Blood Vessel and Lymphatic Disorders Flashcards
A 60 y/o male smoker presents with a 6 month history of impotence along with calf, thigh, and buttocks claudication. The femoralsare not palpable. Angiogram is shown. This man has a (an):
need pic, aorto iliac artery is occluded
aorto-iliac occlusion.
Treatment for artery occlusion
- Smoking cessation and BP control
- ASA and/or clopidogrel(Prevents MI, CVA , etc).
- Cilostazol(Pletal/phosphodiesterase type 3 inhibitor –inhibits platelet aggregation and dilates vessels) 100 mg BID
- Pentoxifylline(Trental/phosphodiesterase inhibitor with antihemorrheologicactivities) 400 mg TID
- Ramipril*
- Statin (rosuvastatin40 mg daily)
- Stent
- Axillo-femoral bypass; Aorto-fem bypass
- Intermittent calf compression. Angiogenesis with injection of mononuclear cells.`
antiplatelet drugs
aspirin thromboxane a2
Cilostazol Pentoxifylline kep 5amp from going to camp
P2Y12 signalling modulates thrombin generation
ADP feedback loop
A 60 y/o diabetic male presents with cramping pain in both calves with walking2-4 blocks. The femoral arterial pulses seem somewhat diminished in the groin, the left popliteal and left pedal pulses are diminished. The right pedal pulses are absent. The Ankle/Brachial index is 0.5 on the left and 0.1 on the right. There is no hair on the right toes and the patient has dependent rubor on the right. The patient most likely has severe occlusion of the
superficial femoral
higher the blockage the sooner you will
have pain
Ankle/Brachial index normal is
.9-1
If the profunduswere involved, the claudication would
occur much earlier
what artery would be the source of collateral network in pt with superficial femoral blocked
profundis
with profundus you could only walk
1-2 blocks
with superficial femoral you can walk
2-4 blocks
under what conditions would it have been possible to have a more normal ABI on the right (ie.8 or .9) and still have poor circulation?
When the vessels are calcified*as in diabetics. This does not allow
practical use of ABI and thus one must resort to wave form analysis.
failed reading with cuff
Osler’s sign or maneuver?
Pseudohypertension because
of calcified vessels.
falsely high
Treatment of superficial and common femoral and popliteal stenosis
- structured walking program
- Fem-pop bypass*
*absolute indication for surgery –rest pain and non-healing ulceration
A 55 year old man is seen for progressive bilateral leg and calf pain
with ambulation and relief with sitting down in a chair. History is positive for hypertension and the patient is on an ACE inhibitor. Physical examination reveals an S4. Present BP is 130/60. He has a “simian gait” and complains of worse pain with extension of his back and improvement with bending forward. Calves are tender.
Pedal pulses are questionably diminished. Which test will most likely be positive?
lumbar mri
Progressive narrowing of the spinal canal may occur alone or in combination with acute
disc herniations. Lumbar spinal stenosis (LSS) remains the leading preoperative diagnosis
for adults older than 65 years who undergo spine surgery.
s4
atrial kick from unrelaxed ventricle (ventricle is stiff so it makes noise going in)
bc hypertensive heart disease
why are pedal pulses diminished
bc dorsalis pedis may not be where it belongs
spinal stenosis may look like peripheral vascular disease but it gets better when
nerve pain from compression
Lumbar spinal stenosis
Absence of pain or improvement of symptoms when seated assists in ruling in LSS. Patients with significant lumbar spinal canal narrowing report pain, weakness, and numbness in the legs while walking. Compressed nerve roots become ischemic due to stenosis. This is the hallmark of neurogenic claudication. The pain is relieved when the patient flexes the spine by, for example, leaning on shopping carts or sitting. Flexion increases canal size. The most common nerve affected is the L5, with associated weakness of extensor hallucislongus. Neurogenic claudication pain is exacerbated by standing erect and downhill ambulation and is alleviated with sitting, squatting, and lumbar flexion.
Lumbar spinal stenosis Neurogenic claudication pain is exacerbated by
standing erect and downhill ambulation
Lumbar spinal stenosis Neurogenic claudication pain is alleviated with
sitting, squatting, and lumbar flexion.
Tibial and pedal artery occlusion A 45 y/o diabetic presents with burning, dorsal foot pain that is relieved by getting up or dangling the foot. How do you know this is not diabetic neuropathy? How is the diagnosis made? What is the treatment?
relieved by dangling
MRA.
Vein bypass to distal tibial or pedal arteries. (sometimes vessels cant take the pressure and they rupture when distal)
A 35 y/o male from south Africa presents with sudden onset painin the right lower extremity. The leg is pale, weak, and numb. The pedal pulses are absent and the foot is cold. The heart rhythm is irregular. What has happened?
Acute arterial occlusion of a limb
neuropathy bc no blood is getting down there
arteries feeding nerve are blocked and so you get numb
afib, he has thrown a clot
Acute arterial occlusion of a limb
A. 50% of cardiac emboli go to the legs.
B. With loss of light touch, surgery should be done immediately.
C. Before revascularization, NaHCO3should be administered. (lactic acidosis from hypoxia)
D. Cause is sometimes due to thrombosis.
E. Pedal pulse are not palpable.
6 Ps of acute arterial occlusion
Pain
Pallor
Paralysis
Paresthesias (most concerned about this one)
Pulselessness
Poikilothermia* (irregular temp, ice cold)
A 58 y/o hypertensive, diabetic, female presents with dizziness, diploplia, dysphagia, dysarthria, dysmetria, and ataxia of 50 minutes duration. The patient is having which type of an event?
Vertebro-basilar TIA
dizziness, diploplia, dysphagia, dysarthria, dysmetria, and ataxia
The Dsof VB TIAs
brainstem function having to do with these things
