General Surgery - Vascular Flashcards
how does PAD occur?
atherosclerotic disease of the arteries in the peripheries
risk factors for PAD?
smoking alcohol DM obesity hypercholesterolaemia HT CV disease
features of PAD?
cramping after walking for a set distance relieved by rest ulcer gangrene foot pain at night
what is found at examination of PAD?
punched out painful ulcers
atrophic skin
cold white legs
absent pulses
what classification is used for PAD? what are the levels?
fontaine 1 - asymp 2 - intermittent 3 - ischaemic rest pain 4 - ulceration/gangrene (critical ischaemia)
What is used for ABPI?
arm/calf systolic
how is ABPI calculated?
arm BP/calf BP
what other Ix should be done for PAD?
US MR/CT angiogram BM FBC U+Es ECG
Tx for PAD?
lifestyle statin (atorvastatin 80mg) HT control DM control antiplatelet (clopidogrel)
what is the Tx for critical limb ischaemia?
gabapentin/amitryptilline
surgery (angioplasty, stent , bypass, amputate)
features of critical limb ischaemia?
burning at rest
ulceration
gangrene
hanging of legs to ease pain
causes of acute limb ischaemia?
thrombosis
trauma
graft/angioplasty occlusion
features of acute limb ischaemia?
6 P's pale pulseless painful paralysed parasthetic perishingly cold
Tx for acute limb ischaemia?
surgical emergency
anticoagulation
what happens in gangrene?
death of tissue due to poor vascular supply
what happens in gas gangrene?
necrotising myositis caused by C. diff
what happens in necrotising fasciitis?
infection of the deep fascia causing necrosis of the subcutaneous tissue
what bacteria often causes necrotising fasciitis?
GABHS
features of necrotising fasciitis?
pain out of proportion
purple/black skin
pulseless
treatment of necrotising fasciitis?
fasciotomy
how do varicose veins occur?
valves become incompetent at preventing backflow
blood goes from deep > superficial veins
risk factors for varicose veins?
FHx obese pregnant pill prolonged standing overactive muscle pumps
features of varicose veins?
pain cramps tingling restless legs oedema eczema haemosiderin deposits
Tx for varicose veins?
elevate legs
weight loss
exercise for calf muscles
stockings
complications of varicose veins?
bleeding
thrombophlebitis
ulceration
risk factors for AAA?
smoking HT Male FHx >50yrs CTDs hypercholesterolaemia
features of a AAA?
abdo pain back pain collapse expansile mass hypotensive
Ix for an AAA?
US
CT
ECG
crossmatch
Tx for a AAA?
EVAR
who get screened for AAA?
> 65yrs by US
criteria for scan follow up with an AAA?
3-4.4cm - 12 months
4.5-5.4cm - 3 months
>5.5cm - refer
what is defined as a chronic leg ulcer?
open lesion between knee and ankle that remains unhealed for 4 weeks
features of venous ulcers?
superficial gaiter area varicosities haemosiderin staining lipodermatosclerosis
features of arterial ulcers?
cold limb pale hairless deep punched out ulcer pain at night in pressure areas
features of vasculitic ulcers?
multiple bilateral lesions
anywhere on the leg
small round
shallow
how does venous insufficiency cause ulcers?
vein valve reflux occurs
stasis
oedema
ischaemia -> necrosis -> ulcer
what are the ABPI ranges? what BP is used?
0.8-1.3 normal
<0.8 severe PAD
>1.5 calcification (PAD)
systolic BP of ankle and arm
Tx for venous leg ulcers?
debride and clean
compression stockings
dressings
Tx for arterial leg ulcers?
angioplasty/endartectomy/bypass
what bacteria commonly infects ulcers?
pseudomonas
GABHS
Tx for infected ulcers?
fluclox
+ met if moderate
+ gent if severe
who gets surgery for a AAA?
symptomatic
>5.5cm if asymptomatic
ruptured
