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1st Year Medicine > Chronic Venous Disease And DVT. > Flashcards

Chronic Venous Disease And DVT. Flashcards

1
Q

What are varicose veins and what causes them?

A

Dilated, torturous, superficial veins due to transmission of deep vein pressure.

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2
Q

What is the epidemiology of varicose veins?

A

Around 30% of people age 18-64 but variable. Male female ratio varies. 80% have we bp and reticular veins. Age pregnancy and obesity are risk factors. Family history plays a part.

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3
Q

Why do we get varicose veins following a DVT?

What other conditions also do the same?

A

It increases deep vein pressure.

Deep vein obstruction and deep valve incompetence.

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4
Q

What are the complications of varicose veins?

A 
Bleeding and bruising.
Superficial thrombophlebitis.
Chronic venous insufficiency 
haemosidering deposits, 
lipodermatosclerosis and ulceration.
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5
Q

What are haemosidering deposits?

A

Hyperpigmentation on the skin caused by iron deposits. Caused by red cell leakage or red cell breakdown.

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6
Q

What is Lipodermatosclerosis?

A

Inflammation of subcut fat causing fibrosis and hard skin that may be red or brown. Can be acute or chronic and is caused by white cells.

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7
Q

What are the first aid steps for bleeding varicose veins?

A

Elevation and pressure.

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8
Q

What is thromboplebitis?

A

Inflammation of a vein caused by a blood clot. They are quite painful.

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9
Q

What is chronic venous insufficency?

A

Irreversible skin damage as a result of sustained ambulatory venous hypertension.

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10
Q

What are some causes of venous hypertension?

A 
Superficial reflux
Deep reflux - first degree or secondary to DVT.
Deep venous occlusion
Mixed superficial and deep disease.
Perforating vein reflux.
Abnormal calf pump.
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11
Q

What is superficial reflux and what veins does it usually effect?

A

Valve not working properly in the vein causing reflux. Usually long or short saphenous veins.

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12
Q

What two systems can cause an abnormal calf pump?

A

Can be MSK or neurological causes.

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13
Q

What 2 main issues do duplex scans focus on?

A

State of the deep veins e.g. Occlusion or incompetence.

Look for saphenofemoral or saphenopoliteal incompetence.

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14
Q

What management do we use of varicose veins?

A

Non interventional e.g. Info and stockings.

Interventional either surgical or not.

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15
Q

What are graduated compression bandages and what are they used for?

A

4 layers of bandaging used for ulcers.

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16
Q

What are graduation compression stockings used for and how many classes are there?

A

Used for ulcer prevention and symptomatic relief. Come in 4 classes with the fourth being of the highest pressure.

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17
Q

What contraindications are there for graduated compression devices?

A

Low ABPI.

18
Q

What interventional non surgical methods can we use to treat varicose veins?

A

Endovenous foam sclerotherapy. They inject foam to occlude the vessel.
Endovenous ablation mechanical, laser or thermal probe inserted causing thrombophlebitis.

19
Q

What surgical interventions do we have?

A

High tie, stripping or foam. Multiple stab avulsions.

20
Q

What are the complications of the interventions for varicose veins?

A

Thrombophlebitis, skin staying in, local ulceration, wound infection, nerve damage and recurrence.

21
Q

What is duplex scanning?

A

A colour Doppler.

22
Q

What are general risk factors for DVT?

A

Age, obesity, immobilisation for longer then three days. Pregnancy and the postpartum period. Major surgery in the last 4 weeks.
Long plane or car trips and varicose veins.

23
Q

What are the medical risk factors for DVT?

A

Cancer, previous DVT, CVA, acute MI. CHF, sepsis, nephrotic syndrome and inflammatory bowel disease.

24
Q

What is nephrotic syndrome?

A

Protein leakage from the kidneys.

25
Q

What are traumatic reasons for DVT?

A

Multiple trauma, CNS or spinal cord damage, burns and lower extremity fractures.

26
Q

What are the symptoms and signs of DVT?

A

Pain swelling, redness, heat, inflammation. Localised tenderness over deep veins.

27
Q

What system do we use to assess risk of DVT?

A

Pre test probability score - PTP.

28
Q

When is PTP scoring not valid?

A

If had previous DVT in the symptomatic leg and if pregnant.

29
Q

What probabilities of getting a DVT does the PTP give us?

A

Low 3% chance
Moderate 17%
High 75 % chance.

30
Q

What are a few examples of criteria on the PTP system?

A

Active malignancy
Calf swellings
Recently bedridden
IV drug use etc.

31
Q

What investigations do we do for DVT?

A

D dimers and imaging.

32
Q

What are D dimers?

A

Fibrin breakdown product. Not specific but can rule out damage.

33
Q

What is venous plethysomography?

A

Strain gauge wire around the affected limb, venous emptying by compression. If there is a fast refill time there isn’t much emptying and therefore a clot.

34
Q

What are the two DVT algorithms for diagnosis of DVT?

A

High PTP score, but neg D dimer and ultrasound = no DVT and we should consider another diagnosis.
High PTP score, pos d dimer, neg ultrasound = repeat assessment and repeat ultrasound later.

35
Q

What is the treatment of DVT?

A

Anti coagulation with LMWH and warfarin.

Compression stocking for up to 6 weeks.

36
Q

What can reduce the incidence of post phlebitic syndrome after treatment of DVT?

A

Grade 2 compression stocking for up to 5 years.

37
Q

What is plegmasia dolens?

A

DVT causing obstruction of arterial inflow.not is a severed DVT with a background of peripheral arterial occlusive disease. It is an emergency causing threat to life and limb.

38
Q

What is the treatment of phlegmasia dolens?

A

IVC filter, femoral arterial line, TPA intra arterially surgical review, decompression and amputation.

39
Q

What two venous systems do we have in the lower limbs and what vessels do they comprise?

A

Deep system - tibial, popliteal and femoral.

Superficial system - saphenous and perforators.

40
Q

What is the differential diagnosis of DVT?

A

Popliteal synovial rupture, superficial thrombophlebitis and calf cellulitis.

41
Q

What is a bakers cyst?

A

Popliteal synovial rupture.

42
Q

What are the different types of imaging we do for DVTs?

A

1st line ultrasound leg Doppler scan.

CT scan.

1st Year Medicine (64 decks)

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