Medical Health Care PowerPoint Templates

Recording the Physical
Examination
The Peripheral Vascular System
Types of Peripheral
Edema
01 Pitting Edema
02 Chronic Venous
Insufficiency
03 Lymphedema
Pitting Edema
• Edema is a soft
• bilateral palpable swelling
• demonstrated by pitting after 1 to 2
seconds of thumb pressure on the
anterior tibiae and feet.
• occurs in several conditions:
 when legs are dependent from
prolonged standing or sitting
 heart failure
 nephrotic syndrome, cirrhosis, or
malnutrition
 with selected medications
Chronic Venous Insufficiency
•Edema is soft
•with pitting on pressure, and occasionally
bilateral.
•Look for brawny changes and skin
thickening (near the ankle)
•Ulceration, brownish
•pigmentation, and edema in the feet are
common.
•It arises from chronic obstruction and
incompetent valves in the deep venous
system.
Lymphedema
• Edema is initially soft and pitting, then
becomes indurated, hard, and
nonpitting, often occurs
• bilaterally in the feet and toes.
• Skin is markedly thickened; ulceration
is rare, no pigmentation
• Lymphedema arises from interstitial
accumulation of protein-rich fluid when
lymph channels are infiltrated or
obstructed by tumor, fibrosis, or
inflammation, or disrupted by axillary
node dissection and/or radiation.
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Raynaud Phenomenon
01
Peripheral Arterial Disease

02
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Raynaud Phenomenon
Primary Secondary
symptoms/signs related
Episodic reversible to autoimmune diseases—
vasoconstriction in the scleroderma,SLE, mixed
fingers and toes connective tissue disease;
Clinical Manifestations: cryoglobulinemia;
Distinct digital color changes also to occupational vascular
of pallor, injury; drugs
cyanosis, and hyperemia Clinical Manifestations: More
(redness); no necrosis severe, with ischemia,
necrosis,
and loss of digits; capillary
loops are distorted
Clinical Manifestations:
gangrene
Localfatigue
 numbness
 progressing to cool dry
hairless skin
trophic nail changes
Diminished to absent pulses
Atherosclerotic disease leading pallor with elevation
to obstruction of peripheral
Ulceration
arteries causing exertional
claudication (muscle pain
relieved by rest) and atypical
leg pain; may progress to
ischemic pain at rest
Clinical Manifestations:
loss of pulses distal to the
occlusion cyanosis or pallor
Mottling
 decreased skin temperature
muscle stiffening
 loss of sensation
Weakness
 absent deep tendon reflexes
Principal causes of acute
arterial occlusion include
embolism, thrombus in situ,
arterial dissection, and
trauma.
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Raynaud Phenomenon
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Superficial Phlebitis and
Superficial Vein Thrombosis
Involves inflammation of a superficial vein

(best termed superficial phlebitis), at times
with venous thrombosis
(now termed superficial vein thrombosis
when clot
confirmed by imaging)
Pain and tenderness along the course of
a superficial vein, most often in the
saphenous system
DEEP-VENOUS THROMBOSIS AND
PULMONARY EMBOLISM
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Common Ulcers of the Ankles
and Feet
Chronic Venous Insufficiency
usually appears over the medial and
sometimes the lateral malleolus.
ulcer contains small, painful granulation
tissue and fibrin; necrosis or exposed
tendons are rare.
Borders are irregular, flat, or slightly steep.
Pain affects quality of life in 75% of

patients
Associated findings
 edema eczematous changes of stasis dermatitis

 reddish pigmentation and (redness, scaling, and pruritus)
 at times cyanosis of the foot when
purpura
 venous varicosities dependent
Gangrene is rare.
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Arterial Insufficiency
occurs in the toes, feet, or possibly areas
of trauma (e.g., the shins).
Surrounding skin shows no callus or
excess pigment, although it may be
atrophic.
Pain often is severe unless masked by
neuropathy..
Associated findings
May be accompanied
by gangrene, along with decreased pulses,
trophic changes, foot pallor on
elevation, and dusky rubor on dependency
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Recording the Physical

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Peripheral Arterial Disease

Peripheral Arterial Disease

Involves inflammation of a superficial vein

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Pain affects quality of life in 75% of

 edema eczematous changes of stasis dermatitis

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