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CVS > 13. Peripheral Arterial And Venous Disease > Flashcards

13. Peripheral Arterial And Venous Disease Flashcards

1
Q

What direction is venous blood flow in the lower limbs?

A

Superficial to deep

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2
Q

What structure are deep veins found in in the lower leg?

A

Muscle

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3
Q

What structure are superficial veins found in in the lower limb?

A

Fat

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4
Q

What does the external iliac vein become as you move down the leg?

A

Femoral vein, popliteal vein.

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5
Q

What part of the left does the long saphenous vein run down?

A

Medial

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6
Q

What part of the leg does the short saphenous vein run down?

A

Lateral

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7
Q

Where can you always find a vein as there is no anatomical variation form person to person?

A

Long saphenous vein anterior to the medial malleolus

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8
Q

How does the calf muscle pump work?

A

Deep veins and perforator beings lie in muscle, so when muscle contracts pushes blood into deep vein and upwards, towards the heart.

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9
Q

What is the definition of varicose veins?

A

Tortuous, twisted, or lengthened veins

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10
Q

What causes varicose veins pathophysiologically?

A

Vein wall is inherently weak, leads to dilation and separation of valve cusps, so become incompetent.

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11
Q

What are the 4 main symptoms of varicose veins?

A

Heaviness, tension, aching, itching.

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12
Q

When the symptoms of varicose veins are along the vein itself, what is this significantly associated with?

A

Trunk varices.

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13
Q

What 2 complications can result from the varicose vein itself?

A

Haemorrhage.

Thrombophlebitis.

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14
Q

What 5 complications can result form venous hypertension (which then leads to varicose veins)?

A 
Oedema.
Skin pigmentation.
Varicose eczema.
Lipodermatosclerosis.
Venous ulceration.
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15
Q

What is thrombophlebitis?

A

Venous thrombosis producing inflammatory response including pain.

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16
Q

What happens to fat in lipodermatosclerosis?

A

Fat becomes really hard.

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17
Q

What leads to venous ulceration?

A

Venous hypertension

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18
Q

What is venous hypertension a result of?

A

Calf muscle pump failure

19
Q

What are the 3 main causes of calf muscle pump failure?

A

Failure of calf muscle contraction eg immobility, obesity.
Deep vein incompetence.
Volume overload - superficial vein incompetence.

20
Q

How does superficial vein incompetence lead to calf muscle pump failure?

A

If valve at branch between deep and superficial vein incompetent, then when blood enters deep veins from superficial via perforating vein, and calf muscle pump pushes blood upwards towards heart, some leaks back into superficial vein via incompetent valve. Over time pooling to blood and calf muscle pump failure.

21
Q

What is Virchow’s triad and what are the 3 components? What type of thrombosis does each lead to?

A

3 broad categories of factors that are thought to contribute to thrombosis.
Changes in the lining of the vessel wall - arterial thrombosis.
Changes in the flow of the blood - stasis leads to envoys thrombosis.
Changes in the constituents of blood.

22
Q

Give 2 examples of other factors, which usually one needs to be present with stasis to lead to venous thrombosis.

A

Surgery, oral contraceptive pill, dehydration, cancer.

23
Q

In which vein does DVT usually occur?

A

Popliteal vein

24
Q

What does arterial thrombosis in response to bleeding involve? Wherefore what are arterial thrombi rich in?

A

Vasoconstriction, platelets, extrinsic then intrinsic pathway.
Rich in platelets.

25
Q

What does venous thrombosis in response to bleeding involve? Wherefore what are venous thrombi rich in?

A

Venoconstriction, intrinsic pathway then extrinsic (does not involve platelets in a major way).
Fibrin rich.

26
Q

What type of response does DVT cause?

A

Inflammatory response

27
Q

What are the 3 main symptoms of DVT?

A

Pain (cannot walk).
Swelling.
Blue-red skin discolouration.

28
Q

Give 5 signs of DVT

A 
Calf tenderness.
Muscle induration.
Skin warmth.
Skin discolouration.
Distended, warm superficial veins.
Oedema.
Pyrexia.
29
Q

Why is there an association between surgery and DVT?

A

Immobility prior to and after surgery.
No calf muscle pump during surgery.
Surgery is trauma, body responds with prothrombotic state.

30
Q

What is a fatal consequence of DVT??

A

PE

31
Q

What happens in acute limb ischaemia? What does this lead do?

A

No chance for collateral development was limb does from normal to greatly impaired blood supply in period of minutes. Therefore if not reversed within 6 hours the limb cannot be recovered and if not amputated the patient will die (hyperkalaemia due to dead tissue releasing intracellular potassium leading to cardiac asystole).

32
Q

What are the 2 commonest causes of acute limb ischaemia?

A

Embolism (from heart of AAA).

Trauma.

33
Q

Name 4 signs/symptoms of acute ischaemia

A

Pain, paralysis, paraesthesia, pallor leading to patchy cyanosis (blanching) and then fixed mottling (nonblanching), perishing cold, pulseless.

34
Q

What are the 2 main signs/symptoms seen with chronic peripheral arterial disease?

A

Intermittent claudication - of calf muscles usually, pain relieved rapidly by stopping exercise for a few minutes, even whilst standing up.
Leads to:
Critical ischaemia - rest pain, leads to: ulceration/gangrene.

35
Q

What is the definition of claudication?

A

Pain in the muscles of the lower limb elicited by walking/exercise.

36
Q

Where is the femoral pulse felt?

A

Common femoral artery at mid-inguinal point (midway between pubic symphysis and anterior superior iliac spine)

37
Q

What 2 pulses can be felt in the foot (pedal pulses)? Where is each found?

A

Dorsalis pedis artery - anterior foot, lateral to extensor hallucis longus tendon.
Posterior tibial artery - posterior to medial malleolus.

38
Q

What symptoms are seen in aortoiliac occlusion? Why is it rare?

A

Bilateral buttock, thick and calf claudication, absent lower limb pulses.
Rare as usually chronic and collaterals develop.

39
Q

What symptoms are seen in common iliac occlusion? How common is it?

A

One-sided buttock, thigh and calf claudication. Absent one-sided lower limb pulses.
Not very common.

40
Q

What symptoms are seen in common femoral occlusion? How common is it?

A

One-sided thigh and calf claudication, absent right lower limb pulses.
Not very common.

41
Q

What symptoms are seen in superficial femoral artery occlusion? How common is it?

A

One-sided calf claudication. Femoral pulse present, absent popliteal and pedal pulses.
Commonest finding in patients with claudication.

42
Q

What is rest pain?

A

Occurs in critical ischaemia. Pain in the good that comes on when the patient goes to bed. Relieved by hanging foot out of bed. Ischaemia is so severe that not enough oxygen to provide for the cells basic metabolic requirements.

43
Q

What does rest pain progress to if left untreated?

A

Gangrene and ulceration

CVS (14 decks)

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