PVD Flashcards
What type of aortic aneurysm is most common
Abdominal
What is the cause if an aortic aneurysm
Weakening of the aortic wall
What is the leading cause of aortic aneurysms
atherosclerosis
When do people often become symptomatic with an aortic aneurysm
when they dissect / rupture
What symptoms will a patient experience with a thoracic aortic dissection
severe tearing back pain
hypotension
shock
What symptoms will a patient experience with an abdominal aortic dissection
severe abdominal / flank pain
hypotension
syncope
potential leg ischemia
What is the test of choice for the initial testing / screening for TAA
CTA (>4.5cm)
What is the test of choice for initial testing / screening for AAA
US (>3cm)
How do you manage AAA
Manage modifiable risks (BP/Lipids)
Surveillance of growth
How big does a AAA need to be for surgical management
> 5.5cm or rapid growth (+.5cm/year)
What are some risk factors for an aortic dissection
Complication of AAA and TAA
Hypertension
+FH
Which gender is at greater risk for aortic dissection
men at at 3x greater risk
What layer in the vessel is torn with an aortic dissection
the intima
*blood enters the space between the intima and media which created a false lumen
What are the three more common locations for aortic aneurysm
aortic root
aortic arch
just distal to subclavian
What does the type A Stanford classification involve
Involves the ascending aorta
*Requires surgery
What is a type 1 deBakey classification
dissection that originates in the ascending aorta and goes down the descending aorta
What is a type 2 DeBakey classification
Confined to the ascending aorta
What is the Type 3 DeBakey classification
Starts distal to subclavian
3A: stays thoracic
3B: propagates to abdomen
How will a patient present with an aortic dissection
severe ripping chest pain that radiates to the back
How do you workup an aortic dissection
EKG and CXR
Echo
CT or TEE (test of choice)
What type of dissections should have medical management before considering surgery
Type B
What is the HR and BP goal for dissection management
60BPM
100-120 systolic
What is the number one risk factor for peripheral artery disease
smoking
What is the most characteristic symptom of peripheral artery disease
intermittent claudication
What can improve leg pain with peripheral artery disease
hanging foot over the side of things (gravity helps)
What makes pain worse with PAD
worse with elevation / laying flat (being woken up at night)
Where does pain generally originate with PAD
Distal metatarsal area
What test can help confirm peripheral artery disease
ABI
What is a normal ABI
.9-1.3
If a patient as an ABI of <.9 what symptoms will they have
intermittent claudication
If a patient has an ABI of <.5 what symptoms will they have
pain at rest
Where will ulcers occur in people with PAD
Lateral malleolus
Where will ulcers occur in people with venous insufficiency
medial malleolus
What are treatment options for PAD
Smoking cessation
Foot care
exercise
clopidogrel
cilostazol (claudication)
Intervention
What is the first line intervention for PAD
PTA +/- stenting
What are intervention options for PAD
Lower leg angio (PTA & stenting)
Endarterectomy
Bypass grafting
Amputation
When is amputation done with PAD
infection
gangrene
severe pain
limb ischemia
What are the 5 Ps of acute arterial occlusion
Pain
Pallor (or mottled)
Pulselessness
Polar sensation
paresthesia
What is a common example of venous insufficiency
Varicose veins
What causes varicose veins to form
incompetent valves
What causes incompetent valves in veins
secondary to increased pressure
which causes reflux
What is the presentation of venous insufficiency
LE pitting edema
pain /achiness
Sx improve w/ rest / elevation
NO CLAUDICATION
What is the workup for venous insufficiency
Primary a clinical dx
ABI to run out PAD
venous reflux testing
What is the top management therapy for venous insufficiency
Compression with stockings or bandaging
Which patients with venous insufficiency can you not use compression socks in
patient sixth co-morbid arterial disease
What are some surgical interventions for venous insufficiency
sclerotherapy
ablation
vein stripping
valvuloplasty
What is one of the most common rectal pathologies
Hemorrhoids
What is the #1 cause of rectal bleeding
hemorrhoids
What is hematochezia
bright red blood (lower GI bleed)
What are risk factors for hemorrhoids
straining with defecation
pregnancy
enlarged prostate
Which type of hemorrhoid is painful
external
How can hemorrhoids be dx
Mostly clinical
can use digital rectal exam
anoscopy for visualization
lastly a colonoscopy
How do you treat hemorrhoids
reduce straining
sitz bath
topical cream
What are procedural treatments for hemorrhoids
rubber band ligation
sclero
photocoagulation
