Published	09/08/2024	•{{c1::Lymphedema}} •Early in course, edema is {{c2::soft}} but over times becomes {{c3::hard}}/indurated.  NON-{{c4::PITTING}}.  Lacks {{c5…
Published	09/08/2024	•{{c1::Deep Venous Thrombosis}} •Unilateral swelling and often painful. Most commonly in calf. Travel or Hypercoagulable state?
Published	09/08/2024	•{{c1::chronic Venous Insufficiency}} •Edema is {{c2::soft}} w/ {{c2::pitting}}. Skin is {{c3::thickened}} & ‘{{c3::brawny}}’ (+/- {{c4::ulcers}})…
Published	09/08/2024	•{{c1::Varicose Veins}} •Tortuous, superficial veins. •Often asymptomatic .{{c2:: Itching}} or {{c2::dull}} ache that is worse after prolonged sittin…
Published	09/08/2024	{{c1::•Heart Failure}}•Swelling may be in {{c2::lower}} extremities and {{c2::abdomen}} or {{c2::lung}}. Accompanied by {{c3::fatigue}} or increasing …
Published	09/08/2024	‘{{c2::Ruddy}}’ color suggests {{c1::arterial changes}}
Published	09/08/2024	Venous ulcers are commonly on {{c1::medial}} aspect and {{c2::wet}}/”l{{c2::eaky}}”
Published	09/08/2024	Arterial ulcers are commonly on {{c1::lateral}} aspect and {{c2::dry}} (poor circulation)
Published	09/08/2024	{{c1::Acute Arterial Occlusion}} is caused by embolic or thrombotic occlusion, often with pre-existing PAD
Published	09/08/2024	Coldness of distal extremity, Tender at site of occlusion, and numbness in an acute onset are clinical presentations of {{c1::acute arterial…
Published	09/08/2024	the 6 P's:{{c2::Paresthesias}}{{c2::Pain (unilateral, distal, sudden onset)}}{{c3::Pallor}}{{c3::Pulselessness (diminished distal pulses suggests arte…
Published	09/08/2024	a big risk factor of buerger's disease is {{c1::tobacco use}}
Published	09/08/2024	{{c1::buerger's disease}} is caused by episodic {{c2::inflammation}} / {{c2::swelling}} of small and medium arteries/veins which l…
Published	09/08/2024	buerger's disease not a result of an {{c1::astherosclerotic }} cause
Published	09/08/2024	a positive allen test and positive angiogram for arterial changes would be expected in {{c1::buerger's disease }}
Published	09/08/2024	{{c1::raynaud's disease}} can be primary ({{c2::benign}}), or secondary ({{c2::connective tissue}} disease, such as scleroderma, SLE, sjorgrens)
Published	09/08/2024	{{c1::Raynaud’s Disease}} is episodic {{c2::vasospastic}} attacks triggered by {{c3::cold}} temperature / {{c3::emotional}} s…
Published	09/08/2024	Contractions of the very small vessels in distal limbs may lead to diminished blood supply (overcompensation) in {{c1::raynoud's disease }}
Published	09/08/2024	clinical presentation of {{c1::raynaud's disease}} involves the digits that become {{c2::pallor}}, {{c2::parestesia}}, {{c2::cold}}. This is…
Published	09/08/2024	{{c1::raynaud's}} is a clinical diagnosis of exclusion; may order labs (ESR, antibodies) or other diagnostics (ultrasound, EMG) to distinguish between…
Published	09/08/2024	Treatment of {{c1::raynaud's}}: {{c2::prevention}} is key, avoid {{c3::triggers}} and stress modification, warm clothing, exe…
Published	09/08/2024	During attack of raynaud's: {{c1::warm}} affected body area {{c2::gradually}} and engage {{c3::relaxation}} techniques
Published	09/08/2024	{{c1::Chronic Venous Insufficiency}} risk factors are:Sedentary lifestyleObesity*PMHx is important here
Published	09/08/2024	{{c1::Chronic Venous Insufficiency}} is caused by venous {{c2::HTN}}, incompetent {{c2::valves}}, and {{c2::Stasis dermatitis…
Published	09/08/2024	Treatment of {{c1::chronic venous insufficiency:}}Smoking cessationLeg elevationCompression stockingsWeight loss and increased activity levelsSki…
Published	09/08/2024	Congestive Heart Failure can be {{c1::acute}} vs {{c1::chronic }}
Published	09/08/2024	{{c1::Congestive Heart Failure}} clinical presentation is:FatigueDyspnea (especially with laying flat or exertion)Pitting edemaSwelling may be in…
Published	09/08/2024	To remember the three pathophysiological components of thrombus formation, think: “HE'S Virchow”: H-{{c1::Hypercoagulability}}, E-…
Published	09/08/2024	Travel history and Hypercoagulable state are important for {{c1::DVT}}
Published	09/08/2024	DVTs most commonly occur in the {{c1::calf}}
Published	09/08/2024	{{c2::DVT's}} clinical presentation is:Virchow’s Triad:StasisVascular injuryHypercoagulable state{{c1::Unilateral}} swellingPain / tenderness+/- dyspn…
Published	09/08/2024	{{c1::Lymphangitis}} is acute and typically follows an infection
Published	09/08/2024	Acute bacterial infection spreading up lymphatic channel causes {{c1::lymphangitis}}
Published	09/08/2024	{{c1::lymphangitis}} clinical presentation has {{c3::fever}}, {{c4::pain}}/{{c4::tenderness}}, red {{c2::streaks}}, {{c2::adeno}}pathy
Published	09/08/2024	PMHx of surgery, mass, or illness is important for {{c1::lymphedema}}
Published	09/08/2024	{{c1::lymphedema}} is the result of decreased lymphatic {{c2::drainage}} caused by destruction of lymphatic {{c2::network}} f…
Published	09/08/2024	lymphedema can also be a primary {{c1::congenital}} issue
Published	09/08/2024	clinical presentation of  {{c1::lympedema}} is:UnilateralSoft, non-pitting Edema (can become firm over time)“Heavy”No ulcerations, pigment change…
Published	09/08/2024	there is no cure for {{c1::lymphedema}}. treatment involves supportive care such as exercise, massage, gravity, compressive (clothing or pneumati…
Published	09/08/2024	{{c1::Varicose Veins}} is caused by aging and prolonged standing
Published	09/08/2024	Superior Vena Cava Syndrome is associated with {{c1::malignancy}}
Published	09/08/2024	Risk factors of PAD: {{c1::smoking, diabetes, dyslipidemia, HTN, CAD Hx}}
Published	09/08/2024	{{c1::Superior Vena Cava Syndrome}} is caused by an {{c2::obstruction}} of SVC, most often due to a {{c3::growing tumor}} com…
Published	09/08/2024	{{c1::Superior vena cava syndrome}} clinical presentation involves:Facial / neck / arm edemaDyspneaCoughDizziness
Published	09/08/2024	the clinical presentation of {{c1::Varicose Veins}}:Tortuous superficial veins+/- tenderRelieved with elevation Often asymptomaticItching or dull…
Published	09/08/2024	{{c1::Claudication}}: A pain of vascular origin that is reliably induced by {{c2::exercise}} and relieved or reduced by {{c3::rest}}. The pain is…
Published	09/08/2024	{{c1::starling law}} is about a balance of pushes and pulls with pressure
Published	09/08/2024	{{c1::Capillary bed}} maintains equilibrium between {{c2::vasculature}} and {{c2::interstitial spaces }}
Published	09/08/2024	{{c1::Lymphatic capillaries}} remove majority of filtered {{c2::fluid}} and {{c2::protein}} from capillary beds to return it to {{c3::systemic}} circu…
Published	09/08/2024	{{c1::Arterioles:}} primarily responsible for resistance to blood flow. Compare anatomy to veins that are “weaker” in general (high vs. low press…
Published	09/08/2024	{{c1::Capillary Beds}}: Endothelial lining only (no media) allows for rapid diffusion of O2 and CO2 between membranes
Published	09/08/2024	{{c1::Lymphatic system}}: Maintains fluid homeostasis, immune function, fat absorption, etc.
Published	09/08/2024	extremities will be cool toward the distal end if there is poor {{c1::arterial}} blood flow
Published	09/08/2024	if superficial veins are noted when assessing the skin for texture palpate for {{c2::tenderness}} as this could indicate a {{c1::DVT}} or {{c1::thromb…
Published	09/08/2024	discrepencies in measurement between extremities when assessing edema can indicate a {{c1::DVT}}
Published	09/08/2024	peripheral vascular disease is a marker for morbidity and mortality of {{c1::CVD}}
Published	09/08/2024	the four categories of PVD are:{{c1::hardening and narrowing}}{{c1::dysplasia & remodeling}}{{c2::clotting & occlusion}}{{c2::inflammation}}
Published	09/08/2024	{{c1::arteriosclerosis}} and {{c1::atherosclerosis}} fall under the category of hardening and narrowing
Published	09/08/2024	{{c1::fibromuscular dysplasia}}, {{c1::AV malformations}}, and {{c1::varicose veins}} fall under the category of dysplasia and remodeling
Published	09/08/2024	{{c1::PAD/CVI}}, {{c1::thromboembolism}}, and {{c1::lymphedema}} fall under the category {{c2::clotting}} and {{c2::occlusion}}
Published	09/08/2024	{{c1::vasculitis}}, {{c1::thrombophlebitis}}, and {{c1::lymphangitis}} fall under the category {{c2::inflammation}}
Published	09/08/2024	CVI stand for {{c1::chronic venous insufficieny}}
Published	09/08/2024	the {{c1::rutherford}} classification is used to classify PAD
Published	09/08/2024	{{c1::peripheral artery disease}} involves stenotic, occlusive, and aneurysmal disease
Published	09/08/2024	Microvasculature: Changes in small arterioles impair {{c1::circulation}} → {{c2::ischemic}} changes → organ {{c3::damage}}
Published	09/08/2024	don't forget to consider {{c1::ED}} when being concerned for microvasculature
Published	09/08/2024	People with {{c1::diabetes}} should be screened annually for dilated eye exam, urine albumin/creatine, BMP, foot/wound check, monofilament testing to …
Published	09/08/2024	peripheral venous disease progresses from {{c2::venous stasis}} → {{c3::inflammation}} → {{c1::thrombosis}}
Published	09/08/2024	peripheral venous disease is progressive and leads to venous stasis or thrombotic complications such as {{c1::Thrombophlebitis}}, {{c1::DVT}…
Published	09/08/2024	causes of edema are excessive {{c1::vasodilation}}increased capillary {{c2::permeability}} / low plasma {{c3::albumin}} / increase…
Published	09/08/2024	in peripheral venous disease the damage that is caused leads to {{c1::incompetent valves}} which leads to blood {{c2::pooling}} and not getting back t…
Published	09/08/2024	an ABI of >1.30 is highly {{c1::calcified }}
Published	09/08/2024	an ABI of >0.9 is considered {{c1::normal}}
Published	09/08/2024	an ABI of <0.89 to >0.60 is considered {{c1::mild and PAD}}
Published	09/08/2024	an ABI of <0.59 to >0.40 is considered {{c1::moderate}}
Published	09/08/2024	an ABI of <0.39 is considered {{c1::severe and peripheral atherosclerotic disease}}
Published	09/08/2024	{{c1::gangrene}} is dead tissue caused by an infection or lack of blood
Published	09/08/2024	{{c1::buerger's disease}} is also known as Thromboangitis Obliterans
Published	09/08/2024	{{c6::buerger's disease}} is commonly seen with severe pain in {{c1::limbs}} with use, associated {{c2::color/skin}} changes,&nbsp…
Published	09/08/2024	both raynaud's and buerger's are episodic, however {{c1::raynaud's}} is NOT painful and {{c1::buerger's}} is.
Published	09/08/2024	ulcers of chronic venous insufficiency are typically on the {{c1::medial}} side and {{c1::wet}}
Published	09/08/2024	chornic venous insufficiency is often relate to {{c1::overweight}}, {{c1::sedentary}} lifestyle, chronic {{c1::fluid}} overload.
Published	09/08/2024	{{c1::peripheral arterial disease}} is a result of supply-demand mismatch and involves episodic muscular ischemia ({{c2::claudication}}), {{c3::progre…
Published	09/08/2024	peripheral arterial disease includes the aorta, visceral branches, and extremities BUT excludes the {{c1::coronary}} and {{c1::cer…
Published	09/08/2024	Microvascular arterial disease: Pts with diabetes, changes in small arterioles impair circulation to {{c2::nerves}} and {{c2::skin…
Published	09/08/2024	{{c1::pale/ruddy}} color suggests arterial changes
Published	09/08/2024	diagnosis of peripheral arterial disease is an ABI <0.{{c1::9}} and an {{c1::US}}
Published	09/08/2024	{{c1::Paresthesia}} is an abnormal sensation (e.g., tingling, prickling, or "pins and needles") caused by damage to peripheral nerves.
Published	09/08/2024	peripheral {{c1::venous}} disease typically has dry, scaling skin while peripheral {{c1::arterial}} disease has thin, smooth, shiny skin
Published	09/08/2024	peripheral {{c1::arterial}} disease typically has unilateral > bilateral while peripheral {{c1::venous}} typically has bilateral >unilateral&nbs…
Published	09/08/2024	peripheral venous disease AND peripheral arterial disease are both {{c1::progressive}}
Published	09/08/2024	the ulcerations of peripheral {{c1::venous}} disease are wet, oozing, painful, and at the medial malleolus while the ulcerations in peripheral {{c1::a…
Published	09/08/2024	reduced pulses and claudication are associated with peripheral {{c1::arterial}} disease while peripheral edema and varicose veins are associated with …
Published	09/08/2024	peripheral {{c1::arterial}} disease typically has lack of hair that is going distal to proximal while peripheral {{c1::venous}} disease typically has …
Published	09/08/2024	pain is associated with peripheral {{c1::venous}} disease while cold temperature is associated with peripheral {{c1::arterial}} disease
Published	09/08/2024	‘{{c2::Brawny}}’ color along ankles or feet suggests {{c1::venous stasis}}
Published	09/08/2024	lower extremity Temperature: Warmth = {{c1::good perfusion}} ; Cold = {{c1::arterial occlusion}}
Published	09/08/2024	lower extremity {{c1::tenderness}} = Thrombophlebitis, clot, cellulitis, wounds
Published	09/08/2024	lower {{c1::edema}} may cause difficulty palpating pulses
Published	09/08/2024	diminished pulses in the lower extremity could indicate {{c1::arterial disease}}
Published	09/08/2024	chronic venous insufficiency is most common in {{c1::lower}} extremities
Published	09/08/2024	{{c1::Poikilothermia}} is an impaired ability to regulate body temperature. Often used to describe acutely ischemic, cool limbs.
Published	09/08/2024	pain localization: Buttock/hip → {{c1::aortoiliac}}
Published	09/08/2024	pain localization: Erectile dysfunction →{{c1:: iliac-pudendal}}
Published	09/08/2024	pain localization: Thigh → {{c1::common femoral}} or {{c1::aortoiliac}}
Published	09/08/2024	pain localization: upper calf → {{c1::popliteal}}
Published	09/08/2024	pain localization: lower calf and foot → {{c1::tibial}} or {{c1::peroneal}}
Published	09/08/2024	AAA most commonly located between {{c1::renal}} and {{c1::iliac}} arteries (pulsatile abdominal mass)
Published	09/08/2024	Peripheral {{c1::arterial}} disease is a problem with getting oxygenated (arterial) blood down to the extremities vs peripheral {{c1::venous}} disease…
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