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Cardiovascular system > Diseases of venous system > Flashcards

Diseases of venous system Flashcards

1
Q

State the Darcy’s law

A

Flow = pressure gradient / resistance, water flows down the pressure gradient

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2
Q

What is congestion?

A

It is accumulation of blood in vessels or tissue organs, it is passive process, happens because of something else

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3
Q

Give examples of congestion

A

Local acute -DVT, local chronic -liver cirrhosis, generalised acute - heart failure

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4
Q

What is the presentation of congestion?

A

Red, swollen, purple color

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5
Q

What is DVT and describe why congestion happens

A

Deep vein thrombosis, there is occlusion in the veins, blood backs up in the veins, venues and capillaries, there is reduced outflow of blood, the pressure gradient is reduced as the inflow pressure is large and the outflow pressure is increased, this overall flow across the system is reduced and this leads to ischaemia and congestion

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6
Q

Describe the congestion in hepatic cirrhosis

A

Severe liver damage from hep B and C and alcohol results in production of hyper plastic nodules, with a lot of fibrous tissue, it is caused by chronic inflammation, normal architecture of life is lost, because of the fibrous band the blood flow is reduced and this leads to congestion of portal circulation (drains gut and spleen)

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7
Q

What happens as a results of congestion of portal system?

A

collateral circulation is formed, several veins anastomose with the systemic circulation, consequences of portal shunts are oesophageal varies (haemorrhage risk), caput medusea (enlarged veins in groin, stomach above umbilicus )

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8
Q

Describe congestion in congenital heart failure

A

Heart is unable to pump blood around the body due to ventricular failure,, because of the reduced CO RAAS is activated, this leads to water and sodium retention, blood is not cleared from heart, this leads to back pressure in the venous system, the end result is fluid overload of systemic and pulmonary circulation

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9
Q

What are the signs of pulmonary convention?

A

pulmonary oedema with left heart failure, crackles, tachycardia

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10
Q

What are the signs of systemic circulation overload ?

A

right side heart, hepatomegaly, peripheral or sacral oedema, raised JVP

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11
Q

Describe the changes that occur in the liver in heart failure congestion

A

nutmeg appearance of the liver, red and pale spotty appearance macroscopically, pericentral hepatocytes looks red due to stasis of poorly oxygenated blood, periportal hepatocytes look white with relatively bettwe oxygenation due to proximity of hepatic arterioles

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12
Q

What is oedema ?

A

Accumulation of abnormal amounts of fluid in the extravascular compartment

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13
Q

What is called oedema in that cavity?

A

Effusion, but in abdominal cavity ascites

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14
Q

What is microcirculation?

A

Connective tissue around the vessels along with vessels, there is constant movement of fluid, it is driven by hydrostatic pressure created by heart, it is opposed by onctic pressure and permeability of the capillaries

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15
Q

Describe the dynamic equilibrium in the microcirculation

A

There is filtration at arterial end driven by hydrostatic pressure, there is reabsorption at venous end that is driven by oncotic pressure, the sequence is capillaries, interstitium and lymphatic system

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16
Q

What is Starling equation?

A

Describes the net flow of fluid

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17
Q

What does not fluid depend on ?

A

Net fluid depends on hydrostatic pressure, oncotic pressure and permeability of the endothelium

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18
Q

What is the pathology of oedema?

A

Disturbance in the equilibrium in the stealing equation, the biggest effect is due to hydrostatic pressure

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19
Q

What can cause the changes in haemodynamic forces?

A

cardiac failure fluid overload, produces transudate, lots of water and electrolytes, not much proteins, due to inflammation and change in the permeability , exudate is formed, it has high protein content, water and electrolytes

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20
Q

Describe pulmonary oedema

A

transudate formation due to changes in hydrostatic pressure, the cause is LV failure and back flow of the blood to the pulmonary circulation, there is increased hydrostatic pressure in the pulmonary vessels which leads to increased filtration, initially there is only perivascular and interstitial exudate, later infiltration to alveoli

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21
Q

Describe peripheral oedema

A

transudate formation in the periphery caused by increased hydrostatic pressure, caused RV failure, blood backs to systemic circulation, there is increased pressure which leads to increased filtration and oedema

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22
Q

Describe lymhoedema

A

transudate formation due to imbalance in hydrostatic forces as there is blockage in the lymphatic system, it is most commonly caused by radiotherapy to axilla in breast cancer, damage and fibrosis occurs, the outflow is reduced and oedema

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23
Q

Describe oedema caused by abnormal renal function

A

due to acute tubular damage caused by hypotension, or due to cardiac failure and reduced blood flow to kidneys, there is reduced renal function and therefore water and salt retention, increased intravascular volume and increased filtration

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24
Q

Describe oedema caused by low proteins in the blood

A

transudate is formed as there is reduced reabsorption and therefore increased net filtration, it is caused by hypoalbuminaemia, it decreases oncotic pressure, causes of low blood proteins are neurotic syndrome or malnutrition

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25
Q

Describe oedema caused by increased permeability

A

exudate is formed as the blood vessels become more leaky, there are bigger gaps in the endothelium and proteins, large molecules and water can escape, it is caused by inflammation, burns

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26
Q

Name the types of oedema

A

Due to imbalance in hydrostatic pressure there can be pulmonary, peripheral oedema, lymhoedema, other causes are abnormal renal function, hypoalbuminaemia, permeability oedema

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27
Q

What is the consequence of oedema

A

discomfort, pain, loss of function

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28
Q

What are the risk factors for DVT and PE ?

A

recent surgery, stasis of blood due to bed rest, travel, immobility, atherosclerosis, trauma, pregnancy, exogenous oestrogen, increasing age, obesity, smoking, cancer, thrombophilia, short or very tall, oral contraceptive pills

29
Q

What is Virchow’s triad?

A

Three components that need to be present for thrombosis, there needs to be stasis, vessels damage and change in blood components

30
Q

What is the difference between venous and arterial thrombus?

A

Arterial thrombus is white, composed of fibrin meshwork and platelets, result in ischaemia and infarction, venous thrombus is red, consists of fibrin meshwork and red blood cells

31
Q

What are the signs of DVT?

A

Unilateral limb swelling, redness, warmth

32
Q

What are the symptoms of DVT?

A

tenderness, warmth, persistent discomfort

33
Q

What are the possible complications of DVT?

A

PE, post-phlebitic syndrome

34
Q

What is post-phlebitic syndrome ?

A

Swelling, discomfort, pigmentation, redness and brownish colour, chronic pain, ulcers, long term problem

35
Q

What is factor V Leiden thrombophilia ?

A

It is genetic disorder of blood clotting factor V that causes increase in blood clotting, it is type of inherited thrombophilia caused by specific genetic mutation

36
Q

How is DVT diagnosed ?

A

Di dimer test, clinical assessment, compression ultrasound

37
Q

How can be DTV prevented?

A

early mobilisation, anti-embolic stockings, low molecular weight injection, at home compression stockings

38
Q

What is the treatment for DVT?

A

low molecular heparin, oral anticoagulants such as warfarin

39
Q

What are the signs of PE?

A

pleural rub, stony dull percussion, bleu lips and tongue, low BP, tachycardia, raised JVP, may cause altered heat sounds

40
Q

What are the symptoms of PE?

A

Pleuritic chest pain, dyspnoea, haemoptysis, milky white or pinky frothy sputum, collapse

41
Q

What are the investigations for PE ?

A

Bloods, Di dimer test, ventillation/perfusion scan, chest X ray, CT pulmonary angiography

42
Q

What are varicose veins?

A

Tortuous and dilated superficial viens, there is pooling of the blood as the valves that prevent back flow are damaged

43
Q

What are the risk factors for varicose veins?

A

Female, family history, age, occupation that involves long hours standing, pregnancy

44
Q

What are the signs of varicose veins?

A

Cosmesis as they are visible, swelling of the legs, skin changes such as eczema, superficial trhomophlebitis, acute haemorrhage, spider veins

45
Q

What are the symptoms of varicose veins?

A

localised or generalised discomfort, nocturnal cramps, pruritis,

46
Q

What are the investigations for varicose veins?

A

Examination, doppler scan (some blood is traveling in the wring direction )

47
Q

When should be varicose veins treated ?

A

Severe cosmesis, superficial thrombophlebitis, signs of chronic vein insufficiency, bleeding, anxiety, self confidence problems

48
Q

What are the possible teaming options ?

A

surgery, foam sclerotherapy, endogenous laser ablation, radio frequency ablation, compression and conservative therapies

49
Q

What is foam sclerotherapy ?

A

Injection of a saloon directly to vein that irritates the lining of the vessels, done under ultrasound control, the vessels collapse and stick together

50
Q

What is endogenous laser ablation ?

A

Micro puncture and laser is introduced under ultrasound guidance, damage to the veins, fibrosis will occur as a result of regeneration that will narrow down the vessels

51
Q

What is radio frequency ablation?

A

damage to the vessels by heat, again fibrosis occurs and the veins narrows down

52
Q

What are the advantages of minimally invasive treatments ?

A

reduction in surgical trauma, less brushing, scarring, less pain,reduced time of work, might be cost effective

53
Q

What is chronic venous insufficiency?

A

inadequate flow flow through veins causing blood pooling in the veins, it affects deep venous system

54
Q

What can cause chronic venous insufficiency ?

A

Most common causes are blood clots, varicose vein, inactivity, obesity

55
Q

What are the signs of chronic vein insufficiency?

A

ankle oedema, telangiectasia (spider veins), venous eczema, hypo pigmentation, lipodermatosclerosis, venous ulceration

56
Q

What is the pathology of chronic venous insufficiency ?

A

venous hypertension, venous engorgement and stasis, imbalance of starling forces and formation of fluid exudate

57
Q

What is the treatment of chronic vein insufficiency ?

A

compression and behavioural changes

58
Q

What is leg ulceration?

A

Breach in the skin below knee , there is epidermal loss, it is present for over 4 weeks

59
Q

What are the causes go leg ulcers ?

A

Venous insufficiency, chronic limb ischaemia, diabetes, rheumatoid arthritis, vasculitis, connective tissue disorders

60
Q

Describe ulcer of venous origin

A

Usually around the circumference , lower mid mid calf to malleolus, uneven edges, ruddy granulous tissue, no dead tissue, blood at the base of ulcer, moderate to no pain, pain is reduced by elevation, shallower but larger, other signs around might include oedema, atropine blanche, dermatitis

61
Q

Describe ulcer of arterial origin

A

Usually on toes and between, on the sole of the foot, anterior to lateral malleolus, little or no blood at the base, well defined edges, black or necrotic tissue, very painful, pain reduced on hanging down the feet, ichaemic signs around the ulcer

62
Q

What are the investigations for ulcers ?

A

bloods, ankle brachial pressure index, duplex scan

63
Q

What is the treatment for ulcers ?

A

high grade compression therapy, dressings, systemic and topical treatment, exercise, elevation of legs

64
Q

What is lymhoedema ?

A

Oedema caused by failure of lymphatic system, chronic condition

65
Q

What are the causes of lymoedema ?

A

primary caused by congenital malformations, defect in development of lymphatic system, secondary causes include malignancy, surgery, radical mastectomy, radiotherapy, infection such as TB, groin/acilla dissection

66
Q

What are the two types of lymhoedema?

A

Obliterates caused by blockage, or hyperplasia - large and dysfunctional glands

67
Q

What are the symptoms of lymhoedema?

A

aching, heavy feeling, difficulty moving, repeated skin infections, hards tight skin, folds development, fluid leaking through the skin, wart-like growth

68
Q

What is the treatment of the lymhoedema?

A

Elevation, manual drainage, compression

Cardiovascular system (18 decks)

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