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Hospital Based Medicine And Surgery > L25/26: Vascular Surgery And Peripheral Arterial Disease And Ulcers > Flashcards

L25/26: Vascular Surgery And Peripheral Arterial Disease And Ulcers Flashcards

1
Q

What are the layers of the arterial wall

A

Tunia intima
Tunica media
Tunica externa

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2
Q

What is the tunica intima made of

A

Endothelium

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3
Q

What is the tunica media made of

A

Smooth muscle

Elastic fibres- internal and external

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4
Q

What is peripheral arterial disease

A

Obstruction of large arteries of the systemic vascular system

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5
Q

What is a atherosclerosis

A

Build up plaque formation which leads to the narrowing of the vessel lumen wall and ischaemia distal to the atheroma

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6
Q

What are the modifiable risk to peripheral arterial disease

A 
Smoking
Blood sugar 
Hyperlipidemia
Hypertension
Obesity
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7
Q

What are the non modifiable risk factors for peripheral arterial disease

A

Age
Geneder
Family history
Genetic

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8
Q

What are the 3 types of ischaemia that can occur in the limb

A

Acute limb ischaemia
Chronic limb ischaemia
Critical limb ischaemia

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9
Q

What is acute limb ischaemia

A

When you suddenly develop a sudden decrease in limb perfusion producing new or worsening symptoms

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10
Q

What is chronic limb ischaemia

A

Gradual worsening of limb pina bough on by exercise and relieved by rest

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11
Q

What is critical limb ischaemia

A

Rest pain and circulation is badly impaired that there is a risk for limb loss

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12
Q

What can acute limb ischaemia be due to

A

Thombus- you already have a thrombus and something occludes it
Embolus
Trauma- crush injury can block the vessel
Transection- transaction of an artey will cut off the blood flow
Dissection: space opening up betwwen the layers of the blood vessel

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13
Q

What should you look at in the history of someone with acute limb ischaemia

A

Atrial fibrillation

Athersclerosis

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14
Q

How does acute limb ischaemia present

A 
6 ps:
Pulseless
Pain
Pallor
Polar (cold)
Paralysis
Paraesthesia
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15
Q

What is the management of acute limb ischaemia

A

Analgesia
Aspirin- to reduce the clotting in the blood
Anti-coagulation- breakdown the clot that has already formed
Thrombolysis: break down the clot

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16
Q

What is the surgical management of acute limb ischaemia

A

Embolectomy- open the vessel and remove the embolus
Bypass surgery- long segment of a clot you will bypass it by diverting the blood flow
Amputation

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17
Q

What can occur if you get the blood flowing back as a complication

A

Reprefusion injury

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18
Q

What is reperfusion injury

A

This is when you re introduce blood flow to the tissue that is being infarcted has a sudden relase of toxic compounds associated with tissue death

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19
Q

What does the release of toxic compounds cause

A

Vasodilation- this leads to shock (not enough blood flowing round the system)
Permeable vessels: more tissue fluid and white blood cells pass into the infected area - you can develop acute respiratory distress syndrome
Renal failure: brocken down tissue relases myoglobulin which sits at the glomerular basement membrane and blocks the kidney

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20
Q

What is another complication fo re introducing blood flow

A

Compartment syndrome

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21
Q

How does compartment syndrome occur

A

Vessels become more leaky
You increase the pressure due to lots of fluid which leads to raised intra compartment pressure
The pressure will obstruct the venous outflow from the limb and the arterial blood flow can become cut off
This leads to secondary limb ischaemia

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22
Q

What is the treatment of compartment syndrome

A

Fasciostomy- open up the compartment to release the pressure

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23
Q

What is chronic limb ischaemia

A

Artery becomes narrow and stiff due to athersclerosis which causes a reduced oxygen supply to the tissue
There is collateralisation (new blood vessel formation) to allow blood flow pass around it

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24
Q

What are the signs and symptoms of chornic limb ischaemia

A
  • claudication: pain that comes on when you do a certain exercise
  • rest pain
  • absent pulse
  • arterial ulcers: blood suply is enough to keep the tissue alive but not for healing
  • skin changes
25
Q

What investigations can be carried out for chronic limb ischaemia

A

Bloods: fbc
Abpi (ankle blood pressure index): pressure in the foot
Duplex scan: ultrasound that look at direction of flow
Angiography: contrast inserted to narrowing of blood vessels

26
Q

What should the abpi (arterial blood pressure index) be in both feet

A

Equal

27
Q

What abpo suggests arterial disease

A

Less than 0.9

28
Q

What abpi suggests hardening of the vessels

A

More than 1.2

29
Q

What is the normal abpi

A

Between 0.9-1.2

30
Q

What does a duplex scan look at

A

Blood flow

31
Q

What is the wave of normal blood flow

A

Triphasic

32
Q

In normal blood flow why do is it triphasic

A
  1. First wave is the blood flowing to the distal tissue
  2. Second wave is the backflow of blood as the heart releases
  3. Third wave is due to the elastic recoil of vessels that causes the blood to go further
33
Q

What are the other types of blood flow that can be abnromal which we might see on a duplex scan

A

Biphasic

Monophasic

34
Q

What does a biphasic blood flow suggest

A

The loss of elastic recoil

35
Q

What does a monophasic blood flow suggest

A

A narrow vessel that can only pass blood by the ejection of the heart

36
Q

What is the medical management of chronic limb ischaemia

A 
Blood pressure control 
Blood sugar control
Statins: reduce the plaque size
Aspirin- reduce clotting
Analgesia-pain
37
Q

What is the surgical management for chronic limb ischaemia

A

Percutaenous trasluminal angioplasty- ballon to dilate the vessel
Vascular bypass
Amputation

38
Q

What is a anueysm

A

Dilatation of an artery

39
Q

What are the 2 types of aneurysm

A

False

True

40
Q

What is a false aneurysm

A

Aneurysms formed due to defect through the tunica intima and media so the aneurysm outer layer is the tunica adventita

41
Q

What is the structute of a true aneurysm

A

Dilatation of formed by the 3 layers of the artery wall (tunica intima, media and adventita/externa)

42
Q

What are the causes of aneurysm

A 
Atheroma
Congenital: berry aneurysm 
Infection: septic emboli, sphyilitis
Connective tissue disorder: marfans syndrome
Iatrogenic: arterial blood sampling
43
Q

What is the presentation of a aneurysm

A

Due to a acute rupture
Expansible mass
Abdominal pain
Incidental finding

44
Q

How can we screen for a aneurysm

A

Abdominal ultrasound scan

45
Q

What is the management of a aneurysm

A

Surgical-open rapir, endovascular aneurysm repair

46
Q

What is lymphoedema

A

Accumulation of excess tissue fluid in the extravascular and extracellular space

47
Q

What can lymphoedema be due to

A

Primary: poor function of lymphatics
Secondary: malgiancy, infectgions, surgery, tumour infiltrates

48
Q

What are the clinical features of lymphoedema

A

Swelling of the leg
Reccurent infection
Ulcers in the leg

49
Q

What is the management of lymphoedema

A 
Reduce swelling
Elevate the leg
Compression stocking
Skin care
Exercise
50
Q

What are varicose veins

A

Dilated superificial veins which cause reverse flow

51
Q

What are the symptoms of varicose veins

A

Aches/pain
Itching
Swelling
Restless leg

52
Q

What are the complications of varicose veins

A

Bleeding
Eczema
Ulcer
Phlebitis

53
Q

What is the management of a bleedin varicose veins

A

Apply pressure
Elevate the leg
Dress
Compressing bandage

54
Q

What is the management of asymptomatic varcose vein

A

Reasurre that treatmetn is not neccessary

55
Q

What is the management of symptomatic uncomplicated varicose veins

A

Reasssurance

Compression stocking

56
Q

What is the management of varicose veins with skin chnages

A

Reasuurance
Compression stocking
Consider treatemtn to reduce tissue damage

57
Q

What is the surgical options for varicose veins

A

Catheter ablation
Ultrasound guided sclerotherapy
Open surgery

58
Q

What is a complication of varicose vein

A

Dvt

Hospital Based Medicine And Surgery (30 decks)

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