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4 General Surgery > Limb Ischaemia > Flashcards

Limb Ischaemia Flashcards

1
Q

name the 3 types of acute limb ischaemia

A

acute
acute on chronic
critical

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2
Q

a solid mass of platelets and/or fibrin that forms locally in a vessel in response to activation of the clotting system…

A

thrombus

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3
Q

what makes an embolus different to a thrombus?

A

it is a piece of thrombus that has broken off and runs through vessels where it can cause blockages

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4
Q

define acute limb ischaemia

A

a SUDDEN decrease in limb perfusion that threatens the viability of the limb

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5
Q

ALI

A

12

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6
Q

after how many hours will the leg appear mottled and blanch on pressure in ALI?

A

4-12

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7
Q

patient presents with a white, painful foot with sensorimotor deficit as a result of ALI - how many hours ago did the injury occur?

A

0-4hrs

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8
Q

how does DVT present differently to ALI?

A

DVT: hot and swollen
ALI: pale and pulseless (6 P’s)

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9
Q

name the 6 P’s of limb ischaemia

A 
pale
pulseless
paraesthesia
pain
pallor
paralysis
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10
Q

DDx for acutely painful limb?

A
  1. ALI
  2. DVT
  3. trauma - look for bony tenderness
  4. neurological eg disc herniation
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11
Q

patient with an acutely painful limb that is worse on movement and has diminished reflexes…

A

neuro cause eg disc herniation or radiculopathy

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12
Q

associated Sx to ask about in vascular?

A

SoB
chest pain
palitations
numbness/tingling

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13
Q

a PMH of what conditions puts the patient at more risk of ALI?

A 
chronic LI
AF
MI
AAA
hypertension
hypercholesterolaemia
prosthetic heart valves
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14
Q

most common cause of ALI?

A

embolism (usually from proximal location eg from AF/MI/AAA)

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15
Q

how can a thrombus-in-situ cause acute limb ischaemia?

A

atheromatous plaque in the artery ruptures and a thrombus forms on the plaque’s cap which can occlude the artery

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16
Q

ALI with a completely normal contralateral limb indicates the cause is…

A

an embolism

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17
Q

a more proximal blockage in ALI will cause what clinical sign?

A

BOTH limbs affected

18
Q

name the 3 main causes of ALI

A

embolism
thrombus in-situ
trauma

19
Q

name traumatic causes of ALI

A

compartment syndrome
dissection
external compression

20
Q

bloods for ALI?

A 
FBC/U+E
LACTATE (++ in ischaemia)
thrombophilia screen
G&S
Troponin and CK for MI
21
Q

Ix ALI

A 
bloods
ECG for MI/AF
ECHO if structural issue
CXR - smokers
Duplex USS - gold standard
CT angio
22
Q

medical Mx ALI

A

high flow O2
IV access
antiplatelet + anticoagulant

23
Q

surgical Mx embolic ALI

A
  1. embolectomy via fogarty catheter

2. amputation

24
Q

surgical Mx thrombotic ALI

A
  1. thrombolysis
  2. angioplasty
  3. bypass surgery
  4. amputation
25
Q

mortality from ALI after treatment

A

10-30%

26
Q

complications of ALI?

A
  1. hyperkalaemia - ++ K from damaged muscle cells
  2. acidosis - H+ release
  3. AKI - + myoglobin release
  4. reperfusion injury - can cause compartment syndrome
27
Q

patient presents with pain that doesn’t fit the clinical presentation, paraesthesia, paralysis and is worse on stretching. peripheral pulses are present. what’s going on?

A

compartment syndrome

28
Q

gold standard investigations for ALI?

A

duplex USS

ct angio

29
Q

Tx compartment syndrome

A

fasciotomy

30
Q

what is different on presentation in patients with AOCLI vs acute ALI?

A

they will have a PMH of claudication and PAD

31
Q

most common cause of AOCLI

A

atheroembolic - small emboli released over time from existing arterial disease

32
Q

Ix AOCLI

A 
same as ALI:
bloods
ECG/ECHO/CXR
duplex USS
CT angio
33
Q

surgical Mx AOCLI (if salvageable)

A
  1. thrombectomy
  2. angioplasty/stent
  3. bypass
34
Q

when pathologically would a limb be classified as having critical limb ischaemia (CLI)?

A

when the lumen is so narrowed that the requirements from distal muscles are higher than the blood supply available

35
Q

symptoms of a patient with CLI?

A
  1. severe claudication - can only walk 10m
  2. rest pain >2 weeks that is worse at night
  3. tissue loss
36
Q

patients with CLI will have what clinical signs on examination?

A

+ve buerger’s test
absent peripheral pulses
may have ulcers/ischaemic toes

37
Q

what extra Ix is done for CLI and why

A

ABPI to show difference in blood flow

38
Q

ABPI is

A

0.5

39
Q

surgical Mx CLI

A
  1. angioplasty
  2. endarterectomy
  3. amputation
40
Q

what is buerger’s test?

A

lift patients feet up and hold for 2 min. swing feet back down over the bed to see if they go pink again

41
Q

what would be a sign of a positive buergers test?

A

feet blanch on elevation and go red again after swinging back over the bed

4 General Surgery (3 decks)

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