Ischaemia, Aneurysm , Varicose Veins

Question 1

What is intermittent claudification?

Answer 1

Lack of O2 on exercise to muscle leading to cramp like pain

Question 2

Clinical Signs of intermittent claudification?

Answer 2

Pain upon walking further steeper faster, but pain is quickly relived upon rest
Ankle brachial pressure under between 0.4-0.85

Question 3

Treatment of intermittent claudification?

Answer 3

No cure for peripheral arterial disease
Slow progression on prevention
Stop smoking, more exercise, lipid lowering
Bypass need healthy inflow and outflow
Endovascular Stent treats only the symptoms

Question 4

Why does walking more despite the pain improve intermittent claudification?

Answer 4

Because more pain means more anastomoses form increasing blood flow to the area

Question 5

What is critical limb ischaemia

Answer 5

Pain occurs in the foot even at rest, particularly bad lying down and sleeping

Question 6

Signs of severe ischaemia?

Answer 6

Cool to touch, absence of peripheral pulses, hairless, thick nails, shiny skin, venous guttering

Question 7

How does critical limb ischaemia lead to limb loss?

Answer 7

Injury, ulcer gangrene amputation

Life or Limb

Question 8

What is Varicose Veins

Answer 8

Dilated tortuous superficial veins due to abnormal transmission of pressure within deep veins

Question 9

What three thing result in VV?

Answer 9

Increased venous pressure, damaged valves, deep vein obstruction

Question 10

Causes of VV

Answer 10

Pregnancy , old age , obesity, females,

Question 11

Risks related to VV

Answer 11

Bleeding- significant and recurrent elevation and pressure
thrombophlebitis - inflammation due to clot sore bruising scaring
Haemosidium deposits- Black dots under the skin red cell leakage out of vessel iron broken down
Liperdermatosclerosis- intense inflammatory response leads to scaring fibrosis- like cellulitis
Venous ulceration

Question 12

Management of VV

Answer 12

Compression bandages, low APBI no bandages as blood completely prevented from getting to foot

Question 13

Foam Sclerotherapay

Answer 13

Chemical treatment of VV fuses veins together

Question 14

Endogenous ablation

Answer 14

Physical thermal radiowaves all damage endothelium of vein closing it off

Question 15

Why is surgery not really used for VV

Answer 15

Are risks to patient and was more for cosmetic reasons , higher success rate endovenous

Question 16

What is an Abdominal Aortic Aneurysm

Answer 16

Aorta has been dilated by more than 50%

Question 17

Two types of Aneurysm?

Answer 17

True- vessel walls are intact

False- Blood contained by the surrounding soft tissue

Question 18

Three shapes of aneurysm

Answer 18

Sacular- simple sack on aorta
Fusiform- bulges out on both sides
Mycotic- due to infection

Question 19

What causes an AAA

Answer 19

Medial degeneration- elastin collagen decrease, increased pressure, increased wall stress

Question 20

Risk factors for an AAA

Answer 20

Old male Smoker Hypertension

Question 21

Are most AAA symptomatic

Answer 21

No 75% are asymptomatic

Question 22

Symptoms of an AAA

Answer 22

Pain can mimic renal colic, trashing

Question 23

What symptoms follow a rupture

Answer 23

tearing sudden epigastric pain radiating to the back, sudden collapse

Question 24

Is an free intraperitoneal worse than a retroeritoneal rupture

Answer 24

Yes as its not contained by anything rapidly bleed out and die

Question 25

When is an aneurysm deemed serious enough to deal with

Answer 25

If over 5.5cm or rapidly growing

Question 26

Two options for treating an AAA

Answer 26

Open surgery- more risky iliac dacron graft used as stent

Endovascular- required good seal before and after AAA

Question 27

Acute limb ischaemia

Answer 27

Sudden loss of blood to the foot

Question 28

Causes of Acute limb ischaemia

Answer 28

Trauma embolism arterial dissection, compression

Question 29

Signs of acute limb ischaemia

Answer 29

6 P's
Pallor 
Pulsless
Perishingly cold
Paraesthesia- pins and needle
Pain
Paralysis

Question 30

0-4 hours in ALI

Answer 30

White foot painful sesorimotor effect- reversible

Question 31

4-12 hours in ALI

Answer 31

White with mottled blanches on pressure- partly reversible

Question 32

12h+ hours in ALI

Answer 32

Fixed mottling non blanching, improving perfusion is dangerous non reversible could lead to harmful systemic effects due to chemical released by necrosis

Question 33

Management of ALI

Answer 33

ABCDE, Blood tests, ECG CXR

Anticoagulants, prevent thrombus formation, increase perfusion

Question 34

Diabetic Foot Sepsis

Answer 34

Pressure as a result of infection results in lack of perfusion to the foot

Question 35

Three things required for diabetic foot sepsis to occur?

Answer 35

Diabetic neuropathy, peripheral vascular disease, infection

Question 36

Common sources that lead to DFS

Answer 36

Pressure ulcers- don’t feel them forming due to neuropathy
Ingrown toe nail
puncture wound

Question 37

Why does pressure build due to infection?

Answer 37

Muscles are confined by fascia and bones into rigid compartments, inflammation due to infection results in obstruction of blood vessels

Question 38

Clinical signs of DFS

Answer 38

Pyrexia, tachypnoea , tachycardia, confused , kussmauls breathing- laboured
Swollen and Boggy, tender to touch, ulcers with puss, erythema tracking up leg, woody necrosis patches, crepitus from microbes releasing gas, pedal pulse is lacking

Question 39

Is the infection usually mononclonal?

Answer 39

No its usually multicultural gram -ve and +ve

Question 40

Treatment for DFS

Answer 40

Remove all infected tissue leave open to encourage drainage