Patho3 - Peripheral Vascular Disease

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Condition characterized by chronic inflammation of the aorta, occlusions of peripheral & coronary arteries (loss of pulse), shortened or stenosed carotids

Takayashu's syndrome

Population, gender, & age most affected by Takayashu's syndrome

-Women 20-50 years old
-Mexican or Asian descent

What to worry about when intubating a person with rheumatoid arthritis

Is arytenoid cartilage stiff or fused (vocal problems)
=if so then you may need to place a smaller (6.0) tube

2 events that occur as a result of vasculitis

-inflammatory response
-thrombus formation

Treatment for Takayashu's syndrome (x2)

-Steroids (suppress immune)
-Anticoagulation

Condition characterized by progressive inflammation & clotting of small/medium arteries & veins of hands & feet, legs

Thromboangiitis obliterans (Beurger's disease)

Another name for thromboangiitis obliterans

Beurger's disease

This condition is worsened by smoking, cold, & trauma

Thromboangiitis obliterans (Beurger's disease)

Condition associated with migratory thrombophlebitis & intermittent claudication

Thromboangiitis obliterans (Beurger's disease)

(Migratory thrombophlebitis: inflammation related to a clot that occurs repeatedly in different locations)
(Intermittent claudication: pain in leg muscles on exercise d/t lack of blood supply.)

3 methods to reduce symptoms of Thromboangiitis obliterans (Beurger's disease) (x3)

-Stop smoking
-Avoid trauma
-Avoid cold

Precautions to take for pts with Thromboangiitis obliterans (Beurger's disease) (x5)

-No radial a-line (femoral or axial ok)
-Keep warm
-Care to prevent trauma to digits
-↑ FiO₂
-Avoid epinephrine in regional

This should be done before placing a radial art line & how to properly report results

Allen's test
(Ulnar is dominant artery)
-Say "allen's test performed, good collateral blood flow"

This autoimmune condition causes formation of granulomas (then infiltration by necrotizing granulomas) near inflamed blood vessels of the entire respiratory tract, kidneys, and tips of the digits

Wegener's Granulomatosis

Define granuloma

a collection immune cell tissue that work to encase the inflammation, injury, or infection

This vasculitis condition can cause significant bleeding in the nose & airway, and even pulmonary airways

Wegener's Granulomatosis (granulomas bleed like crazy)

Significance of hemoptysis if pt has Wegener's Granulomatosis

-Means granulomas have reached the pulmonary circulation & are bursting into the pulmonary airways

Effects of Wegener's granulomatosis on the larynx (x2)

-Narrowing of the glottic opening
-Destructive lesions of the epiglottis common

Most common cause of death among those with Wegener's granulomatosis

-Progressive renal failure

Treatment of Wegener's granulomatosis (x2) & 2 significant side-effects of this treatment

1) Cyclophosphamide
-leukopenia & hemolytic anemia
-↓ activity of plasma cholinesterases (variable response to succs)
2) Corticosteroids

Condition characterized by inflammation & narrowing of the temporal arteries

Temporal arteritis

Treatment for temporal arteritis

high-dose steroids

Condition caused by accute inflammation & necrosis of medium arteries (kidneys, GI & liver infarcts, MI, peripheral nerve damage & gangrene)

Polyarteritis Nodosa

Treatment for Polyarteritis Nodosa

Steroids

Condition caused by autoimmune attack of the small blood vessels (capillaries)

Henoch-Schonlein purpura

Who tends to get Henoch-Schonlein purpura

Children

Treatment for Henoch-Schonlein purpura & expected results & risk of flare-ups

Steroids
-usually resolves in several weeks but can relapse
-it can cause kidney damage

Organ systems at risk with a Henoch-Schonlein purpura attack (x3)

-Kidneys
-GI tract
-Joints

Why would you worry about a person's lungs if they experience Raynaud's phenomena

Reynaud's is an over-reaction to sympathetic stimuli causing excessive vasoconstriction. These people tend to also have over-reactive pulmonary vasculature & pulmonary HTN

Does Raynaud's occur more in men or women?

Female incidence is greater

Treatment of Raynaud's (x3)

-Avoid cold, etc.
-Stop smoking
-Sympathectomy

What inhalation agent would be avoided for a person with Raynaud's?

Nitrous

(Reynaud's is an over-reaction to sympathetic stimuli causing excessive vasoconstriction. These people tend to also have over-reactive pulmonary vasculature & pulmonary HTN. N₂O will worsen pulmonary HTN)

What condition is associated with a narrowing or occlusion of both internal carotid arteries?

Moyamoya disease

(on x-ray the collateral vessels appear as a "puff of smoke"=moyamoya in Japanese)

How do different age groups with Moyamoya Disease present?

Children (TIAs)
Adults (intracerebral hemorrhage)

Treatment for Moyamoya disease (x3)

-ASA
-Cerebral vasodilators
-Surgical intervention

What condition is associated with a sudden-onset of loss of pulses, severe pain (ischemic), muscle weakness, & demarcation of color changes?

Acute arterial occlusive disease

Pain level achievable for acute arterial occlusive disease

If you can get them to a 4/10 then that's probably as good as you can get them without putting them completely out.

How is acute arterial occlusive disease treated & how is the damage repaired

Usually treated by interventional radiology
-Surgery to remove necrotic tissue

NMB + surgical repair for lost muscle, etc. from acute arterial occlusive disease =

Maybe bad because surgeon wants to use bovie to stimulate muscle tissue to see what is still working

Phlebothrombosis vs thrombophlebitis

Phlebothrombosis: venous thrombus formation without prior inflammation (associated with sluggish flow [bedrest])

Thrombophlebitis: venous thrombus formation from inflammatory changes

Which induction agent carries a high risk if given in an infiltrated IV?

Etomidate

(has very high osmolarity & is very damaging. ~30% propelyne glycol [antifreeze])

Important consideration when placing a central line if someone has an IVC filter

Don't advance the wire beyond 20cm!
(or wire will loop onto IVC filter = bad!)

3 areas of the body attacked by necrotizing granulomas by Wegener's granulomatosis

-Upper & lower respiratory tract
-Kidneys
-tips of digits

Areas affected by thromboangiitis obliterans (Beurger's disease) (x3)

-hands
-feet
-legs (intermittent claudication & migratory thrombophlebitis)

Gender that is more prone to Beurger's disease (thromboangiitis obliterans)

Male (smoking is big contributor)

What should be avoided during surgery for acute arterial occlusive disease?

succs (hyperkalemic arrest)

What are the renal effects of Takayshu's syndrome? (x3)

-renal artery stenosis
-renal HTN
-renal dysfunction

What initiates the deposition of plaque in vessel walls in PVD?

Caused by an inflammatory-mediated reaction
(how the body reacts to injury)

Pulmonary effects of Takayashu's syndrome (x2)

-Pulm HTN
-V/Q mismatch

Pulmonary effects of Wegener's granulomatosis

-V/Q mismatch (occlusion from granulomas)

CV effects of Takayashu's syndrome secondary to inflammation of the aorta (x4)

-occlusions of peripheral arteries
-CAD
-cardiac valve dysfunction
-conduction defects

Wegener's granulomatosis effects on nervous system (x2)

-CVA
-Peripheral neuropathy

What can temporal arterities lead to?

Sudden unilateral blindness d/t occlusive arteritis of the opthalmic artery

What causes chronic arterial occlusive disease?

atherosclerosis

How does wegener's granulomatosis affect circulation?

infarctions to the tips of the digits

Condition associated with hyperreactivity to vasoconstrictive stimuli

Raynaud's phenomena

Gender that is more prone to raynaud's phenomena

Female

What is the most common cause of acute arterial occlusive disease

Embolus from the heart (atrial appendage most common)

How is thromboangiitis obliterans treated?

-Stop smoking
-Avoid cold & trauma

How does Wegener's granulomatosis affect the kidneys? (x4)

-destruction of renal glomeruli
-hematuria
-azotemia
-renal failure

What are the CNS effects of Takayashu's syndrome? (x5)

-CVA
-Seizures
-Syncope
-Visual disturbances
-Vertigo

3 diseases associated with Raynaud's phenomena

-SLE
-scleroderma
-HTN

How is temporal arteritis treated?

-High-dose steroids
-Temporal artery biopsy

What is thromboangiitis obliterans?

Inflammatory & occlusive disease of the arteries and veins

Why do adults with Moyamoya disease often have an intracerebral hemorrhage?

14% have aneurysms (collateral circulation)

What type of anesthetic is contraindicated for pts with thromboangiitis obliterans?

Regionals with epi

Where do granulomas form in Wegener's granulomatosis

In the vicinity of inflamed vessels

What is the main symptom of temporal arteritis

unilateral HA

How is venous thrombus diagnosed? (x2)

US
Spiral CT (hip DVTs can't be seen on US)

What is the biggest concern with Takayashu's syndrome?

Inflammation can cause occlusion of major arteries off aortic arch, can lose blood flow to carotid arteries causing stroke or loss of pulses to extremeties

What conditions often accompany Takayashu's syndrome? (x2)

Ankylosing spondylitis
RA

What is the occlusion rate afterpulling an a-line?

80%

What are the s/s of polyarteris nodosa? (x5)

-Renal issues (proteinuria, azotemia, usually no hematuria)
-MI, CVA, HTN
-Gangrene & lower bowel infarcts
-Vague aches & pains
-Petechial hemorrhage

Wegener's granulomatosis effect on the muscular system

-Skeletal muscle wasting

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