Session 11-Peripheral Arterial And Venous Disease

Question 1

Which deep veins in the lower limb do we need to know?

Answer 1

External iliac vein
Femoral vein
Popliteal vein

Question 2

Which superficial veins in the lower limb do we need to know?

Answer 2

Short saphenous vein

Long saphenous vein

Question 3

Where is the long saphenous vein located in relation to the medial malleolus?

Answer 3

Anterior

Question 4

True or false: blood always flows from deep to superficial veins

Answer 4

FALSE - superficial to deep

Question 5

What are varicose veins?

Answer 5

Tortuous, twisted or lengthened veins

Question 6

Describe the pathophysiology of varicose veins

Answer 6

Vein wall is weak, leading to dilatation and separation of valve cusps so they become incompetent

Question 7

What are the symptoms of varicose veins and where do these occur?

Answer 7

Heaviness
Tension
Aching
Itching

All occur along the vein itself

Question 8

Which complications of varicose veins result from the vein itself?

Answer 8

• Haemorrhage

- Thrombophlebitis (inflammation of wall of vein with thrombosis=painful!)

Question 9

Which complications of varicose veins result from venous hypertension?

Answer 9

• oedema
• skin pigmentation
• varicose eczema
• lipodermatosclerosis
• venous ulceration

Question 10

Why does haemosiderin staining occur along varicose veins?

Answer 10

Venous hypertension and increased capillary permeability

Question 11

What is lipodermatosclerosis?

Answer 11

Fat becomes thick and hard around vein

Question 12

What is the result of calf muscle pump failure?

Answer 12

Venous hypertension

Question 13

What are the causes of calf muscle pump failure?

Answer 13

• failure of calf muscle contraction - immobility, obesity, reduced hip, knee and/or ankle movement
• deep vein incompetence
• volume overload - superficial vein incompetence

Question 14

How does venous ulceration occur?

Answer 14

Calf muscle pump dilates because some blood re-enters calf muscle system -> venous hypertension -> venous ulceration

Question 15

What is the pathophysiology of thrombosis (Virchow’s triad)?

Answer 15

• changes in lining of vessel wall
• changes in blood flow
• changes in constituents of blood

Question 16

What is the pathophysiology of arterial thrombosis?

Answer 16

Changes in lining of vessel wall (atheroma)

Question 17

What is the pathophysiology of venous thrombosis?

Answer 17

Changes in blood flow (stasis)

Question 18

Stasis plus which other factors can lead to venous thrombosis?

Answer 18

Surgery (trauma)
Oral contraceptive pill
Dehydration
Cancer

Question 19

True or false: arterial thrombi are platelet rich

Answer 19

TRUE

Question 20

What are venous thrombi rich in?

Answer 20

Fibrin

Question 21

Which pathway is majorly involved in venous bleeding?

Answer 21

Intrinsic

Question 22

True or false: arterial bleeding needs platelets and both intrinsic and extrinsic pathways

Answer 22

TRUE

Question 23

What are the symptoms of deep vein thrombosis?

Answer 23

• pain, cannot walk
• swelling
• blue-red skin discolouration

Question 24

What are the signs of deep vein thrombosis?

Answer 24

• calf tenderness
• muscle induration
• skin warmth
• skin discolouration
• distended, warm superficial veins
• oedema
• pyrexia

Question 25

What is the association between surgery and DVT?

Answer 25

- immobility prior to surgery - no calf muscle pump during surgery - immobility after surgery

Question 26

What is often the fatal consequence of DVT?

Answer 26

Pulmonary embolism

Question 27

Where is natural collateral circulation common?

Answer 27

Across joints such as elbow and knee

Question 28

What does collateral circulation develop in response to?

Answer 28

Stenosis

Question 29

What is acute limb ischaemia?

Answer 29

Limb goes from normal blood supply to greatly impaired blood supply over period of minutes, no chance for collateral vessel development

Question 30

What are the commonest causes of acute limb ischaemia?

Answer 30

Embolism | Trauma

Question 31

What can happen if acute limb ischaemia is not reversed within 6 hours?

Answer 31

Limb cannot be recovered and if not amputated, patient will die (hyperkalaemia due to dead tissue releasing intracellular potassium)

Question 32

What are the symptoms/signs of acute ischaemia (6 Ps)?

Answer 32

``` Pain Paralysis Paraesthesia Pallor Perishing cold Pulseless ```

Question 33

In chronic peripheral arterial disease, what is the equivalent to: 1) stable angina 2) unstable angina 3) MI

Answer 33

1) intermittent claudication 2) rest pain 3) ulceration/gangrene

Question 34

What is claudication?

Answer 34

Pain in muscles of lower limb elicited by walking/exercise

Question 35

Which muscles are most frequently affected in claudication?

Answer 35

Calf muscles

Question 36

How is pain relieved in claudication?

Answer 36

Stopping exercise for a few minutes, even whilst standing up

Question 37

Where is the femoral pulse felt?

Answer 37

Mid-inguinal point

Question 38

Where is the popliteal pulse felt?

Answer 38

Deep in popliteal fossa and difficult to feel

Question 39

Where is the dorsalis pedis pulse felt?

Answer 39

Lateral to extensor hallucis longus tendon

Question 40

Where is the posterior tibial pulse felt?

Answer 40

Behind medial malleolus

Question 41

What is the commonest finding in patients with claudication?

Answer 41

Superficial femoral artery occlusion: | -femoral pulse present, absent popliteal and pedal pulses

Question 42

What is rest pain?

Answer 42

Pain in foot that comes on when patient goes to bed and is relieved by hanging foot out of bed - ischaemia so severe that foot skin, muscles and bones are ischaemic at rest = not enough O2 to provide for cells basic metabolic requirements

Question 43

If left untreated, what can rest pain progress to?

Answer 43

Gangrene and/or ulceration