PVD, Tumors, and Trauma Flashcards
What are the main causes of amputation?
- Vascular disease (54%),
- Trauma (45%)
- Tumors (less than 2%)
What are common etiologies of vascular disease leading to amputation?
- Diabetes
- peripheral arterial disease (conditions under the umbrella of PVD)
How is PVD organized based on pathology?
PVD is organized into…
- arterial occlusive
- inflammatory
- vasomotor
- venous disorders
PVD
What are the common arterial and venous symptoms associated with PVD?
Arterial:
- Sharp pain, diminished pulses, cool skin, dry and shiny skin, hairless areas, and trophic changes.
Venous:
- Aching, heavy legs, swelling, varicose veins, hemosiderin deposits, fibrosis
How can you differentiate arterial vs. venous wounds?
- Arterial wounds are dry, pale, painful, and often distal
- Venous wounds are often on the lower leg, have drainage, granulation, and hyperpigmentation.
What subjective clues indicate arterial vs. venous disease during evaluation?
- Arterial: Cramping with walking, rest pain relieved by dependency, hairless skin, and cool extremities.
- Venous: Aching, heavy legs relieved by elevation, and swelling.
What is chronic venous insufficiency (CVI) and what are the symptoms?
- Chronic Venous Insufficiency (CVI) is a condition where damaged valves in veins cause venous hypertension, reverse blood flow, and chronic edema.
- Symptoms = Dilated veins, leg pain, edema, and stasis dermatitis.
What causes CVI?
Venous occlusion, valvular defects, and problems with the muscle pump.
What is peripheral neuropathy?
Degeneration of peripheral nerves, affecting sensory, motor, or autonomic functions.
What are the main pediatric bone tumors types?
- Osteosarcoma (56%)
- Ewing’s sarcoma (34%)
- Chondrosarcoma (6%)
What are the common symptoms of osteosarcoma and Ewing’s sarcoma?
Osteosarcoma:
- Sharp or dull pain, swelling, redness, limping, and decreased movement of the affected limb.
Ewing’s sarcoma”
- Pain, swelling, fever, weight loss, fatigue, and neurological symptoms if spinal involvement.
Where are osteosarcomas typically located?
Lower end of femur, upper end of tibia, upper end of humerus, and upper end of femur.
What is the radiographic appearance of osteosarcoma?
Sun-burst appearance, periosteal lifting, permeative bone destruction, and osteolysis.
Where is Ewing’s sarcoma most commonly found?
- femur (45%)
- pelvis (20%)
- upper limb (13%)
- spine/ribs (13%)
What are the radiological features of Ewing’s sarcoma?
Permeative bone destruction, laminated periosteal reaction, sclerosis, Codman triangles, and bone expansion.
What are the four key questions in deciding limb salvage vs. amputation?
- Will survival be the same?
- Will morbidities be the same?
- Will function improve?
- Will quality of life improve?
How does survival compare between limb salvage and amputation?
Survival rates are generally similar between limb salvage and amputation.
How do morbidities differ between limb salvage and amputation?
Limb salvage tends to have more immediate and late morbidities compared to amputation.
Is function improved more by limb salvage or amputation?
Limb salvage has a tendency toward improved function, but not overwhelmingly.
How does limb salvage impact quality of life (QOL)?
Limb salvage has not been proven to offer significantly better psychosocial outcomes than amputation.
What are the key symptoms of peripheral neuropathy?
Numbness, tingling, weakness, loss of sensation, and autonomic changes.
What is the role of the muscle pump in venous return?
The muscle pump helps propel blood back to the heart, reducing venous hypertension.
What is intermittent claudication?
Cramping pain in the legs due to reduced blood flow, typically triggered by exercise.
What is rest pain in arterial disease?
Pain that occurs at rest, typically relieved by leg dependency, indicating advanced arterial disease.
