1/2 Flashcards
1
Q
aneurysm
- define
- age/ sex
- cause
- RF
- patho
- symptoms
- signs
- Ix
- classification
- Mx
- complications
A
define
- dilation >3cm
age/ sex
- 5% males >60yrs
- 60% abdo, 40% thoracic aortia
- iliac aa, femoral aa, circle of wilis
RF
- ehlors-danlos
- marfans
- HTN
- hypercholesterolaemia
- atherosclerosis
- trauma
- infective endocarditis, syphilis
- berry aneurysm
- rupture - smoker, HTN, female, fhx
symptoms
- asymptomatic
- rupture - hypotension, shock, loin to grain radiation, severe/ continuous epigastric pain, expansile mass
signs
- different BP in arms
- shock - hypotension, tachycardia
Ix
- CT chest
- every male >65yrs
classification
- <3cm - normal
- 3-4.4 - small, re-scan 12M
- 4.5-5.4 - medium, re-scan 3M
- > 5.5 - large, refer to vasc
Mx
- rupture - A-E, theatre
- unruptured - rescan, modify lifestyle
- surgery if - >5.5cm, growing >1cm/yr, symptomatic - EVAR (femoral aa and stent)
complications
- rupture - death
- pressure on surrounding organs
- emboli - mural thrombi
2
Q
aortic dissection
- define
- cause
- RF
- symptoms
- signs
- Ix
- classification
- Mx
- complications
A
define
- rupture through intima to media, blood travels through media
cause
- HTN, hypercholesterol
RF
- aortic valve replacement, bicuspid aorta, coartation of aorta, CABG, ehlos-danlos, marfan, atheroma
- wt lifting, cocain use
symptoms
- tearing pain radiating down back
- sudden onset, central
- shock, hypotension
signs
- differences in BP in arms
- radial pulse deficit
- focal neuro deficit - limb weakness, paraestheisa
Ix
- CXR - wide mediastinum
- CT angiogram
- MRI angiogram, ECG
classification
- type A and B - A ascending and b not ascending
- DeBakey - type I all and at least aortic arch, II ascending, III descending above diaphragm, IV descending above and below diaphragm
Mx
- A-E
- ITU if SBP 100 with IV esmolol
- type A - sx if risk of tamponade
- type b - med
complication
- tamponade
- two channeled aorta
- coronary aa - MI
- brachiocephalic/ common carotid/ subcv - difference in BP in arms
- iliac - acute lower limb ischaemia
- SMA - acute mesenteric ischaemia
3
Q
DVT
- define
- cause
- RF
- patho
- symptoms
- signs
- Ix
- classification
- Mx
- complications
A
4
Q
acute aa limb disease
- define
- cause
- RF
- symptoms
- signs
- Ix
- classification
- Mx
- complications
A
define
- insufficient o2 supply to limb
cause
- thrombi - 85%
- emboli - 15%
- trauma
RF
symptoms
- thrombus - gradual, collaterals
- emboli - sudden, no collaterals
- 6Ps - perishingly cold, pulseless, pallor, paraesthesia, paralysis, painful
Ix
- dupplex USS
- CT angiogram
classification
- viable or non-viable
- non-viable - fixed staining, ridig mm
Mx
- within 6hrs
- Iv heparin
- analgesia
- reperfusion injury - compartment syndrome
Mx - embolus
- embolectomy and fogarty catheter
Mx - thrombus
- thrombolysis
- thrombectomy
5
Q
chronic aa limb disease
- define
- cause
- symptoms
- signs
- Ix
- classification
- Mx
- complications
A
define
- insufficient O2 supply
cause
- buerger’s disease - young male smoker, inflam and thrombosis of aa
- emboli, thrombus
- fibromuscular dysfunction
symptoms
- pale, pallor, dependent rubor, poor wound healing, mm wasting, hair loss, ulcers
- ic - pain in leg at certain distance, relieved by rest
- pain in bum/ thigh if ileal pain, pain in calf is femoral, penile dysfunction is leriche’s
- leriches - distal aa or prox common iliac aa - pain in thigh/ bum, impotence, absent femoral pulse
- ci - swing leg out of bed at night to relieve pain
signs
- xanthomata
- tar staining
- CVD - midline sternotomy, graft on arm or leg
- weak distal pulses
- De temp and sensation of skin
- IN CRT
Ix
- buerger’s test - buerger’s angle - white, blue then rubor
- ABPI - >1.3 DM, 0.9-1.3 normal, 0.6-.9 mild, 0.3-0.6 mod, <0.3 critical
classification
- asymptomatic
- intermittent claudication
- critical limb ischaemia
- ulceration > gangrene
Mx
- conservative - exercise, lifestyle
- med - atorvastatin 80mg and clopidogrel 75mg
- sx - endartectomy, EVAR, bypass
- critical limb - urgent vasc for EVAR, endartectomy or bypass
