Arteries , Veins , Lymphatics Flashcards

1
Q

Causes of DVT

A

Virchows triad-inflammation, hypercoagualble , endothelial injury

Prothrombotic state
Genetic: factorV leiden and prothrombin gene mutation
Acquired : APAS

Cancer
Laong travel
Pregnancy
Hormone replacement
Surgery
Trauma
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2
Q

Most common acquired cause of thrombophilia

A

APAS

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3
Q

Pathophysiology of hypoxia in PE

A

Increased pulmonary vascular resistance due to vascular obstruction or platelet secretion of vasoconstricting neurohumoral agents such as serotonin. Release of vasoactive mediators can produce ventilation-perfusion mismatching at sites remote from the embolus, thereby accounting for discordance between a small PE and a large alveolar-arterial O2 gradient.

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4
Q

Effect of PE on heart

A

Pulmonary artery obstruction causes a rise in pulmonary artery pressure and in pulmonary vascular resistance. When RV wall tension rises, RV dilation and dysfunction ensue, with release of the cardiac biomarker, brain natriuretic peptide. The interventricular septum bulges into and compresses an intrinsically normal left ventricle (LV). Diastolic LV dysfunction reduces LV distensibility and impairs LV filling. Increased RV wall tension also compresses the right coronary artery, limits myocardial oxygen supply, and precipitates right coronary artery ischemia and RV microinfarction, with release of cardiac biomarkers such as troponin. Underfilling of the LV may lead to a fall in LV cardiac output and systemic arterial pressure, with consequent circulatory collapse and death.

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5
Q

C/f Of DVT

A
Calf pain
Tenderness
Erythema
Pitting edema
Collateral nonvaricose veins
Lungs
Dysnoea
Hemopytsis
Syncope
Hypotension
Cyanosis
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6
Q

Chest x ray findings of PE

A

A normal or nearly normal chest x-ray often occurs in PE. Well-established abnormalities include focal oligemia (Westermark’s sign), a peripheral wedged-shaped density above the diaphragm (Hampton’s hump), and an enlarged right descending pulmonary artery (Palla’s sign).

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7
Q

Dx imaging in DVT/PE

A

Same for both

Low probability-D-dimer (n:no DVT/PE , high:imaging
Moderate/high: imaging

IMAGING
DVT:doppler(if not dxtic: MR ,CT, phlebography)

PE
CT(if not dxtic:vantilation perfusion scan- doppler leg -TE ECHO,MR, angiography)
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8
Q

Leriche s syndrome

A

Claudication (buttocks, thighs and calves) + impotence in males

Artherosclerotic ds of aorta exending to iliac arteries

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9
Q

C/F in pwripheral artery ds

A

SYMPTOM
Intermittent claudication
Rest pain

SIGNS
Dec/absent pulse
Bruits
Muscle atrophy
Hair loss
Thickened nail
Smooth shiny skin
Reduced skin temp
Pallor /cyanosis
Ulcer/gangrene
Edema(if they keep their leg in dependant position on case of rest pain)
Ischemic neuropathy leading to numbness and hyporeflex
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10
Q

What is intermittent claudication

A

which is defined as a pain, ache, cramp, numbness, or a sense of fatigue in the muscles; it occurs during exercise and is relieved by rest. The site of claudication is distal to the location of the occlusive lesion.

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11
Q

Why is ankle pressure higher than arm

A

Due to pulse wave amplification

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12
Q

Fibromuscular dysplasia

A

Hyperplastic ds of small /medium sized vs

Renal and carotid a. mostly involved

on angiography STRING OF BEADS

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13
Q

Thromboangitis obliterans

A

is an inflammatory occlusive vascular disorder involving small and medium-size arteries and veins in the distal upper and lower extremities.

Men

Cigerette smoking

triad of claudication of the affected extremity, Raynaud’s phenomenon, and migratory superficial vein thrombophlebitis

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14
Q

Buergers ds

A

Thrombosngitis obliterans

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15
Q

Vs effected thromboangitis obliterans

A

Distal vessel like radial,ulnar ,tibial

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16
Q

Priciple causes of acute limb ischemia

A

Emboli(heart, aorta)

Thrombus(plaque rupture)

Dissection

Trauma(cathetars, puncture)

17
Q

Thoracic outlet compression syn

A

compression of the neurovascular bundle (artery, vein, or nerves) at the thoracic outlet as it courses through the neck and shoulder.

CAUSES
Cervical ribs
abnormalities of the scalenus anticus muscle
proximity of the clavicle to the first rib abnormal insertion of the pectoralis minor muscle

compress the subclavian artery, subclavian vein, and brachial plexus.

18
Q

Arterivenous fistula

A

Abnormal communications between an artery and a vein, bypassing the capillary bed,

congenital (embryonic vs)
acquired(trauma, hemodialysis)

C/F
Pulsatile mass
Inc temp
Thrill and bruit( continuosly for sys and diastole)
Chronic:venous insufficieny
Large: high output cardiac failure

Compression of a large arteriovenous fistula may cause reflex slowing of the heart rate (Nicoladoni-Branham sign)

19
Q

Raynauds phenomenon

A

episodic digital ischemia, manifested clinically by the sequential development of digital blanching, cyanosis, and rubor of the fingers or toes after cold exposure and subsequent rewarming.

PRIMARY /IDIOPATHIC
Cause:secondry causes excluded ,Due to stress/ emotion

SECONDRY
Collagen vascular diseases: scleroderma, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, polymyositis, mixed connective tissue disease, Sjögren’s syndrome

Arterial occlusive diseases: atherosclerosis of the extremities, thromboangiitis obliterans, acute arterial occlusion, thoracic outlet syndrome

Pulmonary hypertension

Neurologic disorders: intervertebral disk disease, syringomyelia, spinal cord tumors, stroke, poliomyelitis, carpal tunnel syndrome, complex regional pain syndrome

Blood dyscrasias: cold agglutinins, cryoglobulinemia, cryofibrinogenemia, myeloproliferative disorders, lymphoplasmacytic lymphoma

Trauma: vibration injury, hammer hand syndrome, electric shock, cold injury, typing, piano playing

Drugs and toxins: ergot derivatives, methysergide, β-adrenergic receptor blockers, bleomycin, vinblastine, cisplatin, gemcitabine, vinyl chloride

20
Q

Where does raynauds phenomenon occur

A

Fingers and toes only

21
Q

Color change in raynauds phenomenon

A

Sequential

White

Blue

Red

22
Q

Acrocyanosis

A

arterial vasoconstriction and secondary dilation of the capillaries and venules with resulting persistent cyanosis of the hands and, less frequently, the feet.

Differentiating from raynauds
1. No ulcer, pain , gangrene

  1. Persistant , not episodic
  2. Presence of normal pulses
23
Q

Livedo reticularis

A

localized areas of the extremities develop a mottled or rete (netlike) appearance of reddish to blue discoloration

24
Q

Pernio

A

Pernio is a vasculitic disorder associated with exposure to cold

. Raised erythematous lesions develop on the lower part of the legs and feet in cold weather

They are associated with pruritus and a burning sensation, and they may blister and ulcerate.

25
Q

Erythromelalgia

A

Burning pain
Erythema of extremities
Feet more
Ppted by exposure to warm env

26
Q

Frostbite

A

tissue damage results from severe environmental cold exposure or from direct contact with a very cold object. Tissue injury results from both freezing and vasoconstriction. Frostbite usually affects the distal aspects of the extremities or exposed parts of the face, such as the ears, nose, chin, and cheeks.

27
Q

Varocose veins

A

Dilated
Bulging
Tortuous veins

28
Q

Causes of varicose veins

A
PRIMARY:Superficial system
Defect in valve
Wall
Pregnancy
Standing
Obesity
Aging
Hormonal therapy

SECONDRY: deep and perforators
venous hypertension, associated with deep venous insufficiency or deep venous obstruction, and incompetent perforating veins that cause enlargement of superficial veins. Arteriovenous fistulas also cause varicose veins in the affected limb.

29
Q

C/F of varicose veins

A

Asymtomatic

Cosmetic

Rupture/bleeds

Dull ache/throbbing/heaviness/pressure sensation , relived by LEG ELEVATION

Cramping

Burning

Pruritis

Leg swelling

Skin changes:
Hyperpigmentation
Erythema
Eczema
Lipodermatosclerosis(induration, hemosidrin, inflammation)
Atrophie blanche(white patch of scar)
Phlebectasia corona(fan shaped patter of intradermal veins)

30
Q

Diagnostic test for varicose veins

A

Doppler

31
Q

Causes of lymphedema

A

Primary
Sporadic (no identified cause)

Genetic disorders 
Milroy’s disease
 Meige’s disease
 Lymphedema-distichiasis syndrome Cholestasis-lymphedema
 Hypotrichosis-lymphedema-telangiectasia Turner’s syndrome
 Klinefelter’s syndrome
 Trisomy 13, 18, or 21
 Noonan’s syndrome 
Klippel-Trénaunay syndrome
 Parkes-Weber syndrome 
Hennekam’s syndrome
 Yellow nail syndrome 
Intestinal lymphangiectasia syndrome Lymphangiomyomatosis Neurofibromatosis type 1

SECONDRY
Infection
Bacterial lymphangitis (Streptococcus pyogenes, Staphylococcus aureus) Lymphogranuloma venereum (Chlamydia trachomatis)
Filariasis (Wucheria bancrofti, Brugia malayi, B. timori)
Tuberculosis

Neoplastic infiltration of lymph nodes Lymphoma
Prostate
Others

Surgery or irradiation of axillary or inguinal lymph nodes for treatment of cancer

Iatrogenic 
Lymphatic division (during peripheral bypass surgery, varicose vein   surgery, or harvesting of saphenous veins)
32
Q

Primary and secondry lymphedema

A

PRIMARY
Agenesis
Hypoplasia

SECONDRY
acquired condition that results from damage to or obstruction of previously normal lymphatic channels.

33
Q

C/F in lymphedema

A
Painless
Dull, heavy sensation
Edema(initially pitting then nonpitting:due to laying down of adipose tissue and collagen)
Thickening of skin
Peau d orange
Woody texture
34
Q

Difference bw primary and secondry lymphedema in lymphoscintihraphy/angiography

A

primary lymphedema:
lymphatic channels are absent, hypoplastic, or ectatic.

secondary lymphedema:
lymphatic channels often appear dilated beneath the level of obstruction.

35
Q

Classification of pulmonary hypertension

A
WHO GROUP 1/PULMONARY ARTERIAL HTN
mPAP:_>25mm Hg
PCWP:_<15
Transpulmonary gradient: elevated
Pul vascular resistance: elevated
Causes:
IPAH
Hiv
Connective tissue ds(systemic sclerosis)
Portal htn
WHO GROUP 2/PUL HTN ASS WITH LEFT HEART DS
mPAP:inc
PCWP:inc
Transpulmonary gradient: normal
Pul vascular resistance: normal

Causes:
Left heart systolic dysfxn
Valvular ds

WHO GROUP 3/PUL HTN ASS WITH LUNG DS

Causes:
COPD
Interstitial lung ds
Sleep disordered breathing

WHO GROUP 4/PUL HTN ASS WITH CHRONIC THROMBOEMBOLIC EVENT

WHO GROUP 5/PUL HTN WITH MULTIFACTORIAL MECHANISM

Causes:
Sickle cell
Sarcoidosis

36
Q

Pathogenesis of pulmonary arterial htn

A

Pulmonary arterial capillary remodelling marked by initimal fibrosis , increased medial thickness , pul arteriolar occlusion and classic plexiforn lesion

37
Q

Rx of pulmonary htn

A

PROSTANOIDS
Prostacyclin (PGI2) activates cyclic adenosine monophosphate (cAMP)-dependent pathways that mediate vasodilation. PGI2 also has antiproliferative effects on vascular smooth muscle and inhibits platelet aggregation.

ENDOTHELIN RECEPTOR ANTAGONISTS

PHOSPHODIESTRASE TYPE 5 INHIBITOR