DVT, lympahtic and venous disease Flashcards
what % of the population do varicose veins effect
1/3
what is a varicose vein
a vein that is dilated and twisty
often superficial
most commonly in the lower limbs
what are the risk factors of varicose veins
age - older
female
pregnancies
DVT
standing for a long time (occupation)
family history
what is the pathophysiology of varicose veins
damaged valves - lead to more incompetence distally and a build up of blood
what can cause damage to the valves
surgical or trauma
DVT
hormonal changes - pregnancy - weaken valves
how do you diagnose a varicose vein
burning itching heaviness swelling discolouration
ulceration - in extreme circumstances
what are some investigations that can be carried out
ultrasound the valves
what is the management of varicose veins
1st - endovenous treatment
2nd - ultrasound guided sclerotherapy
3rd - open surgery
what is endovenous treatment
when the LSV or SSV is cannulated under ultrasound
the catheter causes irritation to the venous wall and occludes the vein
what is the LSV
lesser saphenous vein
what is the SSV
small saphenous vein
how are the veins occluded
fibrosis of the venous wall
what is foam sclerotherapy
under ultrasound chemical foam is injected into the affect vein
what dose open surgery do for varicose veins
the vein is striped out and removed
what is chronic venous insufficiency
failure calf muscle pump
superficial/ deep venous reflux
venous obstruction
what are the symptoms of chronic venous insufficiency
oedema
eczema
hypopigmentation
ulceration
how do you treat chronic venous insufficiency
exclude arterial disease
wound care
elevation
compression bandaging
what is the pathology of primary lymphedema
congenital
around puberty
what is the pathology of secondary lymphedema
malignancy
surgery
infection
what is the treatment of lymphedema
elevation
drainage
what can cause venous obstruction
heart failure
portal hypertension
obesity
what are venous ulcers
Breach in the skin between the knee and ankle joint, present for >4 weeks
what is the different between arterial and venous thrombosis
caused by stasis and hypercoaguality
causing back pressure
what is the definition of embolism
Intravascular material that migrates from its original location to a distal vessel
E.g: blood clot, fat, air, tumour
what is the definition of thromboembolism
Movement of blood clot along a vessel
what are examples of venous thromboembolisms (VTE)
DVT
PE
what are the risk factors of VTE
surgery
obstetrics
lower limb problems
what are the sings of a DVT
unilateral limb swelling
persistent discomfort
calf tenderness
how do you diagnose a DVT
blood test - d dimer
imaging - compression ultrasound if D-dimer is positive
what is a D Dimer
a chemical from the Breakdown product of cross-linked fibrin
clot
what does the d dimer test have
High sensitivity for VTE
Low specificity for VTE
what are the sings/symptoms of small PEs
pleuritic chest pain
SOB
haemoptysis
tachycardia
what are the sings and symptoms of a massive PE
sever/ sudden onset SOB
collapse
central cyanosis
tachycardia
low BP
how do you diagnoses a PE
blood test - d-dimer
imaging
what are the imaging technique for PEs
isotope ventilation/perfusion scan
CT pulmonary angiogram
what are the aims of treatment for VTE
to prevent…
clot extension
clot embolization
recurrent clot
what are the treatment options of VTE
anticoagulation
thrombolysis for massive PE
what is the drug used in thrombolysis of big PEs
alteplase
how can VTEs be prevented in hospital
early mobilisation
anti-embolism stockings
what are the anticoagulation drugs that are used for VTE
LMW heparin
warfarin
