Peripheral artery and venous disease

Question 1

which way in the legs does the blood run (superficial/deep)

Answer 1

superficiial to deep

Question 2

how is blood pumped up to the heart?

Answer 2

the calf muscle pump

very tight fasicia around the calf muscles–>large increase in pressure on contraction

Question 3

define varicose veins

Answer 3

tortuous, twisted or lengthened veins

Question 4

describe the pathophysiology of varicose veins

Answer 4

wall of veins is inheritiantly weak

cusps of valves separate–>incompetency of valves

Question 5

Four symptoms of varicose veins?

Answer 5

heaviness, itching, aching, tension

ALONG THE VEIN ITSELF

Question 6

2 complications that are as a result of the varicose vein itself?

Answer 6

haemorrhage and thrombophlebitis

Question 7

define thrombophlebitis

Answer 7

inflammation of the vessell wall

pain

Question 8

5 complications due to venous hypertension

Answer 8

oedema, skin pigmentation (Due to haemosiderin staining), varicose eczema, lipodermatosclerosis, venous ulceration

Question 9

why do you get venous hypertension in varicose veins?

Answer 9

the calf muscle pump has stopped working

Question 10

Causes of venous hypertension?

Answer 10

immobility
obesity
(Both associated with calf muscle contraction failure

deep vein incompetence
superficial vein incompetence

Question 11

Explain how superficial vein incompetence can lead to venous hypertension

Answer 11

You get an incompetent valve at the junction of the superficial to deep vein
so when the calf muscle pump contracts, some blood goes from deep to superficial
so taken back to the calf muscle pump system
so you get a dilatation of this system–>calf muscle pump failure

Question 12

how would you treat superficial vein incompetence?

Answer 12

Separate the superficial vein from the deep vein

Question 13

What is virchows triad?

Answer 13

three things thrombosis can be due to:
changes in the vessel wall
changes in blood flow
changes in blood constituents

Question 14

what is arterial thrombosis mostly due to (Virchows triad)

Answer 14

changes in the vessel wall

Question 15

what venous thrombosis most often due to? (Virchows triad)

Answer 15

changes in blood flow

Question 16

With venous thrombosis, as we said it was due to some change in the blood flow. Also need a provacateur. Give 4 examples of provocateurs

Answer 16

cancer
trauma
dehydration
oral contraceptive pill

Question 17

compare artterial and venous thrombus

Answer 17

Arterial: involves platelets (platelet rich
the extrinsic pathway of clotting first, then the intrinsic

Venous: Doesn’t involve platelts in a major way
intrinsic then extrinsic
fibrin rich clot

Question 18

Why do you get pain when you get a DVT?

Answer 18

it induces an inflammatory response

Question 19

Give some symptoms of DVT

Answer 19

oedema
pain
skin discolouration
pyrexia
skin warmth
swelling

Question 20

Why is surgery related to DVT formation. what is the dreaded consequence?

Answer 20

surgery- immobility and a form a trauma so go into a prothrombotic state

Question 21

what is common around joints (Blood supply wise)

Answer 21

collateral circulation

Question 22

Why can collateral circulation not form in acute limb ischaemia?

Answer 22

normal blood supply–>greatly impaird blood supply in mins

not enough time to form

Question 23

Two causes of acute limb ischaemia? Two consequences (untreated and treated)

Answer 23

embolism or trauma
amputation
if not, patient can die of hyperkalaemia as dead cells release K+

Question 24

6 symptoms of acute limb ischaemia?

Answer 24

Pain
Paralysis
Parasthesia
Pallor
Perishingly cold
Pulseless

Question 25

What colour does the leg go initially? At what stage is it ‘too late’ in acute limb ischaemioa

Answer 25

white

When you get fixed mottling of the leg (No blanching so no flow of blood what so ever)

Question 26

Define intermittent claudication

Answer 26

pain on walk due to ischamemia

m ost commmon in the calf

Question 27

Describe the deep venous supply to the leg (proximal to distal

Answer 27

external iliac vein–>femoral vein–>popliteal vein

Question 28

Two superficial veins in the leg?

Answer 28

long saphenous and short saphenous veins

Question 29

where does the long saphenous vein always pass?

Answer 29

anterior to the medial malleolus

Question 30

describe the arterial supply to the leg (proximal to distal)

Answer 30

common iliac artery
internal and external iliac arteries
common femoral artery–>superficial femoral artery and the profunda femoris artery
popliteal artery–>anterior tibial artery, posterior tibial artery and peroneal artery
Anterior tibial artery–>dorsalis pedis

Question 31

Three pulses and where each can be felt?

Answer 31

femoral pulse- the med inguinal point
popliteal pulse- popliteal fossa
pedal pulses (The dorsal pedalis and the posterior tibial arteries- foot

Question 32

what claudication and what pulses would you get with Aorto iliac occlusion

Answer 32

billateral buttock pain, thigh pain, calf claudication

no pulses in lower leg

Question 33

what claudication and what pulses would you get with common iliac occlusion

Answer 33

unilateral buttock, thigh and calf claudication

no pulses

Question 34

what claudication and what pulses would you get with common femoral occlusion

Answer 34

right thigh and calf claudication

no pulses in right lower limb

Question 35

what claudication and what pulses would you get with superficial femoral artery occlusion

Answer 35

right calf claudication
femoral pulse present
popliteal and pedal pulses not

Question 36

Define rest pain. When do you get rest pain in the foot? how is the pain relieved? If untreated what will it progress to?

Answer 36

at rest you are unable to meet the cell’s basic metabolic demands
when you go to bed
hang your foot out of the bed

ulceration and gangrene