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Physical Diagnosis: PVD
Terms in this set (37)
pain on exertion
PAD is found in _____-____% of adults
What vessel is localized to the buttock/hip?
What vessel is localized to the thigh?
Common femoral, or aortoiliac a.
What vessel is localized to the upper calf?
What vessel is localized to the lower calf?
What vessels are localized to the foot?
Tibial or peroneal a.
Describe an acute arterial occlusion
Acute loss of blood flow to anatomic area
May be embolic, thrombotic or traumatic
Symptoms vary depending on anatomic region involved
What are some common symptoms of acute arterial occlusion?
Abrupt onset of Sx...."6 P's":
What's the difference between Raynaud's disease versus Raynaud's phenomenon?
The disease is primary, and the phenomenon is associated with another disorder, ie. RA, lupus...
-Inflammation and thrombus of the superficial veins of the extremities, mostly lower.
-Can be spontaneous or from vascular insult, IV, trauma...
-Superficial hardening, erythema and tenderness of vessel
-Treatment usually elevation, pain control and warm compress
-Thrombus of the deep (larger) veins, typically of the lower extremities but can be upper extremities or pelvic veins.
-Can be from trauma or spontaneous. Eval. Risk factors
Usually edema of affected extremity, pain, redness, +/- fever
Treatment usually anticoagulants and treat underlying conditions.
-Our PE is unreliable with this disorder
Chronic Venous Insufficiency most commonly follows a..
What are some symptoms of chronic venous insufficiency?
Darkening skin discoloration
Ulcer formation- infection
What is the tx for chronic venous insufficiency?
Avoid prolonged standing
Another name for thrombophlebitis obliterans is...
Progressive injury of the small and medium arteries and veins of the hands and feet.
From inflammation and thrombosis of the small vessels
Strongly associated to tobacco use, mostly smoking but can be smokeless as well.
What are the symptoms of thrombophelbitis obliterans?
Decreased blood flow leads to pain
Dec. hair growth
Ulcerations and gangrene leading to amputation
What is the treatment for thrombophlebitis obliterans?
Ischemic injury from increased pressure in body/muscular compartment
Increased pressure compromises capillary flow leading to increased edema leading to more pressure causing decreased outflow of venous and lymphatic fluid leading to more pressure, vicious cycle.
What are some causes of compartment syndrome?
Tibial or forearm Fx
Prolonged limb compression
IV drug injection
What are the signs and symptoms of compartment syndrome?
Pain out of proportion to exam
Pressure of area/skin
emergent fasciotomy is a surgical treatment for
Inflammation and/or infection of the lymph vessels- Usually GAS
Usually indicating infection in the anatomical region served by the vessel. Likely history of skin injury
What are some symptoms of lymphagitis/adenitis?
Erythema of the area
What is the tx for lymphangitis/adenitis?
What are the most frequently palpable lymph nodes?
axillary nodes, they are usually palpable because they drain from 3 areas: Pectoral, Subscapular, Lateral
Drains ulnar forearm and ulnar hand, including 5th, 4th and ulnar aspect of 3rd fingers
Drain into axillary nodes
The remainder of the arm is drained by the axillary nodes directly.
Superficial inguinal nodes
Drains superficial low abd, buttock, ext. genitalia (not testes), anal, perianal, and lower vaginal.
Drains distribution following the great saph. v.
Lesions of the lower lat leg, will not elicit palpable LAN.
what characteristics of a lymph node may raise your suspicion for cancer?
>1cm, fixed, clumped
If you are measuring the calf for edema where should you measure?
10 cm below the tibial tuberosity
Describe the pulse grading system
0- Absent, unable to palpate pulse
1+- Diminished, weaker than expected
2+- Brisk, expected (normal)
When palpating for edema, hold down for 5 seconds in what locations?
Over the dorsal feet, posterior to medial malleoli and anterior tibias (shins) bilaterally
You suspect a pt has a DVT? Should you massage the area?
NO, you don't want to dislodge the thrombus
Place patient prone and while leg is extended, passively dorsiflex the foot to elicit pain in the calf with DVT
This is not specific or sensitive to DVT but commonly encountered clinically
This test makes sure the ulnar artery is sufficient so that the radial artery can be used for a blood draw
How do you interpret ABI findings?
>0.90-1.30 = Normal
<0.89->0.60 = Mild PAD
<0.59->0.40 = Moderate PAD
<0.39 = Severe PAD
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