Chronic Venous Disorders Overview

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Questions and Answers

Which of the following is NOT a primary type of venous disease?

  • Venous insufficiency
  • Arteriosclerosis (correct)
  • Varicose veins
  • Deep venous thromboembolism (DVT)

What is the typical direction of blood flow in the venous system?

  • Toward the heart (correct)
  • From deep to superficial veins
  • Independent of external forces
  • Away from the heart

Which layer of the vein is composed of smooth muscle?

  • Perforating layer
  • Tunica intima
  • Tunica adventitia
  • Tunica media (correct)

What is a key factor that facilitates venous blood return in the extremities?

<p>Skeletal muscle contractions (D)</p> Signup and view all the answers

Which veins directly connect superficial and deep venous systems?

<p>The perforating veins (C)</p> Signup and view all the answers

Which of these venous disorders is most prevalent in both men and women?

<p>Varicose veins (A)</p> Signup and view all the answers

What is the estimated annual incidence of deep venous thrombosis (DVT) per 100,000 people?

<p>80 (B)</p> Signup and view all the answers

Patients often accept venous disease as a slowly progressive condition related primarily to what factor?

<p>Aging (C)</p> Signup and view all the answers

A patient presents with suspected deep vein thrombosis (DVT). A D-dimer test is performed and is negative. What can be inferred?

<p>The patient likely does not have DVT if the Wells criteria score is less than 2. (B)</p> Signup and view all the answers

A patient has a positive D-dimer test and a Wells score of 2. What is the next step?

<p>Perform venous duplex ultrasonography. (B)</p> Signup and view all the answers

Which of the following best describes the use of the D-dimer assay in diagnosing deep vein thrombosis (DVT)?

<p>It is highly sensitive and useful for ruling out DVT when negative. (C)</p> Signup and view all the answers

If venous duplex ultrasonography is inconclusive for DVT, what is the next best imaging test?

<p>Magnetic resonance venography (MRV) with gadolinium contrast (B)</p> Signup and view all the answers

A patient who cannot tolerate intravenous contrast needs to be investigated for a suspected pulmonary embolism. Which of the following would be the most appropriate investigation?

<p>Lung scan (ventilation-perfusion scan) (B)</p> Signup and view all the answers

What is the primary function of the gastrocnemius muscle in the context of venous return?

<p>To provide pumping action for venous blood to return to the heart. (C)</p> Signup and view all the answers

Which characteristic of veins contributes most significantly to their susceptibility to blood stasis?

<p>Their large capacity and ability to hold a large amount of blood. (B)</p> Signup and view all the answers

What is the main function of the valves within veins?

<p>To prevent retrograde flow of venous blood. (D)</p> Signup and view all the answers

Which of the following is an exception in terms of oxygenated and deoxygenated blood flow?

<p>Pulmonary Veins and Pulmonary arteries. (B)</p> Signup and view all the answers

What makes deoxygenated blood in veins appear blue through the skin?

<p>The dispersion of light on the skin. (A)</p> Signup and view all the answers

What is a common cause of venous insufficiency?

<p>Weakening of valve leaflets leading to retrograde flow. (A)</p> Signup and view all the answers

What is the most common form of venous disease according to the text?

<p>Superficial venous incompetence. (B)</p> Signup and view all the answers

What two conditions increase the risk of retrograde blood flow, causing valve weakness in veins?

<p>Obesity and pregnancy. (C)</p> Signup and view all the answers

What is the term for distended and distorted superficial veins resulting from high pressure?

<p>Varicose veins (B)</p> Signup and view all the answers

What is the primary cause of venous insufficiency in both superficial and deep veins?

<p>Valvular dysfunction (C)</p> Signup and view all the answers

In deep venous insufficiency, what occurs in the lower extremities after prolonged standing?

<p>Veins completely filled, and all the venous valves open (D)</p> Signup and view all the answers

What condition can deep venous insufficiency lead to, in contrast to superficial vein insufficiency?

<p>Deep venous thrombosis (C)</p> Signup and view all the answers

What is the term for a thrombus that travels within the bloodstream?

<p>Embolism (A)</p> Signup and view all the answers

What is the combined term for deep vein thrombosis and pulmonary embolism?

<p>Venous thromboembolism (C)</p> Signup and view all the answers

According to Virchow's triad, what are the three predisposing factors to DVT?

<p>Venous stasis, vascular damage, and hypercoagulability (D)</p> Signup and view all the answers

What is the main cause of venous stasis?

<p>Poor venous return (D)</p> Signup and view all the answers

Which of the following is NOT a common clinical sign of a large deep vein thrombosis (DVT)?

<p>Cyanosis (B)</p> Signup and view all the answers

A patient with a recent history of which of the following should be questioned about increased risk of DVT?

<p>Estrogen use (A)</p> Signup and view all the answers

A pulmonary embolism (PE) typically originates from a clot in which location?

<p>A deep vein in the lower extremity (B)</p> Signup and view all the answers

Compared to the upper extremities, DVT occurs how many times more often in the lower extremities?

<p>10 times (A)</p> Signup and view all the answers

Which of the following is a clinical sign sometimes associated with DVT, but not considered reliable on its own for diagnosis?

<p>Positive Homan's sign (C)</p> Signup and view all the answers

Which of the following is a common symptom of a pulmonary embolism (PE)?

<p>Hypotension (B)</p> Signup and view all the answers

Why is it not ideal to perform imaging studies on every patient suspected of having a DVT?

<p>DVT is only diagnosed in 20% of suspected cases, thus it is impractical to image everyone (B)</p> Signup and view all the answers

What blood test is used to help diagnose DVT, detecting fibrin clot degradation products?

<p>D-dimer test (B)</p> Signup and view all the answers

What increases the susceptibility to varicose veins in females?

<p>Increased relaxation of vein walls (A)</p> Signup and view all the answers

Which factor is most strongly associated with the prevalence of varicose veins in older adults?

<p>Age (D)</p> Signup and view all the answers

What is a common etiology for developing varicose veins?

<p>Low levels of exercise (A)</p> Signup and view all the answers

What role does the valve incompetence play in varicose veins?

<p>It leads to blood stagnation (B)</p> Signup and view all the answers

Which demographic is identified to have a higher incidence of superficial varicose veins?

<p>Females compared to males (C)</p> Signup and view all the answers

Which condition is identified as a specific risk factor for varicose veins?

<p>Prolonged standing (B)</p> Signup and view all the answers

What is the primary hormone linked to the increased risk of varicose veins in females during pregnancy?

<p>Progesterone (D)</p> Signup and view all the answers

How does prolonged sitting affect the risk of developing varicose veins?

<p>It causes blood pooling in veins (A)</p> Signup and view all the answers

Flashcards

Chronic Venous Disorders

A condition affecting the veins that can range from mild varicose veins to serious deep vein thrombosis (DVT).

Deep Vein Thrombosis (DVT)

A condition where blood clots form in deep veins, usually in the legs. It can be life-threatening if the clot breaks off and travels to the lungs.

Varicose Veins

Superficial veins that are enlarged and twisted, often appearing as blue or purple bulging veins.

Perforating Veins

Veins that connect the superficial and deep veins, acting as a bridge for blood flow.

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Superficial Veins

The system of veins near the skin surface, carrying blood back to the heart.

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Deep Veins

The system of veins deeper within the body, carrying blood back to the heart.

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Muscular Pump

The action of skeletal muscles squeezing and pushing blood through the veins, helping it move back to the heart.

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Vein Layers

The three layers of a vein: tunica intima (inner lining), tunica media (muscle layer), and tunica adventitia (outer layer).

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Gastrocnemius Muscle Pumping Action

The contraction of calf muscles that helps move venous blood back towards the heart.

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Vein Valves

Structures within veins that prevent blood from flowing backwards.

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Vein Function

Veins carry deoxygenated blood back to the heart, except for pulmonary veins which carry oxygenated blood from the lungs to the heart.

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Gravity's Effect on Venous Blood Flow

The force of gravity working against venous blood flow back to the heart.

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Vein Elasticity

The ability of veins to expand and hold large amounts of blood.

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Valvular Incompetence

Weakening of vein valves that causes blood to flow backwards.

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Venous Stasis

A condition where venous blood flow is slow, often leading to blood clots.

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Venous Insufficiency

A condition involving weakened or damaged veins that results in improper blood flow.

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What are varicose veins?

Superficial veins that become enlarged and twisted, often appearing as blue or purple bulging veins. They are caused by increased pressure in the veins, often due to weakened valves.

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What is deep vein thrombosis (DVT)?

Condition where blood clots form in deep veins, usually in the legs. It can be life-threatening if the clot breaks off and travels to the lungs.

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What is venous thromboembolism (VTE)?

A term used to encompass both DVT and pulmonary embolism (PE). It occurs when a blood clot forms in a deep vein and potentially travels to the lungs.

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Pulmonary Embolism (PE)

A blood clot from a DVT that travels to the lungs, blocking blood flow and oxygen.

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Risk factors for DVT

Immobility, sedentary behavior, trauma, surgery, cancer, estrogen use, and smoking.

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D-dimer test

A blood test that detects the presence of fibrin clot degradation products in the blood.

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Physical exam findings of DVT

Unilateral leg pain, redness, ropiness, tenderness, warmth, edema, and a positive Homan's sign.

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Clinical presentation of PE

Dyspnea, chest pain, tachycardia, hemoptysis, hypotension, and syncope.

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Silent DVT and PE

DVT and PE can often be silent, meaning they have no obvious symptoms.

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Preventive treatment for DVT and PE

Anticoagulants are used to prevent DVT and PE in high-risk patients.

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Wells Criteria

Clinical guidelines used to assess a patient's risk of developing deep vein thrombosis (DVT) based on clinical symptoms like leg swelling and tenderness. The score ranges from 0 to 3, with higher scores indicating a greater risk of DVT.

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Venous Duplex Ultrasonography

A combination of ultrasound imaging and Doppler blood flow studies used to visualize blood flow within the veins and identify blood clots. It is the primary diagnostic tool for deep vein thrombosis (DVT).

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CT Scan of the Chest with Contrast

A medical imaging technique that uses X-rays and contrast dye to visualize the blood vessels in the lungs, helping to diagnose pulmonary embolism (PE).

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Lung Scanning (Ventilation-Perfusion Scan)

A radioactive imaging technique that uses a small dose of radioactive material to detect blood clots in the lungs and is primarily used for patients who cannot tolerate intravenous contrast. It is considered a secondary diagnostic test for pulmonary embolism (PE).

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What is valvular incompetence?

Valvular incompetence means vein valves become weak and cannot prevent blood from flowing backward, causing blood to pool and enlarge veins.

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What causes varicose veins?

Varicose veins happen because high pressure in leg veins weakens their valves. This occurs with prolonged standing, sitting, pregnancy, and obesity.

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How does progesterone link to varicose veins?

Progesterone, a female hormone, relaxes the walls of blood vessels, which weakens vein valves and increases the risk of varicose veins.

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Why are varicose veins more common in women?

The incidence of varicose veins is higher in females than males because of hormone influences.

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Why do varicose veins become more common with age?

The prevalence of varicose veins increases with age because vein walls weaken over time, making it harder for valves to function properly.

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What is the muscular pump?

The muscular pump uses contracting calf muscles to push blood up the legs, aiding venous return to the heart.

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What factors increase the risk of varicose veins?

Factors like prolonged standing or sitting, pregnancy, and obesity increase pressure in veins, leading to varicose veins.

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How can varicose veins be prevented?

Physical activity, smoking cessation, and weight management can reduce the risk of varicose veins by improving circulation and reducing pressure on veins.

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Study Notes

Chronic Venous Disorders

  • Chronic venous disorders are common, ranging from mild varicose veins to severe deep vein thrombosis.
  • Venous disorders are more prevalent in older adults (over 50) but immobility at any age increases susceptibility to deep vein thrombosis.
  • Venous disease includes venous insufficiency, deep vein thrombosis (DVT), and varicose veins.
  • Venous insufficiency is a major illness, common, and often underreported, with prevalence of 6-30% of cardiovascular disease expenditures.
  • Varicose veins are a common form of venous disease, with a reported prevalence as high as 56% in males and 60% in females.
  • Deep vein thrombosis (DVT) is an underdiagnosed disease affecting about 80 people per 100,000 annually, with venous ulcers affecting about 0.3% of adults.
  • Veins return blood to the heart. Two systems exist: superficial (small diameter) and deep (large diameter) veins.

Venous Structure and Function

  • Veins have three layers: tunica intima (endothelial lining), tunica media (smooth muscle layer), and tunica adventitia (connective tissue).
  • Blood flows from superficial veins into perforating veins and then deep veins, eventually returning to the heart via the superior/inferior vena cava.
  • Veins rely on skeletal muscles and valves to move blood towards the heart, as they do not pump blood like arteries.
  • Valves prevent retrograde flow, ensuring unidirectional blood flow to the heart, especially crucial in extremities.
  • Deoxygenated blood is carried from the body to the heart (and lungs for oxygenation), while oxygenated blood is carried from the lungs to the heart.

Deep Vein Thrombosis (DVT)

  • DVT is a blood clot in a deep vein, often in the legs.
  • It's frequently undiagnosed and can lead to pulmonary embolism (PE) if the thrombus travels to the lungs.
  • Risk factors include venous stasis, vascular damage, and hypercoagulability (Virchow's triad).
  • Sedentary behavior, immobility, valve dysfunction, surgery, trauma, cancers, and high estrogen states are possible causes.
  • Approximately 900,000 new cases occur annually in the United States.

Diagnosis of Venous Disorders

  • Clinical presentation (symptoms and physical examination) and diagnostic tests (D-dimer, Wells criteria, venous duplex ultrasonography, CT scan) are utilized for diagnosis.
  • Imaging tests and D-dimer tests are essential for suspecting and confirming venous disorders as symptoms are often subtle or similar to other conditions.
  • D-dimer is a nonspecific blood test, so a negative result does not rule out DVT, but a positive result suggests the possibility.
  • The Wells criteria are clinical guidelines for assessing the likelihood of DVT. A combination of low D-dimer and low Wells score virtually rules out a venous disorder.

Treatment of Venous Disorders

  • Preventive strategies, such as sequential compression devices, elevation of legs, and exercise, can minimize risks.
  • Treatments for DVT and PE often involve anticoagulant medications, with careful patient monitoring.
  • Catheter-directed thrombolysis, using thrombolytic agents directly to the clot, is an alternative approach in specific cases.
  • Surgical procedures (filter placement, thrombectomy), sclerotherapy, and/or compression stockings are used in certain cases or conditions.

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