Session 8- Peripheral venous and arterial disease

Question 1

In what direction does blood move in veins in the lower limb?

Answer 1

superficial to deep

Question 2

how do the calf muscles act like a pump

Answer 2

soleus and gastrocemius muscles contribute to pushing blood against gravity back towards the heart

valves open-> blood pushed through to deep veins -> valves close to prevent retrogade movement

Question 3

varicose veins

Answer 3

valves ineffective and blood movement is slow or even
reversed

saphenous are common site of pathology

walls of veins weaken- varicosities develop and valve cusps separate becoming incompetent

veins become tortuous and twisted

Question 4

symptomatic presentation of peripheral venous disease

Answer 4

heaviness
aching
muscle cramps
throbbing

Question 5

signs of peripheral venous disease

Answer 5

along the affected vein

• leg cramps
• ankle swelling
• variscose eczema
• haemorrhage

Question 6

superficial vein thrombophlebitis

Answer 6

inflammatory processes resulting from a clot in vein

• painful erythematous
• follows varicose veins
• increase risk of deep vein thrombosis

Question 7

lipodermatosclerosis

Answer 7

inflammation and thickening of fat layer under skin

Question 8

haemosiderin staining

Answer 8

browny oedemy

RBC leak and macrophages injest them and release oxidative products which stain

Question 9

what is chronic venous insufficiency

Answer 9

more advanced disease
reflex and or obstruction -> venous hypertension
can lead
-lipodermatosclerosis
-haemosiderin staining
-venous ulceration

Question 10

venous eczema and ulceration

Answer 10

chronic, itchy red and swollen

tight and can lead to lipodermatosclerosis

ulcer chronic painful, often develop around hard nodular areas like medial malleolus- as a result of venous hypertension

Question 11

why does the calf muscle pump fail

Answer 11

when not in use- used in plantarflexion when walking

Question 12

who is at risk of calf muscle pump failure

Answer 12

immobile
obese
injured

Question 13

superficial vein incompetence

Answer 13

superficial to deep becomes deep to superficial

calf muscle pump overloads

Question 14

how do you treat calf muscle pump failure

Answer 14

ligation and vein stripping

Question 15

deep vein incompetence

Answer 15

retrograde flow- system overload

Question 16

what causes arterial thrombosis

Answer 16

artheroma

Question 17

what does a arterial thrombosis consist of

Answer 17

platelet rich

activated platelets aggregate and form a plaque

Question 18

what does a venous thrombosis consist of

Answer 18

low flow and little platelet content- fibrin rich

Question 19

what causes a venous thrombosis

Answer 19

stasis and usually another factor

• trauma
• medication
• dehydration
• chemotherapy
• inflammatory conditions
• pregnancy

Question 20

what is DVT

Answer 20

deep vein thrombsosis
-clotting of blood in a deep vein- commonly calf - impaired venous return and hypercoagulablity

asymmetry, tenderness, warmth, distended, visible superficial veins

Question 21

pyrexia

Answer 21

raised body temp

Question 22

wells test

Answer 22

pre test probability forms part of diagnosis- all suspected DVT patients

Question 23

what is the adaptive response to stenosis of a major vessel over a period of months or years

Answer 23

collateral circulation

Question 24

acute limb ischaemia

Answer 24

occurs in minutes to days- no collateral circulation can develop in this time

Question 25

what can cause acute limb ischaemia

Answer 25

trauma and embolism- artrial fibrillation, popliteal artery aneurysm, sudden rupture of atherosclerotic plaque

Question 26

6 P’s of leg ischaemia

Answer 26

pain
pallor
perishing with cold
pulseless
parasthesia
paralysis or reduced power- subtle

compare both limbs

Question 27

claudication

Answer 27

cramping pain in the leg induced by exercise caused by artherosclerosis

Question 28

chronic peripheral arterial disease

Answer 28

can be considered in similar terms to coronary artery disease

Question 29

ABI

Answer 29

ankle-brachial index
divide ankle systolic by brachial systolic

ABI < 0.9 indicates peripheral artery disease

Question 30

femoral pulse

Answer 30

felt at the mid inguinal pint midway between ASIS and pubic symphysis

Question 31

popliteal pulse

Answer 31

deep in popliteal fossa

Question 32

posterior tibial pulse

Answer 32

just behind medial malleolus

Question 33

dorsalis pedis pulse

Answer 33

just lateral to extensor hallucis longus tendon