Research patho week 4 assignmt.docx - Narbutt J Bowszyc-Dmochowska M Kapi\u0144ska-Mrowiecka M Kaszuba A Krasowska D Kr\u0119cisz B \u2026 Rudnicka L(2018 Chronic

Research patho week 4 assignmt.docx - Narbutt J...

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Narbutt, J., Bowszyc-Dmochowska, M., Kapińska-Mrowiecka, M., Kaszuba, A., Krasowska, D., Kręcisz, B., … Rudnicka, L. (2018). Chronic venous insufficiency - pathogenesis, diagnosis and pharmacological treatment. Diagnostic and therapeutic recommendations of the Polish Dermatological Society. Part II. Dermatology Review / Przeglad Dermatologiczny , 105 (4), 486–497. - org.ezp.waldenulibrary.org/10.5114/dr.2018.78070 Venous return from peripheral tissues back to the heart takes place via the venous and lymphatic sys- tems. Venous valves prevent reflux, i.e. the backflow of blood. Eighty percent of venous blood flows back to the heart through the deep vein system. The walls of venous vessels are very flexible, but it should be noted that flexibility declines as age progresses and, as a consequence, contributes to the development of chronic venous insufficiency. Peripheral venous pres- sure depends primarily on the position of the body and physical activity. Among a variety of mechanisms, a key role is attributed indisputably to venous return through incompetent valves, although it is not en- tirely clear whether this process is the primary cause of the disease or secondary to vein wall remodeling [1]. Probably, however, damage to venous walls and valves is a primary phenomenon leading to valve in- sufficiency and the development of reflux. Also con- sidered are connective tissue abnormalities resulting in venous lumen dilatation, associated with collagen and elastin changes, and altered secretion of metallo- proteinases and tissue inhibitors of metalloprotein- ases Another factor playing an important role in the development of the condition is inflammation followed by activation and dysfunction of endothelial cells through reduced synthesis of anti- inflammatory agents and elevated synthesis of proinflammatory and prothrombotic proteins Visible pathological changes in the vascular walls, their stretching and weakening also lead to valve insufficiency. Another factor contributing to ve- nous insufficiency of the lower limbs is metallopro- teinase-mediated proteolysis. In general, a disorder affecting these proteins and their tissue inhibitors results in structural changes in the vascular walls. Metalloproteinases have an ability to degrade col- lagen and elastin Research indicates that chronic venous insufficien- cy and all its manifestations are linked to changes in the extracellular matrix components, among other factors. Treatment Lifestyle modifications
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Chronic venous insufficiency patients should be advised to modify their lifestyle in order to reduce the venous pressure, promote venous contractions, acti- vate the venous pump and maintain proper ankle joint mobility. The simplest method is to extend the period of walking, as it lowers venous pressure, increases venous return and promotes tissue fluid reabsorption.
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