Angiogenesis, lymphatics and oedema

Question 1

Examples of pathological neovascularisation:

Answer 1

Tumour, retinopathies
Psoriasis, RA
Plaque progression
Restenosis
Endometreosis
Vascular malformations

Question 2

What mechanical factor drives arteriogenesis?

Answer 2

Flow shear stress

Question 3

Definition of erythema?

Answer 3

Redness of skin or mucus membranes in superficial capillaries

Question 4

Angiogenic promoters:

Answer 4

VEGF, FGFs, angiopoietins (relative concentration dependent)

Question 5

Angiogenic inhibitors:

Answer 5

Angiopoietins
Angiostatin
Troponin I
Integrins beta3
IL-12

Question 6

What happens at the level of the inguinal ligament?

Answer 6

The external iliac becomes the common femoral artery

Question 7

What is the autonomic response to necrosis?

Answer 7

Vasodilation of surrounding capillaries causing mummification and surrounding erythema

Question 8

Definition of claudication?

Answer 8

Cramping pain in the leg induced by exercise due to obstruction of arteries

Question 9

What can follow claudication?

Answer 9

Rest pain then gangrene

Question 10

Sign that leg oedema is caused by heart failure?

Answer 10

Bilateral (both legs) with raised JVP

Question 11

Sign that leg oedema is caused by a DVT?

Answer 11

Only present in one leg

Question 12

Other causes of leg oedema?

Answer 12

Dependancy/immobility
Pregnancy - central veins compressed
Low plasma proteins
Chronic venous insufficiency
Lymphatic insufficiency
Chronic renal failure

Question 13

Differences between transudate and exudate?

Answer 13

Transudate contains little protein and comes as a result of increased hydrostatic pressure/decreased colloid pressure as liver synthesises less protein
Exudate contains cells, proteins and is inflammatory in nature from a leaky epithelium - readily clots due to fibrinogen

Question 14

Syndromic causes of primary lymphoedema?

Answer 14

Turner’s
Noonan’s
Prader-Willi’s

Question 15

Overgrowth, vascular or cutaneous cause of primary lymphoedema?

Answer 15

Klippel-Trenaunay

Question 16

Congenital cause of primary lymphoedema?

Answer 16

Milroy’s - VEGFR3 mutation - onset is typically <1 year old, is present at birth and is bilateral

Question 17

Late onset cause of primary lymphoedema?

Answer 17

Lymphoedema distichiasis (FOXG2 mutation)
Late onset >1 year old
Typical presentation is a teenager with double rows of eyelashes

Question 18

Causes of secondary lymphoedema:

Answer 18

RT (axillary)
Surgery (groin LN resection)
Cellulitis (destroys lymphatics)
Filariasis (helminths parasite that destroys lymphatics)

Question 19

Management of oedema?

Answer 19

Treat cause
Elevation
Compression
Massage
Skin care
Liposuction

Question 20

Danger of compression in oedema?

Answer 20

Can cause ulcers
Must check pedal pulses, cap refill and ankle-brachial pressure index to see occlusions or duplex of the leg to observe disease distribution

Question 21

Why can you not perform ankle-brachial pressure index on diabetics?

Answer 21

Because their vessels are stenosed and calcified so their vessels can’t be compressed and their pressure indices will be falsely high

Question 22

What is the Charles procedure?

Answer 22

Removing all tissue down to the fascia and skin grafting legs

Question 23

What is the Homann’s procedure?

Answer 23

Keeping skin flaps, debulking and suturing