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CVS > Lecture 16 > Flashcards

Lecture 16 Flashcards

1
Q

What are the different classifications of the veins?

A

Deep veins: underneath deep fascia/through muscles
Superficial veins: in subcutaneous tissue
Connected by perforating veins, from superficial in subcutaneous tissues into deep veins, and sent back to heart

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2
Q

What is the divisions of the deep vein?

A
  • inferior vena cava
  • common iliac
  • external/internal iliac
  • external iliac branches to femoral (which branches into deep femoral and superficial femoral)
  • superficial femoral turns into the popliteal vein behind knee
  • popliteal branches into anterior and posterior tibial veins and the peroneal vein
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3
Q

What are the classifications of the superficial veins?

A

Long saphenous vein- runs medially down inside of leg from the femoral vein via perforators

Short saphenous vein- connects through perforators at popliteal vein, at the back of the calf

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4
Q

Where is the long saphenous vein?

A

Runs medially along leg, and along front of medial malleolus

Used to be the site where IV’s were cannulated

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5
Q

What is the calf muscle pump?

A

‘Peripheral heart’

  • soleus and gastrocnemius push blood against gravity back towards heart (push blood from superficial veins, through perforating veins, into deep veins)
  • valves open:blood pushed through, valves closed: prevent retrograde movement
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6
Q

What happens to the venous pressure in the foot during exercise?

A

Venous pressure is reduced

-as blood is no longer pooling in the feet, it is being pumped back towards right side of heart

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7
Q

What is peripheral venous disease?

A

Varicose veins

  • more common in older ages/females
  • valves ineffective, blood movement is slow/reversed
  • saphenous veins common site (superficial)
  • walls of veins weaken (valve cusps separate and varicosities form), causing the veins to become incompetent, can get pooling
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8
Q

What are some symptoms associated with varicose veins?

A
  • heavy/ache/muscle cramps/throbbing
  • thin, itchy skin along affected veins
  • haemorrhage: in shower, venous pooling and heat causing vasodilation=bleeding out of legs
  • varicose eczema
  • superficial vein thrombophlebitis (inflammatory process resulting in a clot in the vein= these put you at a greater risk of a DVT)
  • chronic venous insufficiency
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9
Q

What is an example of haemosiderin staining?

A

-venous eczema/ulceration

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10
Q

Why does the calf muscle pump fail?

A

Need to be using the calf muscles-plantarflexion of ankle joint during walking
-if not using muscles, leads to retrograde flow

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11
Q

Who is at risk of venous hypertension/calf muscle pump not working?

A
  • elderly, obese, injured (immobile)

- Parkinson’s: shuffling- not plantarflexing properly

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12
Q

What does calf muscle pump failure cause?

A
  • deep vein incompetence (retrograde flow)

- superficial vein incompetence (retrograde flow back down through perforators into superficial veins)

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13
Q

What is the most common cause of arterial thrombosis?

A

Atheroma

-platelet rich aggregate, plug damaged vessel

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14
Q

What is Virchow’s triad?

A
  • vessel wall damage
  • stasis (flow)
  • hypercoagulability
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15
Q

What is a venous thrombosis like?

A

Little platelet component, fibrin rich

Often due to slow flow:stasis-trauma, dehydration, chemo, pregnancy

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16
Q

What factors can cause venous thrombosis?

A
  • trauma
  • chemo
  • pregnancy
  • inflammatory conditions
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17
Q

What is a DVT?

A

Clotting of blood in a deep vein (common in calf)

  • impaired venous return
  • inflammatory component: redness/swelling following thrombosis
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18
Q

Who is risk at a DVT?

A
  • ambulatory patients
  • long flight
  • post surgery patients
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19
Q

What are some symptoms of DVT?

A
  • calf tenderness
  • warm
  • distended/visible superficial veins
  • oedema
  • pyrexia with no other cause (if a patient post-op have pyrexia with no other cause it could be a DVT)
  • asymmetry
20
Q

Why do DVT’s occur?

A

Stasis-no calf muscle pump
-prothrombotic/hypercoagulability state following malignancy/pregnancy/before or after surgery

=promote mobility soon after surgery

21
Q

What is a fatal consequence of a DVT?

A

Pulmonary embolism

22
Q

How do you treat a DVT?

A

Prophylaxis

Anticoagulant agents

23
Q

How do you limit incidence of acute ischaemia/stenosis of major vessel?

A 
Collateral circulation 
(Knee/shoulder/hip/stenosed arteries- around joints, as vessels could be occluded while flexing or around stenosis)
24
Q

What is acute limb ischameia?

A

Major occlusion of an arterial in lower limb
(Occurs in mins/days= acute)
-no collateral circulation can develop in this time

25
Q

What are the 6 P’s in leg ischameia?

A 
Pain
Pallor (can become cyanotic and necrotic, can become hyperkalaemic)
Perishing with cold
Pulseless
Paraesthesia 
Paralysis/reduced power
26
Q

What is chronic peripheral arterial disease?

A

Intermittent claudication in limb-occurs over a period of time

  • caused by atherosclerosis: oxygen supply/demand ratio is not balanced
  • cramping in leg: exercise induced (pain goes away when resting)
27
Q

How do you manage chronic peripheral arterial disease?

A
  • exercise: increase collateral circulation
  • smoking cessation
  • antiplatelet drugs
  • angioplasty
  • bypass graft
28
Q

What is critical ischaemia?

A

Rest pain: poor blood supply so pain at rest
(Get pain when sleeping, and relieve it when they stick their leg out of the bed- last attempt to try and get blood to lower limbs)
-at rest oxygen supply/demand ratio is not sufficient
(Like unstable angina- chest pain at rest)

29
Q

What can untreated critical ischameia lead to?

A

-ulceration
-gangrene (dry)
(Viability of limb is compromised)
-requires referral to vascular surgical unit immediately

30
Q

What are the different classifications of claudication?

A

-mild
-moderate
-severe
-rest pain
Where stenosis is, dictates what pulses you will be able to feel

31
Q

What are the difference pulses of lower limbs?

A
  • femoral pulse: mid-inguinal point, midway between anterior superior iliac spine and pubic symphysis ) (if can’t palpate= urgent as this pulse is high up)
  • popliteal pulse: deep in popliteal fossa
  • dorsalis pedis pulse: lateral to extensor hallucis longus tendon
  • posterior tibial pulse: behind medial malleolus
32
Q

What is ultrasonography and its uses?

A

Sonogram using ultrasound and Doppler effector measure flow/velocity

  • used to record flow/velocity of blood: disrupted in occlusion
  • used in echocardiogram
  • used in distal vessels
  • echoes produced from moving blood are detected and computed into flow direction and velocity
33
Q

What is the ankle-brachial pressure index?

A

ABPI

  • measure pressure in brachial artery
  • measurement of BP in dorsalis pedis, posterior tibial arteries
  • if the BP in the ankle is less than in the brachial = peripheral artery disease

DIVIDE ANKLE SYSTOLIC BY BRACHIAL SYSTOLIC
ABPI <0.9 indicated peripheral artery disease

34
Q

What do varicose veins look like?

A

Tortuous/twisted

34
Q

What is haemosiderin staining?

A

Venule pressure is high, RBC’s leak out, macrophages oxidise RBC’s and haem converted to ferrous > ferric
-staining in tissues

34
Q

What is lipodermatosclerosis?

A

Inflammation and thickening of fat layer under skin

=chronic venous insufficiency

35
Q

What can eczema lead to?

A

Chronic/itchy/red skin can lead to lipodermatosclerosis (hard to the touch)

36
Q

Where does venous eczema and ulceration usually present?

A

Hard modular areas e.g. medial malleolus

37
Q

What is chronic venous insufficiency and what can it cause?

A

Venous wall/valves in leg aren’t working properly making it difficult for blood to return back to the heart
=stasis

Causes:

  • venous hypertension
  • oedema
  • haemosiderin staining
  • lipodermatosclerosis
  • venous ulceration
38
Q

In what patients is the development of chronic venous deficiency common?

A

50% of DVT patients

39
Q

How do you treat venous ulceration?

A

Ligation/vein stripping perforating vein (stop retrograde blood flow back into superficial veins)

40
Q

What is Virchow’s triad?

A
  • vessel wall damage
  • stasis
  • hypercoagulability
41
Q

What are some diagnosis you should consider when diagnosing a DVT?

A
  • soft tissue trauma
  • cellulitis
  • lymphatic obstruction
42
Q

What is the Well’s score?

A

Pre-test probability
-give different numbers to different risk factors, overall number dictates whether you should be considering a DVT as prognosis

43
Q

What are the most common causes for acute limb ischaemia?

A
  • trauma

- leg embolism

44
Q

What is the most common presentation of claudication?

A

Atheroma

-atherosclerosis of superficial femoral artery

45
Q

What is an atheroma?

A

Degeneration of walls of arteries caused by accumulation of fatty deposits

CVS (16 decks)

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