Miscellaneous Flashcards
Situations in which lipids should be measured
MI, CVA, other vascular disease, acute pancreatitis, family history, clinical signs
Clinical signs involving lipids
Xanthomata (deposits around eye), xanthelasma (deposits under skin usually on hands), corneal arcus (ring around eye), milky blood/serum
Considerations for comparison of drugs within/between class
Efficacy, safety, cost, interactions, evidence
Drug interactions with statins
Ketoconazole, erythromycin, diltiazem, mibefradil, itraconazole, grapefruit
How does hypertriglyceridaemia cause acute pancreatitis?
- Chylomicrons are large and may obstruct capillaries leading to local ischaemia and acidaemia
- Local damage can expose triglycerides to pancreatic lipases
- Degradation of triglycerides or free fatty acids can lead to cytotoxic injury
Varicose veins
Dilated, tortuous superficial veins due to the abnormal transmission of deep vein pressure
Conditions that can increase the deep veins pressure
Deep vein obstruction, deep valve incompetence
Risk factors for varicose veins
Age, pregnancy, obesity
Signs of varicose veins
Dilated and tortuous superficial veins, more prominent when standing and more common arising in the groin or behind the knee
Complications of varicose veins
Bleeding and bruising, superficial thrombophlebitis, ulceration, lipodermosclerosis
Superficial thrombophlebitis
Inflammation of a vein caused by a blood clot
Investigations for chronic venous diseases
Duplex scan
2 main issued a duplex scan focuses on
State of the deep veins, saphenofemoral or saphenopopliteal incompetence
Non-interventional management for chronic venous diseases
4 layer bandaging for ulcers, stockings for ulcer prevention and symptomatic relief (except in low ABPI_
Interventional management for chronic venous diseases
Foam scleropathy, endovenous ablation (mechanical, laser or radiofrequency)
Surgical management for chronic venous diseases
High tie, distal foam ablation
Complications of interventional management for chronic venous diseases
Thrombophlebitis, skin staining, local ulceration, wound infection, nerve damage, recurrence of the veins
What regulates regional blood flow to capillary bed in most tissues?
Terminal arterioles
How do small, water-soluble molecules cross the capillary wall?
Through pores
How do lipid-soluble substances cross the capillary wall?
Through endothelial cells
What is transcapillary fluid flow driven by?
Passively driven by pressure gradients
Forces involved in transcapillary fluid flow:
- Forces favouring filtration
- Forces opposing filtration
Favouring = capillary hydrostatic pressure and interstitial fluid osmotic pressure Opposing = capillary osmotic pressure and interstitial fluid hydrostatic pressure
Where do Starling forces favour filtration and reabsorption
Filtration = arteriolar end of capillary Reabsorption = venular end of capillary
Oedema
Accumulation of fluid in the interstitial space
Causes of oedema
Raised capillary pressure, reduced plasma osmotic pressure, lymphatic insufficiency, changes in capillary permability
What can result in raised capillary pressure?
Arteriolar dilatation, raised venous pressure
Oedema related to left ventricular failure
Pulmonary oedema
Oedema related to right ventricular failure
Peripheral oedema
Causes of oedema through reduced plasma osmotic pressure
Malnutrition, protein malabsorption, excessive renal excretion protein, hepatic failure
CXR findings of pulmonary oedema
Haziness in perihilar region
