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CVS > Peripheral Arterial and Venous Diseases > Flashcards

Peripheral Arterial and Venous Diseases Flashcards

1
Q

lower limb anatomy

A
  • veins deep and superficial
  • deep veins runs deep fascia with major arteries and deep veins are connected via perforating
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2
Q

movement of heart through the veins normally

A

superficial veins throughout the perforating veins to deep then sent back to the right side of heart

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3
Q

important veins in vd

A
  • femoral
  • long saphenous
  • politeal
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4
Q

is femoral vein deep or superficial?

A

nah deep

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5
Q

is saphenous vein deep or superficial and what else it ?

A

superficial at popliteal vein connects to the saphenous vein and longest vein in the body

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6
Q

whats the division of the veins from the external iliac

A

image

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7
Q

what an imprint site of locating a specific vein?

A
  • long saph runs infront of medial malleolus
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8
Q

calf muscle function

A
  • soleus and gastrocnemius muscle contribute to pushing blood against gravity towards the heart
  • valves open and b pushes through these deep veins , valves close to prevent retrograde movement
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9
Q

during exercise what happens to venous pressure

A

decreases b blood isn’t polling at the feet , if it pools for too long their vp drop too low and get to hypotension

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10
Q

varicose

A

varicose - damage to valves (d walls of veins weakening; varicosities develop and valve cusps separate becoming incompetent) of vessel wallso ineffevie movement of b and stasis , most common in saphenous veins hence why easy to view in les, more common in women

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11
Q

symptomatic development and complication

A
  • throbbing, itchy -haemorrhage (during hot showers, vasodilation, d damage to veins , veinodilation, haemmoraghe, can be fixed if they bring their legs up) - superficial vein thrombophlebitis (inflammatory process resulting in clot in vein) -chronic venous insufficiency; reflex or obstruction c venous hypertension and oedema -haemosidirin staining (venous pressure high b pours out the iron is leaked out -lipidermatosclerosis ; inflam. ad thickening of fat layer under skin -venous ulceration; damage to the skin damage
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12
Q

differential diagnosis of venous ulcers from arterial and diabetic ulcers

A
  • itching , throbbing and irregular and shallow and red is VENOUS - arterial ulcers are more pale, with defined edge - deep, red, plantar part of foot is Diabetic ulcer
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13
Q

whats CVI and what does it development into?

A

-chronic venous insufficiency -b pushed out of the capillaries into the interstitum and so c lymphatic compromised function d the chronic venous leakage - 50% get DVT

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14
Q

why does calf muscle pump fail

A
  • b muscle not being used properly, plantar flexion o ankle at joint
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15
Q

who’s most at risk of DV incompetence

A

-elderly/injured/obese/waiting for hip and knee replacement/parkinson 9since they shuffle and don’t flex) b more idle

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16
Q

retrograde flow?

A

-pooling of b

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17
Q

superficial vein incp

A

-valve damage so b moves from deep to superficial, so sup is overwhelmed - this increases risk of venous ulcers

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18
Q

whats does pooling increase risk of

A

ulcers - treatment is = ligating that perforating vein

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19
Q

arterial thrmbosis ?

A
  • platelet rich - activated- aggregate - plug hole
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20
Q

venous thrombosis

A
  • stasis and other factor -fibrin rich - virchows triad
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21
Q

DVT

A

-commomly calf -impaired vein return and hypercoaguabilty - - combined oral contraceptive pill ^ risk d changes in coagulability

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22
Q

post surgery pyrexia for no reason?

A
  • then post surgical DVT
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23
Q

what scoring system do you use

A

Well’s score

24
Q

economy class syndrome and risk factors od DVT

A
  • DVT more common in people who dot move or long-haul flights so economy class - stasis patients before and after -trauma increase hypercoagulity not even major surgery -cancers and pregnancy
25
Q

treatments

A
  • anticoagulants -movement -ted stocking
26
Q

what can DVT c

A

pulmonary embolism

27
Q

peripheral arterial disease common routes

A

knee , shoulder hip

28
Q

whats an adaptive response to stenosis of major vessel over a period of months or years

A

collateral circulation

29
Q

phyisiological design to limit incidence of ischaemia when we end or flex a joint?

A

collateral circulation

30
Q

acute limb ischaemia

A
  • occlusion d trauma or embolism -happens in matte of minutes or days -6 Ps
31
Q

leg ischameia Ps

A

-pain -pallor -pulseless -parasethia -paralysis or reduced power (d to occlusion) -perishing with cold

32
Q

treatments of AVD

A
  • angioplasty/thrombectomy/intra-ateraial thrombolysis
33
Q

what happens in ischamic leg

A
  • necrosis then hyperkalemia wc damage the heart and c asystole and death
34
Q

necrosis what should you think of

A

hyperkalemai

35
Q

chronic pAD how does it present

A
  • claudificaion (pain induced on exercise) -caused by arthero. -oxugen supply and demand ratio is imbalanced and so get angina
36
Q

management of CPAD

A
  • exercise, smoking, antiplatelet drugs, angioplasty , bypass grafts
37
Q

critical ischameia and rest pain

A
  • rest pain ; b supply so bad its painful even at rest; unstable angina
  • REST PAIN: even at rest pain but patients say its really painful at bed but releive the pain by hanging foot out of bed, this is because they are inducing gravity to stimulate gravity to get b into lower limbs
38
Q

treatment for critical isachemia

A
  • imaging
  • angioplasty/thrombectomy/intra-arterial thrmoblysis or amputation
39
Q

pathology of claudification

A

1) first mild where one 1 vessel occluded then more adn more and more
- most common is atheroma borught about the atheroschelrosis of the superficial femoral artery , pateitn presents with calf muscle claudification , untreated becomes critical ischamea
- then stenonsis can c infarctionadn necrosis (coagulative) , then dry gangrene and ulcers

40
Q

palpitations of lower limb

A
  • femoral - mid lingual point midway been ASIS and pubic symphysis
  • popliteal pulse - deep in popliteal fossa
  • dorsalis pedis pulse - just lateral to extensor hallucis longus tendon (ask patient to flex big toe and go lateral to the tendon)
  • posterior tibial pulse - just behind the medial malleolus
41
Q

doppler ulstrasound

A
  • used in diagnosis
  • measures flow and velocity w Is dirubed in occlusion
  • used in echo to demonstrate movement
  • also used in ankle-brachial pressure index
42
Q

ankle brachial pressure index

A
  • measure in brachial artery and ankle (looking at the doralis pedis artery and posterior tibial artery ) and divide it and systolic brachial if <0.9 theres an issue
43
Q

what are the risk factors for PAD

A
  • PVD ; ^ cholesertol, uncontrolled hypertension, smoking, diabetes
44
Q

what are risk factors for PVD

A

pregnancy (hence the ted stocking), oral contraceptive being female

45
Q

Buerger’s disease

A
  • occurs the b vessels of hands and feet become inflamed and clots form, they block b flow(veins and arteries) - d smoking
46
Q

Raynauds disease

A
  • spasm of the arteries in the fingers, toes sometimes nose and ears, Brough about by stress and cold c ischaemia to those areas -treatment is keep warm
47
Q

most common cause of PAD

A

atheroschelorsis ( build up of fatty plaque on the artery wall ; this is different to arterioschelrosis wc is hardening of artery walls)

48
Q

T/F PVD occurs due to thickening of the valves in the veins

A

false , occurs due to overstretched valves wc become incompentent and allow for retrograde flow and so pooling of blood

49
Q

with PAD whats important about tempreature

A
  • prevent the foot from getting too cold or else it will undergo vasoconstriction wc impedes b flow further
50
Q
A

-superficial vein thrombophlebitis (inflammatory response that cause b clot to form in vein) - patients present with painful erythematous

51
Q
A

arterial

52
Q
A

venous

53
Q
A

diabetic

54
Q

vascular arterial examination

A
  • consent
  • ASK IF PAIN OR DISCOMFORT
  • remove clothes and banadges
  • suppine position, patient at 45 degree angle or flat
  • lookat patient hands for temp , cyanosis, tabacoo,radial pulse to rule out AFib
  • pulse in both arms
  • scar for surgey
  • sources of external bleeding, look for pallor, ischaemia, erythema , gangree, hair loss hard skin(chronic ischaemia), swelling
  • feel skin with back of hand to assess tempreture and palpate the knee thigh and leg and ask about painand look at their face
  • slightly left to mid line use 2 hands to palpate the abdominal aorta
  • palpate the femoral, popliteal, dorsalis and tibial
  • assess capilaary refil time by pressing on the toe for 3 seconds and seeing how long it takes for reperfusiion to return to it >3 is abnormal
  • bones abnoamrlaies can c occlusion adn stenosis
  • assessneural impingement by checking motor funtion and sensation (e/f knee and hip adn dorsflexion adn plantar)
  • Buerger’s test
  • doppler ultrassound
55
Q

buerger’s test

A
  • patient in supine postion as to raise leg flexed
  • even raised the leg should be pink , but with positive they go pallor and when leg returned it goes blue then red

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