Peripheral vascular disease

Question 1

Peripheal arterial disease is casued by

Answer 1

atherosclerosis

Question 2

peripheral arterial disease progresses in stages (3):

Answer 2

asymptomatic— intermittant claudication—- rest pain—– acute ischaemia

Question 3

what is peripheral arterial disease strongly associated with?

Answer 3

vascular disease of other body systems

Question 4

which other areas of arteries other than legs can be affected

Answer 4

abdomen and neck——- ischaemic bowel, acute abdominal

Question 5

DVT presents as

Answer 5

acutely painful

swollen leg

Question 6

Venous insufficiency

Answer 6

very common

causes varicose veins, swelling and skin changes

Question 7

what is the peripheral vascular system

Answer 7

blood vessels of the body aside from the head and chest

Question 8

oedema

Answer 8

swelling caused by excessive fluid in the tissues

Question 9

atherosclerosis

Answer 9

the build up of fats to form plaques inside arteries

Question 10

ischaemia

Answer 10

blood and oxygen flow is insufficient to meet the metabolic demands of the body

Question 11

necrosis

Answer 11

messy unprogrammed cell death

Question 12

extravasation

Answer 12

things that are normally present in a blood vessel leaking into the surrounding tissues

Question 13

thrombosis in situ

Answer 13

blockage of a vessel by a clot arising from an existing narrowed area of atherosclerosis

Question 14

thromboembolism

Answer 14

blood clot blocking a vessel that started in one place and broke off to move to another

embolus usually from the left atrium, associated w atrial fibrillation from DVT

Question 15

aneurysm

Answer 15

bulge in a blood vessel, caused by a weakness in its walls and or excessive pressure in the vessel

Question 16

peripheral arterial disease

Answer 16

• occurs whwn there is significant narrowing of the arteries, usually due to atherosclerosis
• 8x more common in legs than arms
• PAD causes limb ischaemia and progresses in stages

Question 17

risk factors for PAD

Answer 17

>50 year olds most affected

CV risk factors: smoking, hypertension, dyslipidaemia, diabetes

Question 18

risk of CV event is sigmificantly increased by

Answer 18

heart attacks

most people with PAD actually die from ehart attacks and strokes

Question 19

progressive stages of lower limb ischaemia

Answer 19

1. ischaemia
2. intermittent claudication
3. night/rest pain
4. tissue loss

Question 20

asymptomatic nature of PAD

Answer 20

patients may not be healthy enough to walk to bring on symptoms

Question 21

intermittent claudication

Answer 21

• pain in the legs on walking due to ischaemia
• tighten/ cramp, worse uphill, goes on rest but restarts when walking
• often has a predictable ‘claudication distance’
• claudication itself doesn’t cause damage to the limb, but is a marker of extensive atherosclerotic disease

Question 22

claudication distance

Answer 22

how far can you walk before pain gets too bad so you have to stop

Question 23

Night/ rest pain in atherosclerosis

Answer 23

severe enough atherosclerosis that blood flow isn’t good enough to meet the normal demands of the tissues at rest.

may be ‘unmasked’ at night:

when you sleep HR and BP decrease

lose aid of gravity in perfusing the feet

indicates severe prorgession of disease- refer to vascular surgeon

Question 24

tissue loss stage of atherosclerosis

Answer 24

ulcers and or necrosis

starts distally and works proximally

often starts with a proximal wound that doesnt heal

can be caused by emboli that block downstream capillaries

Question 25

arterial ulcers

Answer 25

lower legs tops of feet and toes

painful

symmetrical in shape

cool/ pale bluish surrounding skim that appears shiny

loss of leg hair

faint or absent pulses

Question 26

what is acute limb ischaemia

Answer 26

sudden drop in BP that threatens the viability of a limb may cause irreversible tissue death and limb amputation

Question 27

6 P’s of limb ischaemia

Answer 27

painful

pale

pulseless

perishingly cold

paraesthesia- numbness due to comprimised nerve function

paralysis- indicates comprimised muscle function

Question 28

examples of diseases that casue Abdominal pain

Answer 28

mesenteric artery disease

mesenteric ischaemia

acute ischaemic bowel

abdominal aortic aneurysm

Question 29

mesenteric ischaemia

Answer 29

abdominal pain brought on by eating

uncommon as the gut has many sources of blood flow so several vessels would need to be significantly affected by atherosclerosis

Question 30

acute ischaemic bowel

Answer 30

usually an embolus from the left atrium of the heart or by thrombosis in situ of mesenteric artery

lack of BF– portion of bowel dies – leaky – passage for microbiota tp enter abdominal cavity– severe sepsis– high mortality

severe pain wo abdominal tenderness

Question 31

carotid artery disease

Answer 31

carotid atherosclerosis is a main risk factor for stroke and TIA

Question 32

stroke

Answer 32

neurological deficit attributed ti acute focal injury of the CNS by a vascular cause

Question 33

TIA

Answer 33

temporary lack of BF to a part of the brain giving symptoms and signs of a stroke but lasting less than 24 hours

Question 34

Raynaud’s

Answer 34

ischaemia of digits caused by a spasm or blockage of arteries in response to cold

pallor- as arterial BF is blocked

cyanosis- as oxygen is used up

hyperaemia- when blockage is relieved and there is a sudden influx of O2 rixh blood

raynaud’s sydrome is when there is smething else underlying e.g., blood clotting disorder

Question 35

What are the superficial veins if the leg

Answer 35

long and short saphenous veins

Question 36

where in the leg is the long saphenous vein found

Answer 36

superficially inthe middle of the leg

Question 37

where is the short saphenous vein found

Answer 37

lateral + posterior + superficial aspect of calf

Question 38

deep vein thrombosis

Answer 38

a blood clot in a deep vein

usually in the lower leg or thigh but can be in the arm or pelvis

Question 39

signs and symptoms of deep vein thrombosis

Answer 39

limb pain and or tenderness

swelling of the calf/ thigh

pitting oedema

distension of the superficial veins

red/ warm skin

Question 40

risk factors for dVT

Answer 40

previous hitsory of DVT/PE (collectively called venous thromboembolism)

immobilisation- e.g., during hospital admission

cancer

pregnancy

severe dehydration

thrombophilia

oral oestrogen (combined contraceptive pill)

smoking

obesity

Question 41

chronic venous insuficiency and varicose veins

Answer 41

you can have cvi with or w/o varicose veins

• dilated superficial veins
• tortuous veins
• superficial veins

look at the inner aspct of the calf but anywhere on the leg

usually due to incompetent valves or previous DVT leading to chronic high pressure in the venous system

pain, itch, swelling, skin changes

Question 42

haemodiserin

Question 43

varicose eczema

Answer 43

red, dry, scaly sometimes blistered

Question 44

lipodermatsclerosis

Answer 44

-fat -skin -hard -process

Question 45

core presenting complaints and differentials for peripheral diseases

Answer 45

leg pain- intermittent claudication/ acute sichaemic limb/ DVT/ varicose vein insuffiency

leg swelling- DVT, venous insuffiency

ulcers- arterial disease, venous insuffiency

finger colour changes- reynaudes, peripheral arterial disease of arm

abdominal pain- mesenteric ischaemia/ ischameic bowel/ AAA