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Cardiovascular System > Peripheral arterial and venous disease > Flashcards

Peripheral arterial and venous disease Flashcards

1
Q

What are the lower limb veins divided into?

A

Superficial and deep

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2
Q

Where are superficial veins located?

A

Subcutaneous tissue

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3
Q

What do the superficial veins drain into?

A

Deep veins

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4
Q

Where are the deep veins located?

A

Within muscles

e.g. calf

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5
Q

What are the veins that go between superficial and deep veins called and why?

A

Perforating veins - because they perforate the deep fascia

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6
Q

What is the function of valves?

A

To prevent backflow of blood

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7
Q

What are the deep veins of the lower limb?

A

External iliac vein
Femoral vein
Popliteal vein

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8
Q

What are the superficial veins of the lower limb?

A

Long saphenous vein

Short saphenous vein

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9
Q

What does the long saphenous vein drain into?

A

Femoral vein

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10
Q

Describe the course of the long saphenous vein

A

Descends medially down though
posterior to knee
medially down leg
anterior to medial malleolus

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11
Q

What does the short saphenous vein drain into?

A

Popliteal vein

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12
Q

Describe the course of the short saphenous vein

A

Midline of posterior leg

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13
Q

What happens to blood flow when the muscles relax?

A

Deep veins expand
blood is sucked into the deep veins
from the superficial veins

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14
Q

What happens to blood flow when the muscles contract?

A

Muscles contract within their compartments
increases pressure within compartments
compresses deep veins
pushes blood along

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15
Q

What happens to velocity of blood after a stenosis? Why?

A

Increases
Because cross-sectional area of blood vessel decreases, same amount of blood moving through smaller area, has to move faster

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16
Q

What happens to blood flow after a stenosis?

A

Decreases

less blood passing through narrowed area of blood vessel

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17
Q

If flow increases, what happens to velocity?

A

Increases

more blood moving through same blood vessel means it has to move faster

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18
Q

If area of blood vessel decreases, what happens to velocity?

A

Increases

because same amount of blood moving through smaller vessel, so has to move faster

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19
Q

If area of blood vessel increases, what happens to velocity?

A

Decreases
because same amount of blood moving through larger vessel
can move slower

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20
Q

What is a varciose vein?

A

Tortuous, twisted or lengthened veins

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21
Q

Are varicose veins more common in men or women?

A

Men

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22
Q

What is the pathophysiology of varicose veins?

A

Wall of vein becomes weak
vein dilates
valves separate
become incompetent

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23
Q

What are the symptoms of varicose veins?

A

Heaviness
Tension
Aching
Itching

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24
Q

Where are the symptoms of varicose veins felt?

A

Only along the actual vein

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25
Q

What are the causes of complications of varicose veins?

A

Problems with the vein itself

Venous hypertension

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26
Q

Problems with the vein itself causes which complications?

A

Haemorrhage

Thrombophlebitis

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27
Q

Venous hypertension causes which complications?

A 
Oedema
Skin pigmentation
Varicose eczema
Lipodermatosclerosis
Venous ulceration
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28
Q

How is haemorrhage from varicose veins treated?

A

Lie patient down

Lift leg up

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29
Q

What is thrombophlebitis?

A

Venous thrombosis

producing inflammatory response - pain

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30
Q

How does arterial thrombosis differ from venous thrombosis?

A

Arterial thrombosis doesn’t itself cause pain
the consequences e.g. ischaemia, infarction cause pain

Whereas venous thrombosis itself causes pain

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31
Q

What does thrombophlebitis look like?

A

Dark brown staining over skin

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32
Q

Why is there dark brown staining over the skin with thrombophlebitis?

A

Red blood cells leak out of vein
macrophages phagocytose red blood cells
oxidise Fe2+ in Hb to ferric oxide

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33
Q

What is lipodermatosclerosis?

A

Hardening of fat in subcutaneous tissue over vein

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34
Q

What causes venous hypertension?

A

Calf muscle pump failure

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35
Q

What causes calf muscle pump failure?

A

Immobility
Obesity
Reduced hip, knee, ankle movement

Deep vein incompetence

Volume overload - superficial vein incompetence

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36
Q

How does deep vein incompetence cause calf muscle pump failure?

A

Valve in deep vein allows some backflow of blood

blood falls back into down deep vein

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37
Q

How does superficial vein incompetence cause calf muscle pump failure?

A

Valve between superficial and deep vein is incompetent
allows some backflow of blood
blood keeps falling back into superficial vein
enters deep veins

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38
Q

What is the pathophysiology of thrombosis? - Virchow’s triad

A

Change in lining of vessel wall

Change in flow of blood

Change in constituents of blood

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39
Q

What is the pathophysiology of arterial thrombosis?

A

Change in lining of wall of artery

40
Q

What is the most common cause of changes in lining of arterial walls?

A

Atheroma

41
Q

What is the pathophysiology of venous thrombosis?

A

Changes in flow of blood

42
Q

What change in blood flow causes venous thrombosis?

A

Stasis of blood

43
Q

Does stasis alone cause venous thrombosis?

A

Not usually

other factors involved

44
Q

What are some of the other factors involved in venous thrombosis - alongside stasis of blood?

A

Trauma e.g. surgery

Oral contraceptive pill

Cancer

45
Q

How does arterial thrombosis occur?

A

Platelets

Clotting factors - intrinsic and extrinsic pathway

46
Q

How are arterial thrombi described in terms of their constituents?

A

Platelet-rich

47
Q

How does venous thrombosis occur?

A

Firstly the intrinsic pathway

then the extrinsic pathway aswell

48
Q

How are venous thrombi described in terms of their constituents?

A

Fibrin rich

49
Q

What occurs in both arteries and veins when they bleed?

A

Constriction of blood vessel
arteries - vasoconstriction
veins - venoconstriction

50
Q

Where is deep vein thrombosis most common?

A

Deep calf veins

51
Q

What are the symptoms of deep vein thrombosis?

A

Pain
Can’t walk

Swelling

Blue-red skin discolouration

52
Q

What are the signs of deep vein thrombosis?

A

Calf tenderness - pain

Muscle induration - muscles harden

Skin warmth

Skin discolouration

Distended, warm superficial veins

Oedema

Pyrexia - fever

53
Q

Why is surgery associated with deep vein thrombosis?

A

Immobility prior to, during, and after surgery
don’t use calf muscle pump

Surgery induces a prothrombotic state

54
Q

What is the complication of deep vein thrombosis? Why is it important?

A

Pulmonary embolism

Can lead to death

55
Q

How is peripheral arterial disease categorised?

A

Acute

Chronic

56
Q

Where are collateral arteries common? Why?

A

Around joints e.g. elbow and knee

Because flexing the joint occludes the main arteries
but the collateral arteries ensure there is still sufficient blood supply

57
Q

When do new collateral arteries form? Why?

A

Gradual narrowing of blood vessel

Collateral arteries develop to bypass the stenosis
maintain blood supply

58
Q

What is acute limb ischaemia?

A

Limb suddenly has largely impaired blood supply

over a few minutes

59
Q

What causes acute limb ischaemia?

A

Embolism from heart
or from abdominal aortic aneurysm

Trauma

60
Q

Within what timeframe must acute limb ischaemia be reversed?

A

Within 6 hours

61
Q

What are the consequences of acute limb ischaemia after 6 hours?

A

Muscle necrosis
Dead cells release lots of K+, hyperkalaemia
Causes cardiac asystole, cardiac arrest

62
Q

What must be done to the limb after 6 hours?

A

It must be amputated

63
Q

What are the signs and symptoms of acute ischaemia? 6 P’s

A

Pain

Paraesthesia

Paralysis

Pallor

Perishing cold

Pulseless

64
Q

What is the apperance of an acute ischaemic limb with different times from onset?

A

Onset - white

1 hour - moveable mottling

6 hours - fixed mottling

65
Q

What does moveable mottling look like?

A

Patchy cyanosis - blue/purple discolouration

66
Q

What causes moveable mottling?

A

Deoxygenated Hb in blood

Deoxygenated blood in limb

67
Q

What is a feature of moveable mottling?

A

It blanches

still some blood flow in capillaries

68
Q

What does fixed mottling like?

A

Widespread constant cyanosis

69
Q

What causes fixed mottling?

A

Deoxygenated Hb, blood

as with moveable mottling

70
Q

What is a feature of fixed mottling?

A

Non-blanching

because absolutely no blood flow

71
Q

How is chronic peripheral arterial disease categorised?

A

Intermittent claudication

Critical ischaemia

72
Q

What does claudication mean?

A

Limping

73
Q

What are the features of chronic peripheral arterial disease?

A

Rest pain

Ulceration, gangrene

74
Q

What does intermittent claudication mean?

A

Pain in muscles of lower limb

brought on by walking, exercise

75
Q

Which muscles are most frequently affected by intermittent claudcation?

A

Calf muscles

76
Q

What relieves the pain of intermittent claudication?

A

Stopping exercising, standing up

sitting down

77
Q

What are the arteries of the lower limb?

A

Common iliac artery
Internal iliac artery - gives off gluteal arteries
External iliac artery
Femoral artery
Profunda femoris artery
Popliteal artery
Anterior tibial artery - continues as dorsalis pedis into foot
Posterior tibial artery - continues into foot
Common fibular artery

78
Q

Where is the common femoral artery palpated?

A

Mid-inguinal point

79
Q

What is the mid-inguinal point?

A

Midway between ASIS and pubic symphysis

80
Q

Is the popliteal artery easy or difficult to palpate?

A

Difficult

81
Q

What does an easily palpable popliteal artery possibly mean?

A

Popliteal aneurysm

82
Q

Where is the dorsalis pedis palpated?

A

Lateral to tendon of extensor hallucis longus

83
Q

Where is posterior tibial artery palpated?

A

Posterior to medial malleolus

84
Q

What are the features of chronic aorti-iliac occlusion?

A

Bilateral buttock, thigh, calf claudication

Absent lower limb pulses

85
Q

What are the features of chronic right common iliac occlusion?

A

Right-sided buttock, thigh, calf claudcation

Absent right lower limb pulses

86
Q

What are the features chronic right common femoral artery occlusion?

A

Right-sided thigh and calf claudcation

Absent right lower limb pulses

87
Q

What are the features of right superficial femoral artery occlusion?

A

Right-sided calf claudication

Absent right-sided popliteal artery, posterior tibial artery and dorsalis pedis artery

88
Q

Which artery is most commonly occluded?

A

Superficial femoral artery occlusion

89
Q

What is rest pain?

A

Pain in the foot at rest

90
Q

What causes rest pain?

A

Skin, muscles, bone are ischaemic at rest

Not enough oxygen for basal metabolic requirements of cells

91
Q

What is the typical history of rest pain?

A

Comes on when going to bed

Relieved by hanging foot out of bed

92
Q

Explain the typical history of rest pain - why does it come on when going to bed?

A

Reduced effect of gravity drawing blood down arteries of foot

Increased temperature of foot
metabolic rate goes up
increased demand for oxygen

Cardiac output decreases at night
increased parasympathetic activity

93
Q

If rest pain is untreated, what are the consequences?

A

Ulceration

Gangrene

94
Q

Where is ulceration due to ischaemia most common?

A

Anterior tibia (shin)
because poor blood supply to this region
more prone to worsening ischaemia, ulceration

95
Q

What is intermittent claudication equivalent to when compared to heart disease?

A

Stable angina

96
Q

What is rest pain equivalent to when compared to heart disease?

A

Unstable angina

Cardiovascular System (22 decks)

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