A & V disease Flashcards
what do we use the doppler for?
to measure velocity and direction of flow
where r the superficial and deep veins located in our body? how is the pattern of flow between them orientated?
deep veins r w/in the muscles of the calf!
superficial veins r w/in the subcutaneous fat!
Flow is always superficial to deep!
the veins that go from superficial to deep r called________
perforating veins
the deep fascia is tightly adhered to the calf muscles,
why is this clinically important?
cuz when the muscles contract, they contract w/ in the compartment, the fascia is drawn in tight, and the pressure rises w/ in the compartment!
this rise in pressure compresses the deep veins and pushes the blood back to the heart!
if there was no fascial compartment, then there would be no compartment for the pressure to rise in!
what r the superficial veins of our legs?
which of the 2 veins is constant in our body?
describe its route
what is the clinical significance of the long saphenous vein being anterior to the medial malleolus ?
that if a patient is in shock, and their veins r all empty cuz theyre losing blood, if u need to find that vein, u will ALWAYS be able to see it in front of the MEDIAL MALLELOUS!
bc of the effectivness of the calf msucle pump, it reduces the pressure in lower limbs by 80 % during excersize!
ok
what r varicose veins? pathophysiology ?
describe their appearence?
swollen and enlarged veins that usually occur on the legs and feet.
vein wall is weak> dilates>valve cusps seperate causing regurgitation of blod.
They may be blue or dark purple and are often lumpy, bulging or twisted in appearance.
symptoms of varicose veins?
how do u releive them?
• Heaviness
- Tension
- Aching
- Itching
these symptoms occurs along the vein ITSELF
lie them down and put leg in an upward position
complications of Varicose Veins
why do they arise
can cause complications because they stop your blood flowing properly.
what is thrombophlebitis?
Phlebitis literally means ‘inflammation of a vein’ due to blood clotting inside it or the vein walls are damaged.
name the complication
describe its appearence?
Varicose eczema
- itchy
- red and swollen
- dry and flaky
- scaly or crusty
what is this complucation?
Lipodermatosclerosis
which causes your skin, usually around the calf area, to become hardened and tight, and you may find it turns a red or brown colour
what can lead to Venous ulceration?
VENOUS HYPERTENSION
what might cause ur calf muscle pump to fail?
- -contration failure>> due to obesity, immobility, reduced hip or ankle movement (maybe due toosteoarhtrids)
- deep vein incompetence
- superficial vein incompetence
explain the retrograde circuit u get if ur
if its competence, everytime blood ejected a proportion of blood keeps going back into the calf muscle pump, causing it to dilate> cant functions as a pump> venous hypertension> venous ulceration
Virchows triad
if its competence, everytime blood ejected a proportion of blood keeps going back into the calf muscle pump, causing it to dilate> cant functions as a pump> venous hypertension> venous ulceration
difference btw arterial thrombosis and venous thrombosis!
In arterial>> Changes in the lining of the vessel wall
In Venous>> Changes in the flow of blood
why does Stasis lead to Venous thrombosis?
u normally have to have some “else” combined with the stais for ex: surgery (trauma), oral contraceptive pill, dehydration, cancer
DVT
DVT usually occurs in a deep leg vein, a larger vein that runs through the muscles of the calf and the thigh.
• Produces an inflammatory response
– Calor
– Dolor
– Functio laesa
– Rubor
– Tumor
what r the Symptoms/signs of acute ischaemia
(6p’s)
how does an acute ischemic foot look like?
white
what is fixed mottling?
it’ll get patchy cyanosis,
bc w/ in that leg, there will be little areas where the blood in the capillaries o2 is used up> redcued Hb> if u press it it wont blanche! bc vessels r thrombosed> walls r broken down> no flow!
MUST AMPUTATE ASAP
chronic peripheral arterial disease divided into (2)
• Intermittent claudication (equivalent to stable angina)
• Critical ischaemia
– Rest pain (equivalent to unstable angina)
– Ulceration/gangrene (equivalent to myocardial infarction)
Define intermittent claudication
Pain in the muscles of the lower limb when walking / exercise
where is the femoral artery felt?
what 2 landmarks help locate the femoral pulse?
how to u palpate for the popliteal pulse?
how do u palpate for the Pedis pulses? where r they anatomically?
Dorsalis pedis> lateral to the extensor hallucis longus tendon
Posterior tibial> behind the medial mallelous!
what r we feeling for here?
Dorsalis pedis
what r we feeling for here?
posterioir tibial A.
what is rest pain? what causes it? how is it relieved?
Pain in the FOOT that comes on when the patient goes to bed.
The ischaemia is so severe that at rest the foot skin, muscles, bones are ischaemic at rest.
relieved by dangling the foot out of the bed (restoring gravity)
what happens if rest pain is untreated?
u get Dry Gangrene and ulceration!
what is the most common place for ulceration due to ischemia in the legs/foot?
blood supply in front of tibai is not so great> takes ages for it to heal
what type of occlusion is by far the commonest finding in patients with claudication ?
why do u get pain in ischemia?
When muscle is ischaemic the pH drops>>stimulates pain afferents (nociceptors) in muscle.
Substance P>>> a neuropeptide is released locally which then increases the sensitvity of pain afferents in muscle
