Question

1. Pathophysiology & clinical manifestations of arterial and venous diseases:

     a. chronic and acute arterial occlusion

     b. chronic venous insufficiency and deep vein thrombosis.

     

• Know the signs and symptoms of chronic venous disease
• Know the signs and symptoms of deep vein thrombosis
• Know the signs and symptoms of arterial peripheral vascular disease
• What is intermittent claudication and what causes the pain
• What are the characteristic signs of a venous ulcer vs an arterial ulcer

Answer 1

A).Pathophysiology of chronic and acute arterial occlusion:

●Atherosclerosis it is considered and identified as the most common cause of chronic arterial occlusive disease which mainly affects the lower extremities. The arterial vessels undergo narrowing or gets obstructed and that this is occured due to the accumulation of plaques on the arter ial wall or is also known as atherosclerotic process. This reduces blood circulation through the blood vessels to the lower extrimities during exercise, work or at rest. The common symptoms that might be occured will be intermittent claudication to pain at rest. Intermittent claudication means the pain that occure in the affected limb while doing exercises and is reduced with rest and relaxation.This pain mainly occurs distal to the arterial narrowing / obstruction. The most commonly affected blood vessels are superficial femoral and popliteal arteries. Narrowing of these arteries due to atherosclerotic changes may produce and also increases the pain in the buttocks or the thighs as well as in the part of leg. The atherosclerotic changes are often slowly progressing in such cases the blood flow to the affected limb will be compensated and managed by the collateral blood circulation or the capillaries. And if the blockage of a blood vessel is sudden then their is no chance for a collateral circulation to act upon.

● clinical manifestation:

* severe pain , coldness and the numbness on the affected extrimity

* Pain , aching, tired feeling in the muscles which increases while doing excercises and relieves when at rest

* Muscle cramps

* Blockage of the arm arteries might cause fatigue, cramping or muscle pain at the arms.

* cynotic symptoms might seen in the affected limb part (blueish discoloration)

* The abscense of pulse feeling at the distal part of the blockage or the occlusion

* The reduced blood flow causes loss of sensation at the sight and also the paralysis of the limbs.

* If the occlusion is not treated at the right time and if it is kept untreated for a long period then it will cause the tissue death and that body part needs to be get amputed.

B.) Pathophysiology of chronic venous insuficiency :

●Pathophysiology of this condition can be classified into two main aspects. One is reflux and the other is obstruction. Venous reflux is based on the venous valve incompetence, inflammation of the vessel wall, hemodynamic factors and also venous hypertension. This specific mechanisms will get aggravated by dysfunctional pump mechanisms (muscle pump, vascular pump), ma inly in immobile patients or those patients having immobile joints or stiff joints. This sort of inflammatory changes in the vessel wall and venous valves results in the occurance of the venous incompetence. Changes in the blood vessel might include development of vessel wall inflammation.Venous hypertension and the hemodynamic changes are associated with the release of vasoactive substances , and results in inflammatory changes.The infiltration of venous valves and the blood vessel walls by monocytes and macrophages is initiated in the condition. This chronic inflammation ultimately leads to lipodermatosclerosis .

● Clinical manifestations of chronic venous insuficiency:

* Heavy legs

* pruritus,nocturnal leg cramps and pain

* Evening edema on legs

* Telengiectasis (spider veins)

* Development of vericose veins

* vericose vein with edema

* Purpura, pigmentation, eczema

* Active or healed venous ulcer.

● pathophysiology of deep vein thrombosis

Lower and the Upper extremity deep vein thrombosis is resulted due to part of superior vena cava syndrome.This is compression of superior venacava blood veseel often results in facial swelling, dilated neck veins, and facial flushing. The subclavian vein compression is also seen. Deep venous thrombosis is seen to be started or is begins in venous valve cusps. Thrombi include or consist of thrombin, fibrin, and red blood cells with relatively few platelets.

●Clinical manifestations of deep vein thrombosis:

*vague aching pain

*tenderness along way of the veins

*edema

*erythema

* dilated collateral superfical veins will be visible

* Homans sign

* tenderness

* swelling of the leg

* pitting edema