Term
| PHYSIOLOGY OF VENOUS SYSTEM |
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Definition
TRANSPORT BLOOD BACK TO HEART
CARRIES AWAY CELLULAR WASTE PRODUCTS
CARRIES AWAY CARBON DIOXIDE |
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Term
| DIFFERENCES BETWEEN ARTERIES & VEINS |
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Definition
VEINS ARE NOT AS STRONG AS ARTERIES
VEINS ARE THIN WALLED
VEINS COLLAPSE EASILY WITH MINIMUM PRESSURE
VEINS ARE HIGHLY COMPLIANT
VEINS ARE HIGHLY DISTENSIBLE
VEINS HAVE LOW PRESSURE STEADY FLOW STATES |
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Term
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Definition
| THE INTRALUMINAL PRESSURE IS THE PRESSURE EXERTED BY THE BLOOD WITHIN THE LUMEN OF THE VEIN. |
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Term
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Definition
| THE INTERSTITIAL PRESSURE IS THE PRESSURE EXERTED BY THE TISSUES OUTSIDE THE VEIN. |
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Term
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Definition
| THE TRANSMURAL PRESSURE REPRESENTS THE DIFFERENCE BETWEEN THE INTRALUMINAL AND INTERSTITIAL PRESSURE. THE TRANSMURAL PRESSURE DETERMINES THE CROSS SECTIONAL SHAPE OF THE VEIN. |
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Term
| FACTORS INFLUENCING VENOUS RETURN: |
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Definition
Pressure gradient
Calf muscle pump
Valves
Respiration
Gravity
Vasoconstriction |
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Term
| THE EFFECT OF PRESSURE GRADIENT IN BLOOD CIRCULATION FROM ARTERIES TO VEINS |
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Definition
PRESSURE BETWEEN ARTERIAL AND VENOUS SYSTEM DIFFERS BY 20mmHg
CAUSES BLOOD TO FLOW FROM ARTERIOLES TO VENULES |
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Term
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Definition
| HIGH PRESSURE IN THE ARTERIOLES AND LOW PRESSURE IN THE VENULES CAUSES FLOW FROM THE ARTERIOLES TO MOVE INTO THE VENULES, AND FROM THE VENULES TO THE HEART |
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Term
| WHAT CAUSES THE MOVEMENT OF BLOOD FROM DISTAL EXTREMITY TO PROXIMAL EXTREMITY |
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Definition
Contraction of soleal and gastrocnemius muscles
Contraction
Pressure from muscles squeezes blood forward
Relaxation
Potential space, blood pools, low or absent pressure |
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Term
| EXPLAIN COMPETENT AND INCOMPETENT VALVES |
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Definition
| VALVES THAT FUNCTION PROPERLY ARE TERMED COMPETENT. THEY ARE CAPABLE OF MAINTAINING UNI-DIRECTIONAL FLOW. VEINS THAT ARE DAMAGED AND NOT WORKING PROPERLY ARE CALLED INCOMPETENT. INCOMPETENT VALVES ALLOW THE BLOOD TO FLOW BACKWARDS. |
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Term
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Definition
Maintain unidirectional flow
Competent valves prevent the backflow of blood
Incompetent valves = venous insufficiency |
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Term
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Definition
| THE ROLE THAT RESPIRATION PLAYS IN VENOUS FLOW PATTERNS IS CALLED PHASICITY |
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Term
| WHAT HAPPENS TO VENOUS FLOW WITH RESPIRATION |
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Definition
INSPIRATION
Decrease intrathoracic pressure
Increase intraabdominal pressure
Decreased venous flow in lower extremities
EXPIRATION
Increase intrathoracic pressure
Decrease intraabdominal pressure
Increased venous flow in lower extremities |
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Term
| WHAT IS VALSAVA MANEUVER AND IT'S EFFECT ON VENOUS FLOW |
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Definition
| THE VALSALVA MANEUVER REQUIRES THAT THE PATIENT TAKE A DEEP BREATH AND BEAR DOWN AGAINST A CLOSED GLOTTIS. UTILIZATION OF THE VALSALVA MANEUVER IS SOMETIMES USED IN ORDER TO ASSESS FOR VALVULAR INCOMPETENCE. NORMALLY, WHEN THE PATIENT BEARS DOWN, THERE IS AN INCREASE IN INTRAABDOMINAL PRESSURE. THE NORMAL RESPONSE TO THIS BEARING DOWN, IS A CESSATION OR SLOW IN VENOUS FLOW. IN THE CASE OF VENOUS INCOMPETENCE, AN INCREASED OR AUGMENTED FLOW WILL BE PRESENT WHEN THE PATIENT BEARS DOWN AGAINST A CLOSED GLOTTIS. |
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Term
| WHAT IS HYDROSTATIC PRESSURE AND IT'S EFFECT ON VENOUS RETURNE |
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Definition
| THE EFFECTS OF GRAVITY ALSO AFFECT THE AMOUNT OF VENOUS BLOOD THAT RETURNS TO THE HEART. + HYDROSTATIC PRESSURE IS DEFINED AS THE WEIGHT OF A COLUMN OF BLOOD EXTENDING TO THE HEART FROM THE POINT WHERE IT IS MEASURED. + WHEN THE PATIENT IS SUPINE, THE HYDROSTATIC PRESSURE IS ONLY 10 MM OF HG.WHEN THE PATIENT IS WALKING HYDROSTATIC PRESSURE INCREASES TO 25 MM OF HG. WHEN THE PATIENT IS IN A STANDING POSITION IT IS ELEVATED TO 80 MM HG. |
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Term
| WHAT IS EDEMA AND HOW IT OCCURS |
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Definition
| WITH FLUID ACCUMULATION, INDURATION OF THE TISSUE IS SEEN AS + EDEMA. PITTING EDEMA IS THE ACCUMULATION OF FLUID IN THE SUBCUTANEOUS TISSUE. WHEN PRESSURE IS APPLIED ON THE TISSUE, SOME OF THE FLUID IS DISPLACED AND A DEPRESSION REMAINS ON THE SURFACE OF THE SKIN. PITTING EDEMA MAY BE CAUSED BY FLUID RETENTION, ELECTROLYTE IMBALANCE, RENAL DYSFUNCTION, AND CONGESTIVE HEART FAILURE. IN NON-PITTING EDEMA, THE FLUID CANNOT BE DISPLACED BY MANUAL PRESSURE. ONE TYPE OF NON-PITTING EDEMA IS LYMPHEDEMA (OBSTRUCTION OF THE LYMPHATIC SYSTEM. + REDNESS MAY OCCUR DUE TO AN INFLAMMATORY PROCESS AND OR CELLULITIS. + THE SKIN MAY TAKE ON A LIGHT OR DARK BROWN COLOR (USUALLY IN THE AREA BETWEEN THE ANKLE TO KNEE). + PHLEGMASIA ALBA DOLENS (MILK LEG OR WHITE LEG) OCCURS SECONDARY TO EXTENSIVE ACUTE DVT IN THE ILIAC OR FEMORAL REGION. LEG SWELLING IS SEVERE (SIZE OF THE LIMB MAY DOUBLE IN 24 HOURS). NO REDNESS OR CYANOSIS IS IN EVIDENCE. + PHLEGMASIA CERULEA DOLENS IS ANOTHER COMPLICATION OF DVT. BECAUSE THE VENOUS OUTFLOW IS SO SEVERELY REDUCED, ARTERIAL INFLOW IS REDUCED. TISSUE HYPOXIA MAY RESULT AND LEAD TO GANGRENE. |
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Term
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Definition
| VENOMOTOR TONE RELATES TO THE CAPACITY OF THE VEINS FOR CONTRACTION AND DILATION OF THE SMOOTH MUSCLE IN THE TUNICA MEDIA OF THE VEIN. THIS MECHANISM IS CONTROLLED BY THE SYMPATHETIC NERVOUS SYSTEM AND COMPENSATES FOR CIRCULATORY PROBLEMS. CHANGES IN THE BODY TEMPERATURE OF THE LIMBS DUE TO CERTAIN PATHOLOGICAL CONDITIONS, MAY ALSO ALTER THE DEGREE TO WHICH THE VEINS DILATE OR CONTRACT. |
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Term
| 5 NORMAL DOPPLER FINDINGS |
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Definition
SPONTANEOUS FLOW
PHASICITY
AUGMENTATION
COMPETENCE OF VALVES
NON PULSATILITY |
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Term
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Definition
| WHEN THE VEIN IS COMPRESSED DISTAL TO THE TRANSDUCER, THERE SHOULD BE A RUSH OF BLOOD SUPERIORLY |
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Term
| SYSTEMIC VEINS CLASSIFICATION |
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Definition
Deep veins
Superficial veins
Perforators
Venous sinuses |
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Term
| WHAT ARE VENAE COMITANTES (COMPANION VEINS) |
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Definition
| + THE PAIRED PERONEAL VEINS EMPTY THE LATERAL PORTION OF THE CALF AND CARRY BLOOD TO THE TIBEOPERONEAL TRUNK. + THE PAIRED POSTERIOR TIBIAL VEINS EMPTY THE BACK OF THE CALF AND CARRY BLOOD TO THE TIBEOPERONEAL TRUNK AS WELL. + THE PAIRED ANTERIOR TIBIAL VEINS ARE LOCATED ON THE ANTERIOR PORTION OF THE CALF BETWEEN THE TIBIA AND FIBULA. THE ANTERIOR TIBIAL VEINS AND THE TIBEOPERONEAL TRUNK VEINS JOIN BELOW THE KNEE + AND BECOME THE POPLITEAL VEIN. |
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Term
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Definition
GREATER SAPHENOUS VEIN
Begins on dorsum of foot, travels anterior to medial malleolus and continues medially up the leg to unite with the CFV
Longest vein in the body
Lies just beneath the skin
LESSER SAPHENOUS VEIN
Stocking seam vein
Ascends back of calf to join with popliteal vein |
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Term
| WHICH VEINS HAVE THE GREATEST NUMBER OF VALVES |
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Definition
Greater Saphenous: 10-12
Lesser Saphenous: 6-12 |
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Term
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Definition
| THE PERFORATING VEINS FORM CHANNELS OF COMMUNICATION BETWEEN THE SUPERFICIAL AND DEEP VENOUS SYSTEMS. EACH PERFORATOR CONTAINS ONE VALVE. THIS VALVE ASSURES UNI-DIRECTIONAL FLOW FROM THE SUPERFICIAL TO DEEP SYSTEM.IF THE VALVES IN THE PERFORATORS BECOME INCOMPETENT, BLOOD CAN FLOW DOWN THE VEINS IN THE WRONG DIRECTION AND PUDDLE IN THE LOWER LEG. THIS MAY LEAD TO VARICOSE VEINS, PAIN, SWELLING, HYPERPIGMENTATION, OR VENOUS STASIS ULCERS. |
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Term
| NAME THE PERFORATORS IN THE LOWER EXTREMITY |
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Definition
THE COCKETT’S PERFORATORS IN THE LOWER CALF NEAR THE ANKLE
THE PERFORATORS OF DODDS IN THE UPPER THIGH AND THE PERFORATORS OF BOYD’S IN THE LOWER THIGH NEAR THE KNEE. |
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Term
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Definition
LOCATED IN THE CALF MUSCLES
SPACES THAT ALLOW BLOOD TO ACCUMULATE
WHEN CALF MUSCLES CONTRACT THEY RETURN BLOOD TO POSTERIOR TIBIAL AND PERONEAL VEINS
ARE OF GREAT IMPORTANCE IN THE “CALF MUSCLE PUMP” |
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Term
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Definition
Changes or injury to vein walls
Venous stasis
Hypercoaguability of blood |
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Term
| FACTORS WHICH MAY CAUSE VENOUS STASIS |
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Definition
| BED REST (>4 DAYS), IMMOBILITY, MYOCARDIAL INFARCTION (MI), CONGESTIVE HEART FAILURE (CHF), CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), OBESITY, PREGNANCY, ESTROGEN INTAKE (ORAL CONTRACEPTIVES), PREVIOUS EPISODES OF DVT (INJURY TO VALVES CAUSES POOLING OF BLOOD IN THE VENOUS SYSTEM), AND LOWER LIMB PARALYSIS (PARAPLEGIA) |
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Term
| FACTORS FOR HYPERCOAGUABILITY OF BLOOD |
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Definition
Pregnancy
Cancer
Estrogen intake
Myeloproliferative disorders |
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Term
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Definition
| WITH ACUTE DVT, THE CLINICAL DIAGNOSIS IS NOTORIOUSLY UNRELIABLE IN UP TO 50% OF PATIENTS. IN OTHER WORDS, ONLY 50% OF THE PATIENTS WHO PRESENT WITH THE SYMPTOMS OF DVT ACTUALLY HAVE DVT.THE PATIENT WITH ACUTE DVT MAY PRESENT WITH SWELLING, ACUTE ONSET OF PAIN IN THE AFFECTED LEG, REDNESS OR ERYTHEMA OF THE LEG, OR AN EXTREMITY THAT IS WARM TO THE TOUCH. |
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Term
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Definition
| PATIENTS WHO HAVE HAD REPEATED EPISODES OF DEEP VEIN THROMBOSIS (CHRONIC) MAY PRESENT WITH LEGS THAT ARE SWOLLEN, HEAVY, HAVE BRAWNY DISCOLORATIONS, VENOUS ULCERS, AND VARICOSITIES. |
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Term
| DIFFERENTIAL DIAGNOSIS FOR DVT |
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Definition
MUSCLE STRAIN
DIRECT INJURY TO LEG
MUSCLE TEAR
BAKER’S CYST
CELLULITIS
LYMPHANGITIS
HEART FAILURE
EXTRINSIC COMPRESSION
COMPLICATIONS OF CHRONIC VENOUS INSUFFICIENCY |
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Term
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Definition
| WHEN FLOW BECOMES RESTRICTED DUE TO CLOT FORMATION, THE VENOUS PRESSURE INCREASES, CAUSING VENOUS HYPERTENSION. WITH REPEATED EPISODES OF DVT, THE VALVES BECOME STRETCHED AND DAMAGED LEADING TO VENOUS INSUFFICIENCY. ALTHOUGH A PULMONARY EMBOLUS IS NOT THE MOST COMMON SEQUELA OF DVT, IT IS BY FAR THE MOST SERIOUS ONE, FOR THAT REASON, DVT IS CONSIDERED LIFE THREATENING AND PROMPT DIAGNOSIS IS A PRIORITY. |
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Term
| COMMON SITES FOR THROMBOSIS FORMATION IN LOWER LEG |
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Definition
| CLOT MAY DEVELOP AT THE CUSPS OF VENOUS VALVES OR IN THE SOLEAL SINUSES |
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Term
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Definition
COLLATERAL FORMATION
VALVULAR DAMAGE
VENOUS HYPERTENSION
SKIN CHANGES
VARICOSE VEINS |
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Term
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Definition
| THE CUSPS OF THE VALVE DO NOT MEET AND CAUSES BLOOD TO LEAK CAUDALLY |
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Term
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Definition
| LEADS TO SKIN CHANGES, VARICOSE VEINS, VENOUS HYPERTENSION |
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Term
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Definition
PRIMARY - hereditary, not related to DVT, affects greater and lesser saphenous veins
SECONDARY - valves of deep and communicating system are incompetent, related to repeated episodes of DVT, pregnancy, or obesity, collaterals form |
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Term
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Definition
| PITTING EDEMA IS THE ACCUMULATION OF FLUID IN THE SUBCUTANEOUS TISSUE. WHEN PRESSURE IS APPLIED ON THE TISSUE, SOME OF THE FLUID IS DISPLACED AND A DEPRESSION REMAINS ON THE SURFACE OF THE SKIN. PITTING EDEMA MAY BE CAUSED BY FLUID RETENTION, ELECTROLYTE IMBALANCE, RENAL DYSFUNCTION, AND CONGESTIVE HEART FAILURE. |
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Term
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Definition
| IN NON-PITTING EDEMA, THE FLUID CANNOT BE DISPLACED BY MANUAL PRESSURE. ONE TYPE OF NON-PITTING EDEMA IS LYMPHEDEMA (OBSTRUCTION OF THE LYMPHATIC SYSTEM. |
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Term
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Definition
| + PHLEGMASIA ALBA DOLENS (MILK LEG OR WHITE LEG) IS DUE TO THE EFFECT OF ARTERIAL SPASMS THAT OCCUR SECONDARY TO EXTENSIVE ACUTE ILIOFEMORAL DVT. SEVERE SWELLING IS PRESENT (LIMB SIZE MAY DOUBLE IN 24 HOURS) WITHOUT REDNESS OR CYANOSIS. |
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Term
| PHLEGMASIA CERULEA DOLENS |
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Definition
| PHLEGMASIA CERULEA DOLENS MAY ALSO OCCUR AS A RESULT OF ILIOFEMORAL THROMBUS. IN THIS CASE, REDUCED VENOUS OUTFLOW REDUCES THE ARTERIAL INFLOW. TISSUE HYPOXIA OCCURS AND CAUSES CYANOSIS. THIS CONDITION MAY LEAD TO VENOUS GANGRENE. |
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Term
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Definition
VENOUS ULCERS
Near medial malleolus
Pain is mild
Irregular & shallow
Venous ooze
May see brawny discoloration & varicosities |
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Term
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Definition
ARTERIAL ULCERS
Tibial area, toes, & bony prominences
Pain is severe
Regular & deep
Little bleeding
Skin shiny & hairless
Thickened toenails |
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Term
| DIAGNOSTIC CRITERIA FOR DVT |
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Definition
Absence of vein compressibility
Visualization of thrombus
Vein distention
Abnormal Doppler signals
Reduced / absent augmentation
Reduced / absent color filling |
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Term
| DIAGNOSTIC CRITERIA FOR ACUTE DVT |
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Definition
ACUTE DVT
May be sonolucent
Spongy
Loosely attached (tail of the dog)
Expansion of vessel lumen
No collaterals |
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Term
| DIAGNOSTIC CRITERIA FOR CHRONIC DVT |
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Definition
CHRONIC DVT
More echogenic thrombus
Well attached
Irregular vein walls
Smaller vessel size
Collateral formation |
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Term
| ULTRASOUND FINDINGS OF ACUTE DVT |
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Definition
| ON ULTRASOUND, THE PATIENT WITH ACUTE DVT MAY HAVE THROMBUS THAT IS SONOLUCENT, SPONGY, LOOSELY ATTACHED TO THE VESSEL WALL (WE SOMETIMES CALL THIS “TAIL OF THE DOG”), A DILATED EXPANDED VESSEL LUMEN, AND NO COLLATERAL VEINS IN EVIDENCE. IN THESE IMAGES WE SEE ACUTE DVT IN THE CFV IN TRANSVERSE AND IN LONG VIEWS. |
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Term
| MEDICAL THERAPY AS A TREATMENT OPTION FOR DVT INCLUDS |
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Definition
| THIS INCLUDES LIMITING PERIODS OF INACTIVITY OR BED REST, PROMOTING VENOUS DRAINAGE THROUGH USE OF SUPPORT HOSE, LEG ELEVATION, AND PNEUMATIC CALF COMPRESSION DURING AND AFTER SURGICAL PROCEDURES, AND PREVENTING INJURY OF INFECTION TO THE EXTREMITY. AN UNNA BOOT IS A MEDICATED COMPRESSION DRESSING USED IN THE TREATMENT OF VENOUS ULCERS |
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Term
| WHAT IS GREENFIELD FILTER |
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Definition
| FOR PATIENTS WHO CANNOT USE ANTICOAGULANT THERAPY, A VENAL CAVAL INTERRUPTION DEVICE (GREENFIELD FILTER) ,MAY BE USED TO PREVENT THROMBUS FROM TRAVELLING TO THE HEART OR PULMONARY SYSTEM. IN THE CASE OF CHRONIC VENOUS INSUFFICIENCY, LIGATION OF THE INCOMPETENT SUPERFICIAL VEINS MAY BE PERFORMED, RARELY VALVES ARE RECONSTRUCTED OR TRANSPLANTED. SCLEROTHERAPY FOR SMALL VARICOSITIES IS PERFORMED. |
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