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Semester 2-CVS > Session 11-Peripheral Arterial And Venous Disease > Flashcards

Session 11-Peripheral Arterial And Venous Disease Flashcards

1
Q

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

A

External iliac vein
Femoral vein
Popliteal vein

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2
Q

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

A

Short saphenous vein

Long saphenous vein

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3
Q

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

A

Anterior

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4
Q

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

A

FALSE - superficial to deep

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5
Q

What are varicose veins?

A

Tortuous, twisted or lengthened veins

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6
Q

Describe the pathophysiology of varicose veins

A

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

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7
Q

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

A

Heaviness
Tension
Aching
Itching

All occur along the vein itself

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8
Q

Which complications of varicose veins result from the vein itself?

A
  • Haemorrhage

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

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9
Q

Which complications of varicose veins result from venous hypertension?

A
  • oedema
  • skin pigmentation
  • varicose eczema
  • lipodermatosclerosis
  • venous ulceration
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10
Q

Why does haemosiderin staining occur along varicose veins?

A

Venous hypertension and increased capillary permeability

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11
Q

What is lipodermatosclerosis?

A

Fat becomes thick and hard around vein

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12
Q

What is the result of calf muscle pump failure?

A

Venous hypertension

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13
Q

What are the causes of calf muscle pump failure?

A
  • failure of calf muscle contraction - immobility, obesity, reduced hip, knee and/or ankle movement
  • deep vein incompetence
  • volume overload - superficial vein incompetence
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14
Q

How does venous ulceration occur?

A

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

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15
Q

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

A
  • changes in lining of vessel wall
  • changes in blood flow
  • changes in constituents of blood
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16
Q

What is the pathophysiology of arterial thrombosis?

A

Changes in lining of vessel wall (atheroma)

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17
Q

What is the pathophysiology of venous thrombosis?

A

Changes in blood flow (stasis)

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18
Q

Stasis plus which other factors can lead to venous thrombosis?

A

Surgery (trauma)
Oral contraceptive pill
Dehydration
Cancer

19
Q

True or false: arterial thrombi are platelet rich

A

TRUE

20
Q

What are venous thrombi rich in?

A

Fibrin

21
Q

Which pathway is majorly involved in venous bleeding?

A

Intrinsic

22
Q

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

A

TRUE

23
Q

What are the symptoms of deep vein thrombosis?

A
  • pain, cannot walk
  • swelling
  • blue-red skin discolouration
24
Q

What are the signs of deep vein thrombosis?

A
  • calf tenderness
  • muscle induration
  • skin warmth
  • skin discolouration
  • distended, warm superficial veins
  • oedema
  • pyrexia
25
Q

What is the association between surgery and DVT?

A
  • immobility prior to surgery
  • no calf muscle pump during surgery
  • immobility after surgery
26
Q

What is often the fatal consequence of DVT?

A

Pulmonary embolism

27
Q

Where is natural collateral circulation common?

A

Across joints such as elbow and knee

28
Q

What does collateral circulation develop in response to?

A

Stenosis

29
Q

What is acute limb ischaemia?

A

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

30
Q

What are the commonest causes of acute limb ischaemia?

A

Embolism

Trauma

31
Q

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

A

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

32
Q

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

A 
Pain
Paralysis 
Paraesthesia
Pallor 
Perishing cold
Pulseless
33
Q

In chronic peripheral arterial disease, what is the equivalent to:

1) stable angina
2) unstable angina
3) MI

A

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

34
Q

What is claudication?

A

Pain in muscles of lower limb elicited by walking/exercise

35
Q

Which muscles are most frequently affected in claudication?

A

Calf muscles

36
Q

How is pain relieved in claudication?

A

Stopping exercise for a few minutes, even whilst standing up

37
Q

Where is the femoral pulse felt?

A

Mid-inguinal point

38
Q

Where is the popliteal pulse felt?

A

Deep in popliteal fossa and difficult to feel

39
Q

Where is the dorsalis pedis pulse felt?

A

Lateral to extensor hallucis longus tendon

40
Q

Where is the posterior tibial pulse felt?

A

Behind medial malleolus

41
Q

What is the commonest finding in patients with claudication?

A

Superficial femoral artery occlusion:

-femoral pulse present, absent popliteal and pedal pulses

42
Q

What is rest pain?

A

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

43
Q

If left untreated, what can rest pain progress to?

A

Gangrene and/or ulceration

Semester 2-CVS (18 decks)

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