Peripheral Arterial and Venous Disease

Question 1

Outline deep veins

Answer 1

Found in the muscle

Flow aided by muscle contraction

Question 2

Outline superficial veins

Answer 2

Found in the subcutaneous fat

Superficial veins always flow into deep veins by perforating veins, not the other way round

Question 3

What is the purpose of fascia around a compartment?

Answer 3

When a muscle contracts it pulls the facia inward creating a -ve pressure

This aids blood flow in the veins

Question 4

What are the deep veins in the leg?

Answer 4

• IVC
• Common iliac vein
• External iliac vein
• Femoral vein
• Popliteal

Question 5

What are the superficial veins?

Answer 5

Long saphenous – drains into the femoral vein, anterior to the medial malleolus

Short saphenous – drains into the popliteal vein

Question 6

What is the one constant vein in the body?

Answer 6

Long saphenous vein is ALWAYS anterior to the medial malleolus

Question 7

What direction does blood flow in the aorta?

Answer 7

Nearly all the blood travels towards the periphery

Very small amount of blood is refracted back due to bifurcations

Question 8

Does Doppler measure flow or velocity?

Answer 8

Velocity

Question 9

Why is the velocity high in the common iliac than the aorta?

Answer 9

Same amount of blood flowing through a vessel that has no branches

Question 10

What is the def of a varicose vein?

Answer 10

Tortuous twisted or lengthened vein

Vein wall is inherently weak, leads to dilation and separation of valve cusps = become incompetent

Question 11

What are the symptoms of varicose veins?

Answer 11

Heaviness, tension, aching, itching

Question 12

What are the complications of varicose veins?

Answer 12

Haemorrhage, thrombophlebitis (thrombosis prod inflam including pain)

Oedema, skin pigmentation (ferrous oxide), varicose eczema, lipodrmatosclerosis(hardened fat)

Question 13

What causes venous ulceration?

Answer 13

Calf muscle failure venous hypertension venous ulcers

Question 14

What causes calf muscle pump failure?

Answer 14

• Failure calf contraction = immobility, obesity
• Deep vein incompetence
• Volume overload

Question 15

What is a retrograde circuit?

Answer 15

Superficial vein incompetence leading to ulceration

Valve incompetence setting up an incorrect circuit of blood flow

Question 16

What is the pathophysiology of arterial vs venous thrombosis?

Answer 16

A = changes in lining of vessel wall

V = changes in blood flow

Question 17

Why does stasis lead to venous thrombosis?

Answer 17

Normally stasis plus another ‘provocateur’ = oral pill, dehydration, cancer

Question 18

What is natural collateral circulation?

Answer 18

Particularly common across joints – otherwise when flexed joint of flow would take place

Devel in response to stenosis

When there is acute ischaemia collateral circulation has no time to devel (need to reverse in 6 hours, hyperkalemia)

Question 19

How does DVT present?

Answer 19

Calor, dolor, functio laesa, rubor, tumor

Pain, cannot walk, swelling, calf tenderness, distended warm veins

Question 20

Why is surgery associated with DVT?

Answer 20

Immobility prior and post surgery

Surgery is trauma = body’s response includes a prothrombic state

Question 21

What is acute limb ischaemia?

Answer 21

Impaired blood supply over period of minutes

No collateral blood devel

Commonest cause = embolism

Symp/signs = pain, paralysis, paraethesia, pallor, perishing cold, pulseless

Question 22

What is fixed mottling?

Answer 22

Non-blanching skin

Thrombosed Hb

Question 23

Outline chronic peripheral arterial disease?

Answer 23

Intermittent claudication = pain in muscles of lower limb elicited by walking commonly due to diseased superficial femoral artery

Question 24

What are the arteries of the lower limbs?

Answer 24

External iliac artery

Common femoral artery (branching off – profunda femoris artery)

Superficial femoral artery

Popliteal artery

Divides into – anterior tibial artery, peroneal artery, posterior tibial artery

Question 25

What is the mid-inguinal point?

Answer 25

Half way between ASIS and pubic synthesis

Femoral pulse felt here

Question 26

What places can pulses be felt?

Answer 26

Femoral – mid-inguinal point

Popliteal – deep in popliteal fossa

Dorsalis pedal – lateral to extensor hallucis longus tendon

Posterior tibial – behind medial malleolus

Question 27

What is critical ischaemia?

Answer 27

Rest pain = pain in foot at night when lying

Ulceration/gangrene

Question 28

What is ischaemia?

Answer 28

Insufficient blood supply to cell, lack of O2, pH drops

Reversible

Question 29

What are the diff types of ischaemic damage to the heart?

Answer 29

Unstable angina
Stable angina
MI

Question 30

Outline referred pain

Answer 30

Visceral and somatic afferents synapse in similar place in spinal cord

Brain cant tell if pain is from skin or heart

Question 31

What beats are irregularly irregular?

Answer 31

Ventricular/atrial ectopics

AF

Question 32

What beats are regularly irregular?

Answer 32

2nd degree heart block

Question 33

What is the cause of a bounding pulse?

Answer 33

Lowing of the diastolic pressure = widens pulse pressure = bounding

Question 34

Why does raising the arm exaggerate a bounding pulse?

Answer 34

Increased pulse pressure as blood falls away more profoundly

Question 35

Why is S2 normally split on inspiration?

Answer 35

On inspiration the chest wall moves out and the diaphragm flattens = -ve pressure = air rushes into the lungs and more blood drawn into the right side of the heart

= pulmonary valve closes after aortic valve = split second heart sound

Question 36

Why are right-sided murmurs increased during inspiration?

Answer 36

-ve pressure = more blood drawn into the right side of the heart

Blood flowing though tricuspid and pulmonary valves increased = hear R-sided murmur better

Question 37

Why are left-sided murmurs increased during expiration?

Answer 37

+ve pressure = more blood pushed out of the heart

More blood flowing through the mitral and aortic valve = hear L-sided murmurs better