Vas 245: Classification & Comps Of Acute & Chronic Dvt

Front 1

T or F:

DVT typically starts in calf veins

Back 1

TRUE:

Front 2

Where can DVT originate?

Back 2

Anywhere in the venous system

Front 3

Where would you except to see DVT form around valves?

Back 3

Initially form behind valve cusps in the vein sinusoids

Front 4

What is thought to be the most common origin site for LE DVT?

Back 4

Soleal sinuses

Front 5

T or F:


Risk for propagation into larger below knee veins

Back 5

FALSE:

Risk for propagation into larger ABOVE knee veins

Front 6

What would make a valve cusp extremely dilated?

Back 6

If there is clot there

Front 7

T or F:

Stasis of blood is anterior to the cusp

Back 7

FALSE:

Stasis of blood BEHIND cusp

* In live can see blood swirling around cusp of valve leaflet

Front 8

T or F:

The blood is echogenic

If true, how?

Back 8

- TRUE

- RBC's have aggregated into larger units that reflect US efectively

Front 9

How is movement displayed?

Back 9

Movement is visible in real time

Front 10

What must we distinguish between?

Back 10

- Sluggish flow

- Thrombus

Front 11

What are the 4 classifications of DVT

Back 11

- Non-obstructive

- Obstructive

- Acute

- Chronic

Front 12

If a non-obstructive clot resolves, what is the amount of damage done?

Back 12

Minimal vein damage

Front 13

It is possible for a non-obstructive clot to become obstructive?

Back 13

Yes

Front 14

T or F:

A free floater is an considered an obstructive DVT?

Back 14

FALSE:

Front 15

Why isn't a free floater considered an obstructive DVT?

Back 15

- It appears very poorly attached

- It is a critical situation----but---it is non-obstructive because if its poorly attached its not completely obstructing the lumen

Front 16

What causes the clot to become obstructive?

Back 16

- The clot contracts and pulls the vein inward causing the clot to become obstructive

Front 17

What is often a result of an obstructive DVT?

Back 17

- Vein valves are destroyed

- Valves become non-functional

Front 18

How is it possible for flow to occur when there is an obstructive DVT?

Back 18

Recanalization may occur to allow flow

Front 19

An acute venous obstruction is the initial period of time where vein wall is ____________ and thrombus is ___________

Back 19

- vein wall inflamed


- thrombus is loosely attached

Front 20

How would sufficient collaterals affect a patient w/acute obstructive DVT?

Back 20

- They may cause the sx's to not appear immediately because some flow is still getting through because of the collaterals

Front 21

Sx's associated w/acute obstruction may ______________

Back 21

diminish w/time

Front 22

What would make the sx's diminish w/time?

Back 22

- The clot undergoes fibrosis

- The clot undergoes reorganization and gets smaller

Front 23

The process of clot retraction is ______________

Back 23

when the clot undergoes reorganization and gets smaller

Front 24

T or F:

Some patient's never recanalize

Back 24

TRUE:

They may just run off collaterals

Front 25

Which of the following is not an acute DVT comp?

1. Majority of sx's occur when clot is in high thigh

2. Venous Claudication

3. Phelgmasia cerulea dolens

4. Ambulatory Venous Hypertension

Back 25

4. Ambulatory venous HTN is a chronic comp of DVT

Front 26

What are the 7 comps of acute DVT?

Back 26

- Majority of sx's occur when clot is in high thigh

- Venous Claudication

- Phlegmasia alba dolens

- Phlegmasia cerulea dolens

- Free floating tails may embolize

- Systemic Arterial Hypoxemia

- Pulmonary Embolism

Front 27

If there is venous outflow obstruction or iliofemoral obstruction where would you expect to find the obstruction?

Back 27

High thigh

Front 28

In venous claudication, the severe venous outflow obstruction is affecting what?

Back 28

The arterial system

- It backs up the arterial system (inflow)

Front 29

In venous claudication, what causes pain?

Back 29

When the pt exercises and oxygenated blood is not available to the muscles---its due to poor venous drainage---results in pain

Front 30

T or F:

Phlegmasia alba dolens is more severe than Phlegmasia cerulea dolens?

Back 30

FALSE:

Phlegmasia cerulea dolens is more severe than Phlegmasia alba dolens

Front 31

Which acute DVT comp would you expect to see skin "white as snow?"

Also referred to as "milk leg"

Back 31

Phlegmasia albla dolens

Front 32

Which acute DVT comp is the result of such severe inflow issue that there's not enough skin perfusion?

Back 32

- Phlegmasia Alba Dolens


* A swollen pale extremity

Front 33

In phlegmasia alba dolens, pallor or whiteness may be secondary to _______________

Back 33

arterial spasms in acute iliofemoral deep venous thrombosis

Front 34

What acute DVT comp is when the obstruction is so severe that arterial flow is impeded?

Back 34

Phlegmasia cerulea dolens

Front 35

T or F:

You would expect to see a massively swollen leg w/severe cyanosis and intense pain in a chronic DVT

Back 35

FALSE:

- Phlegmasia Alba Dolens

- Acute DVT comp

Front 36

What can lead to venous induced gangrene?

Back 36

Phlegmasia cerulea dolens

Front 37

What 2 things could a free floating clot that embolizes causes?

Back 37

- Systemic Arterial Hypoxemia

- Pulmonary Embolism

Front 38

If Systemic Arterial Hypoxemia occurs, what does the blood fail to do and what is impaired?

Back 38

- Blood fails to reach the pulmonary capillary bed

- Oxygenation of blood is impaired

Front 39

T or F:

In systemic arterial hypoxemia, there is an increased percutaneous (through the skin) O2 level

Back 39

FALSE:

Decreased percutaneous O2 level

Front 40

What is the relationship between the size of the embolus and the percutaneous O2 levels?

Back 40

An inverse relationship

Front 41

What is the most significant comp of acute DVT?

Back 41

Pulmonary Embolism

Front 42

Are patient's more or less likely to have a PE when thrombus is below the knee?

Back 42

Patients with above knee thrombus have PE in 50% of cases

* That's why should always scan below the knee

Front 43

What determines the outcome of a PE?

Back 43

- The size of the embolus

- Health of the person's cardiovascular system

Front 44

What are the 6 sx's of PE?

Back 44

- Dyspnea

- Pleuritic Pain

- Tachypnea

- Apprehension/Anxiety

- Non-productive cough

- Hemoptysis

Front 45

What is the most common sx of PE?

Back 45

Dyspnea

Front 46

What is a sudden onset of CP termed?

Back 46

Pleuritic pain

Front 47

What are the 5 exams done to diagnose a PE?

Back 47

- Chest xray

- VG Scan --Nuc Med

- Ventilation Scintiscan--radioactive gas

- Perfusion Scintiscan--radioisotope injection

- Pulmonary Angiography--contrast medium and xray

Front 48

What are examples of chronic venous DVT?

Back 48

Chronic venous obstruction:

- Postphlebitic Syndrome

- Chronic Venous Insufficiency (result of valvular incompetence)

- Abnormally high venous pressure in deep veins---ambulatory venous hypertension

Front 49

When is acute DVT more serious of an outcome than chronic?

Back 49

When there is a PE

Front 50

What is another name for "after-vein inflammation syndrome?"

Back 50

Postphlebitic Syndrome

Front 51

In postphlebitic syndrome, the vein lumen is small and flow is directed ____________

Back 51

toward the center of the vessel

Front 52

Thrombus adheres to the vein wall and becomes ________

Back 52

fibroelastic (neointimal thickening)


* Much like scar tissue

Front 53

T or F:

The pattern of resolution of postphlebitic syndrome is the same

Back 53

FALSE:

The pattern of resolution varies

Front 54

__________ is an impaired or inadequate ability to move blood out of the leg

Back 54

Chronic venous insufficiency

Front 55

T or F:

There is evidence of postphlebitic syndrome in chronic venous insufficiency

Back 55

TRUE

Front 56

What destroys the vein valves causing valvular incompetency?

Back 56

Consolidation of clot

Front 57

What does valvular incompetency result in?

Back 57

Venous reflux

Front 58

What is venous reflux?

Back 58

Leakage or significant backward venous flow

Front 59

If valve leaflet is involved---leaflet stays open---what occurs?

Back 59

reflux occurs

Front 60

What is the affect on pressure from chronic DVT?

Back 60

Abnormally high venous pressure in deep veins

Front 61

What is the term for when there is an abnormally high venous pressure in the legs when a patient stands or walks?

Back 61

Ambulatory Venous HTN


* Its the venous pressure in that particular vein

Front 62

If the intraluminal pressure changes then the ________ also changes

Back 62

lumen size

Front 63

Where is the venous pressure higher?

Back 63

Distally

Front 64

What are the 5 clinical manifestations (sx's) of Chronic DVT?

Back 64

- Swelling

- Venous Dilation

- Leg pain

- Hyperpigmentation

- Venous Stasis Ulcers

Front 65

If chronic DVT the swelling is usually ______ at first and just above the ____________

Back 65

usually mild at first

just above the shoe line

Front 66

If the swelling went down when they elevate their feet this would indicate ___________

Back 66

insufficiency----not DVT

Front 67

The edema is dependent upon the severity but what is the general type associated w/Chronic DVT?

Back 67

Pitting edema

Front 68

In venous dilation, what vessels in particular dilate?

Back 68

Superficial veins dilate particularly in the ankle

Front 69

T or F:

Distension of veins is decreased when standing

Back 69

FALSE:

Distension of veins is more pronounced when standing

Front 70

What is the result of the superficial veins w/progression of venous insufficiency?

Back 70

The superficial veins become more dilated and tortuous

Front 71

What causes the veins to move?

Back 71

The pressure w/in the vein causes them to move---tortuous

Front 72

What causes the leg pain associated w/chronic DVT?

Back 72

- Trapped deoxygenated blood>>>>causes edema>>>creates a pressure change>>>results in pain

Front 73

What type of pain is associated w/chronic DVT?

Back 73

- Limb heaviness

- Dull ache which worsens w/long periods of dependency

Front 74

T or F:

Pain is relieved by elevating the feet

Back 74

TRUE


* Often the pain or leg fullness will start suddenly upon standing

Front 75

What causes the hyperpigmentation?

Back 75

High pressure in the venous system due to poor venous outflow>>>causes RBC's to be forced out of the capillaries and into interstitial areas

Front 76

Dying RBC's metabolize iron---iron ion which causes ___________

Back 76

a brown discoloration of the skin

Front 77

What is often associated w/hyperpigmentation?

Back 77

scaling dermatitis

Front 78

T or F:

Usually lots of incompetence in the deep system

Back 78

FALSE:

Usually lots of incompetence in the SUPERFICIAL system

Front 79

If you have alot of chronic DVT will probably have incompetence in the ____________

Back 79

deep system

Front 80

What is the last clinical manifestation of chronic dvt to occur?

Back 80

Venous stasis ulcers



***Common

Front 81

What causes venous stasis ulcers?

Back 81

Post phlebitic syndrome

Front 82

High capillary pressure forces __________ into interstitial tissue where it becomes ______________

Back 82

Forces fibrinogen

become fibrin

Front 83

________ prevents proper nutrition and oxygenation of tissues

Back 83

fibrin

Front 84

T or F:

Venous ulcers are at pressure points

Back 84

FALSE:

Arterial pressures are at pressure points

Front 85

Where do venous stasis ulcers form

Back 85

- In the superficial areas of the skin near the medial aspect of the ankle

- the 'gaiter' zone

* but if ulcer is really bad it may go more lateral or even past the 'gaiter' zone

Front 86

Why are venous ulcers usually weepy and will bleed easily?

Back 86

Because all of the superficial veins have alot of blood pooled in them

Front 87

T or F:

Venous ulcers are more painful than arterial ulcers

Back 87

TRUE

Front 88

What kind of borders do venous ulcers have?

Back 88

Irregular borders w/a moist granulating base surrounded by a zone of inflammation

Front 89

Perforators often feed ulcers ___________

Back 89

w/deoxygenated pooled blood

Front 90

___________ is a term for when there is no good venous outflow

Back 90

venous insufficiency

Front 91

T or F:

Valvular incompetence is the inadequate ability of a vein valve to perform the function of two way flow

Back 91

FALSE:

ONE way flow

Front 92

If the valvular incompetence is from postphlebetic syndrome then which system is the issue?

Back 92

the deep system