3. Peripheral Vasuclar Disease And Pulmonary Embolism

Question 1

How does a DVT cause a patient to present with a swollen tender leg

Answer 1

Outflow is blocked due to thrombus
Increase in hydrostatic pressure because blood is being pumped there but not released from there
This causes fluid to move out into the extrvascular space
Collateral blood flow= leg looks red
Hydrostatic pressure more than oncotic pressure

Question 2

What will a pateint with a DVT present with

Answer 2

Swollen tender leg
Tachycardic
Normal chest exam

Question 3

What is the Wells Criteria

Answer 3

Works out how likely a PE is by looking at factors such as signs of a DVT, tachycardia, imbbolisaton of pateint for past few weeks etc.

Question 4

What tests can you do to confirm a PE

Answer 4

CT pulmonary angiogram - radioopaqu dye injected into vessels so they show up white

Question 5

What treatment is given for a pulmonary embolism (PE)

Answer 5

Low molecular heparin - for breaking down embolus

Thrombolysis and anticoagulation considered

Question 6

Give a causes of hypercogauloability

Answer 6

Cancer 
Dehydration 
Obesity 
Over counter contraceptive pills 
FV Lieden 
HRT pregnancy

Question 7

What might a doctor do to asses for peripheral arterial disease

Answer 7

Reduced ankle brachial index = measures blood pressure of ankle and arm and compares
If reduced = problem with peripheral arterial system

Question 8

Initial treatment for peripheral arterial disease PAD

Answer 8

Exercise

Aspirin

Question 9

What test can be done to test for PAD

Answer 9

Magnetic resonance angiogram - injected with contrast to see vessels = might be able to see collateral blood vessels or bloackeg of major artery

Question 10

What can an unstable, ruptured plaque lead to

Answer 10

More sudden narrowing of lumen

-eg, in heart can lead to MI

Question 11

How does a narrow lumen cause tissue damage/ death

Answer 11

Reduced blood flow = ischamia = tissue damage/ death

Question 12

In PAD there is obstruction to what

Answer 12

INFLOW to the tissues

Question 13

Give some symptoms of PAD and why they occur

Answer 13

Due to reduced flow of nutrients to tissues:

• pale
• dry
• wasted muscles
• numb, weak legs
• ulcers on feet and legs that dont heal
• hair loss on legs n feet

Question 14

Symptoms of critical limb ischaemia

Answer 14

Severe pain in Lower limbs
Skin pale, shiny, smooth, dry
Loss of muscle mass in legs
Toe/ lower limb skin = cold, numb, red, black, swell, smelly pus

Question 15

Effect on peripheral tissues on VTE

Answer 15

Swelling
Dark
Tender

Question 16

Effect on peripheral tissues in PAD

Answer 16

Atrophy
Pallor
Pain