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Lucy Knox - Year 2.5 > 226 - Varicose Veins > Flashcards

226 - Varicose Veins Flashcards

1
Q

What is a varicose vein?

A

Enlarged and twisted vein

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2
Q

Which veins are varicose veins most common in?

A

90% Long saphenous vein (medial side)

Rest usually short saphenous vein

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3
Q

What symptoms can you get with Varicose veins?

A

Mostly cosmetic
painful, achy, heavy when standing for long periods
Restless leg syndrome

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4
Q

What complications can varicose veins cause? (7 things)

A 
Chronic venous insufficiency -> oedema
Thrombophlebitis
Hamorsiderin staining
Varicose eczema
leg ulcers
Haemorrhage
Lipodermatosclerosis
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5
Q

What is lipodermatosclerosis?

A

Skin hardness due to s/c fibrosis, inflammation and necrosis of s/c adipose tissue

  • pain, brownish-red staining
  • inverted champagne bottle leg
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6
Q

What causes varicose veins?

A

Primary cause unknown
? age (veins loose elasticity)
? imobility / standing (no muscle pump)
? female - progesterone effect on vessel walls

Secondary - impaired flow from deep system

  • DVT
  • Abdominal mass
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7
Q

Describe the process of varicose vein formation

A

Valvular incompetance, reflux, hypertension -> stress distally

or, cellular and ECM changes -> vein wall weakens - venous dilatation - valvular incompetance

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8
Q

What are the 5 key treatment options for varicose veins?

A 
Surgery - strip vein
Radiofrequency ablation
EVLT - Endovenous laser treatment
Foam sclerotherapy
Compression therapy
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9
Q

What can be done if there are leg ulcers caused by arterial ischaemia?

A

Bypass surgery of artery

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10
Q

What is chronic oedema?

A

Oedema lasting more than 3 months

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11
Q

What are the 4 key types of chronic oedema?

A

Lymphovenous
Dependancy
Lipoedema
Lymphodema

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12
Q

Describe lymphovenous oedema

A

A lymphatic overload
Venous system pathology causing increased capilary filtration
s/c tissues are soft and pitting
oedema reduces with elevation

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13
Q

What tissue changes can be seen in lymphovenous oedema?

A 
Haemosiderin staining
Ulceration
varicose eczema
Lipodermatosclerosis
Telangicetasia
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14
Q

What is dependancy oedema?

A 
A lymphatic overload
Gravitational
Occurs in dependant, immobile limbs
reduced venous return -> increased cap filtration
Often people with comorbidities
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15
Q

What tissue changes are seen in dependancy oedema?

A

Translucent skin
Wet legs - lymph leaks
Shiny
soft + pitting

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16
Q

What is lipodema?

A 
A lymphatic overload
Symmetrical fatty deposits occur
? disterbed venous function
? normal lymph system
But lymph transport capacity is reduced -
> backlog
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17
Q

What is lymphoedema?

A

Oedema with a normal lymph load

There is normal capillary filtration but reduced lymphatic drainage - so increased protein conc

18
Q

What are the primary causes of lymphoedema?

A

Congenital - aplasia, hypoplasia, valvular incompetance

Herediatory - milroy’s

19
Q

What are the secondary causes of lymphoedema?

A 
Parasitic - filleriasis (blocks lymph ducts)
Obstruction of vessels
Trauma
Cancer - lymph clearance
Infection
Venous disease
Immobility
20
Q

What signs are seen in lymphoedema?

A 
Tickened, non-pitting s/c tissue
Dry and flaky skin
Doesn't reduce with elevation
Limb misshapen
Aching and heaviness
Altered sensation on skin
21
Q

What are the management approaches for lymphoedema?

A

Skin care
Multi-layer bandaging
Exercises
Weight management

22
Q

When is lymphatic damage suspected in an oedematous limb?

A

When the swelling doesn’t resolve overnight or with elevation

23
Q

Which vessels make up the microcirculation of the body?

A

Arterioles, capillaries, vennules

24
Q

What are the functions of the microvessels?

A

Transport, convection, diffusion

25
Q

Who first produced the evidence that microvessels existed?

A

Harvery - discovered circulation

Malpighi - Saw microvressels first in frog lung capillaries

26
Q

What species/part was studied to discover the organisation of microvessels?

A

Rat cremaster muscles

27
Q

What is vasomotion of microvessels?

A

The intermittancy of flow.
Terminal arterioles open and close
Allows for fluid reabsorption

28
Q

What are the 3 structural types of capillaries and where are they found?

A

Continuous - flattened, wrap around junction, in skin, lung, muscle.
Fenestrated - have windows in cells to increase filtration - choroid plexus, GI mucosa, glands
Discontinuous - gaps (100nm) between cells - BM, spleen, liver

29
Q

What is the diffusional permeability relationship?

A 
Js = -PS x Conc change
A variation of flicks law
P=permeability depends on what substance is crossing
s= surface area
Js = diffusion rate
30
Q

What are the differences in permeability of lipid soluble, water soluble and larger solutes, and what does this mean?

A

Lipid soluble (eg. O2) - high perm - as expected as lipid bilayer

Water soluble (glucose, hormones) - high perm - higher than expected if just a lipid bilayer - there must be water filled channels - Small pore system?

Larger solutes - reduced permeability - different sizes have different permeabilities - molecular sieving with limit of about 5nm. But some larger ones do get through - large pores too?

31
Q

Describe the mechanisms that enable different solutes to diffuse across a capillary wall

A

Lipophilic - transcellular diffusion

Water soluble - Intracellular small pores + fenestrations

LArge solutes - Endothelial gaps of inflammation, transendothelial channels (large pores), vesicular transport

32
Q

What is the glycocalx in a capillary?

A

How sieving works?

A carbohydrate polymer that excludes larger proteins - so they can’t get close to the capillary wall to try get across.

33
Q

How do we explain small pores existing in capillary walls?

A

Clefts between cells
Despite tight junctions occuring between cells, there are small clefts between that could form channels.

They are slightly too big so the glycocalx acts as a sieve

34
Q

How does fluid cross vessel walls?

A

By convection across microvessel walls

35
Q

What principle is applied to fluid movement across vessel walls?

A

Starlings principles

Tissue fluid balance - most well perfused capillaries filter fluid along their length

36
Q

How much fluid is taken up by the lymphatic system a day?

A

8L / day

37
Q

What are the 2 mechanisms that cause oedema?

A

Reduced lymphatic drainage

Increased cap filtration rate

38
Q

What 3 mechanisms can increase cap filtration rate?

A

Increased capillary pressure (heart failure in lungs)
Reduced oncotic pressure (plasma proteins lost through kidneys - kidney or liver diesase)
Increased hydrolic permeability (inflammation - larger gaps)

39
Q

What pressure changes are seen int he leg veins when we stand up?

A

Pressure increases from 10 mmHg to 90 mmHg

40
Q

When muscle pumps are working when standing what pressure is in the leg veins?

A

10 mmHg

41
Q

If the leg veins have incompetent valves, what is the pressure in them on standing even with muscle pump action

A

60 mmHg

Lucy Knox - Year 2.5 (15 decks)

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