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CP1 > vascular > Flashcards

vascular Flashcards

1
Q

Aneurysm definition

A

localised dilatation with permanent diameter >1.5x normal. True are formed by arterial wall, false has another tissue

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2
Q

fusiform aneurysm

A

symmetrical

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3
Q

Saccular aneursym

A

asymmetrical (berry)

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4
Q

False aneurysm

A

Leaking blood pools around vessel (can look fusiform)

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5
Q

Common aneurysm sites

A

Aorta (normally abdominal, and often below renal artery branches. Can also get thoracic (50% ascending aorta) -incidence increasing).
Popliteal is most common peripheral aneurysm - associated with AAAs. More common in men.

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6
Q

Aneurysm RF

A

Smoking, male>60, DM, HTN, high LDL, CT disorders, coarctation of aorta, pregnancy

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7
Q

Aneurysm complications

A

Intact often asymptomatic, but can compress nearby structures.
Berry aneurysm can cause intense headache
Thoracic aneurysm near aortic valve can prevent valve shutting and give aortic insufficiency due to backflow
Ruptured AAA can show Grey-Turney’s sign (but also seen in pancreatitis)

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8
Q

Aneurysm rupture

A

Hypotension, tachycardia, syncope, anaemia, expansile abdo mass, shock, severe left flank pain, vomiting, collapse

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9
Q

Aneurysm investigation and surveillance

A

USS shows location and can FU on development
CT angiography shows detailed image.

AAA screening for men >66 (but consider in higher risk too (COPD, vascular/CV issues, european origin, FHx AAA, hyperlipidaemia, HTN, smoking (ex and current)
On screening:
3.0-4.5 means 2 yearly surveillance
4.5-5.4 is 3 monthly surveillance

Also look at Risk modification

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10
Q

Management of aneurysm rupture

A

A->E (urgent issues, analgesia, ECG, inform ITU)
Bloods + crossmatch (wide bore cannula, blood tests, coag screen)
Fluids admin in hypotension
Major haemorrhage protocol
Vascular team involvement
Abdo USS to check size and rupture evidence
Surgical management (EVAR or open in complex cases)

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11
Q

Management of unruptured

A

Surgery is symptomatic, or asymptomatic and >5.5cm, or >4.0cm but growing by more than 1cm/year

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12
Q

Popliteal aneurysm signs and symtpoms

A

Often asymptomatic, but many have palpable/pulsatile mass behind knee. Can cause mass effects (tibial nerve compression, leg pain, paraesthesia, popliteal vein compression (Swelling)
Can lead to acute complication with thrombosis and acute limb ischaemia (pallor, cold leg, pain, parasthesia)

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13
Q

Investigating popliteal aneurysm

A 
Duplex USS (vessel patency, thrombus development)
CT/MR as alternative for accurate measure of lumen diameter
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14
Q

Popliteal aneurysm management

A

Conservative if <2cm (duplex surveillance) or surgical (EVAR/open)

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15
Q

Aortic dissection

A

Intima tears, tunica media separation and false lumen development. Common in first 10cm of aorta, but needs weakness to predispose (weakness can give aneurysm or dissection)

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16
Q

DeBakey 1

A

Intimal tear in ascending aorta, but descending also involved

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17
Q

De Bakey 2

A

Only ascending involvement

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18
Q

De Bakey 3

A

Only descending involvement

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19
Q

Stanford A

A

Ascending involvement involved (De Bakey 1 and 2)

20
Q

Stanford B

A

Descending only (De bakey 3)

21
Q

Aortic dissection risk factors

A

HTN (main one), smoking, hyperlipidaemia, thoracic AA, aortic valve abnormalities, FHx of dissections, previous cardiac surgery, trauma, cocaine/amphetamine use, CT disease

22
Q

Aortic dissection Signs and symptoms

A

Sharp chest pain radiating to back
Weak pulse in downstream artery
May have difference in BP between right and left arm
Hypotension in rupture (and shock)

23
Q

Aortic dissection Investigations

A

CXR widened mediastinum (due to widened aorta)
TOE (false lumen detection)
CT angiogram

24
Q

Aortic dissection complications

A

1) pericardial tamponade due to backflow in false lumen
2) Rupture
3) False lumen compresses nearby branch (E.g. subclavian/renal artery) and leads to ischaemia

25
Q

Management of aortic dissection

A

A->E, stabilise haemodynamically
Vascular team involvement
Can medically manage stable patients with BP reduction (ant hypertensive and beta blockers)
Surgical management if increasing aortic diameter, compromise of branches, imepending rupture or thoracic cavity bleed. Resect and replace area.

26
Q

Popliteal vein

A

Formed by anterior tibial, posterior tibial and fibular vein. Small saphenous empties in.
Become femoral vein in thigh

27
Q

Femoral vein

A

Was popliteal vein, great saphenous vein empties in.

28
Q

Varicose veins

A

Tortuous dilated veins due to incompetent valves. Allow reflux into superficial veins

29
Q

Varicose veins RF

A

Age, female, obesity, inactivity, pregnancy, smoking, standing for long periods

30
Q

Varicose veins clinical features

A

Enlarged, tortuous veins
Pruritis
oedema
Yellow/red brown skin (haemosiderin release)
Generalised or local leg pain, worse on standing but better on walking.

31
Q

varicose vein complications

A

Venous ulcer (shallow, sloping/gradual outline. Minimal pain. Large. Wet with exudate. Often medial malleolus)

Thrombophlebitis (superficial vein inflammation -red and painful)

Excessive bleeding from trauma

Venous eczema (dry, scaly legs)

Lipodermatosclerosis (localised, chronic skin/subcut inflammation with painful, hardened skin)

32
Q

Investigations for Varicose vein

A

Clinical diagnosis (Hx and examination) but can do duplex USS for vein/valve structure and check for retrograde flow

33
Q

Management of varicose veins

A

Conservative with compression stockings (CI in arterial disease)
Surgical management with radiofrequency ablation (FLT), chemical ablation/sclerotherapy) or surgical stripping (if not accessible/deep)

34
Q

Primary lymphoedema

A

Intrinsic genetic abnormality of lymphatic system

35
Q

Secondary lymphoedema

A 
Damage to normal lymphatic:
Cancer treatment
infection
trauma
immobility
venous oedema
Obesity
HF
Advanced cancer/liver disease
36
Q

Venous thrombi

A

Not from atheroma, but often at valve sites due to valves providing site of turbulence.
Can:
1) lye and resolve
2) organise (scar tissue obliterates lumen)
3) Recanalisation (scar tissue but with remaining thrombus in lumen - inflammatory)
4) embolism

37
Q

Embolism types

A

Can be numerous small emboli that are asymptomatic (result in idiopathic pulmonary HTN), larger emboli that cause SOB and chest pain and Long emboli (lodge at pulmonary vessel bifurcation - acute outcome)

38
Q

Virchow’s triad

A

Hypercoagulable state, stasis and vessel wall injury

39
Q

Hypercoagulable state factors

A 
Oestrogen therapy
Pregnancy
Sepsis/sever infection
Malignancy
Nephrotic syndrome
Myeloproliferative disorder
Congestive heart disease
Inherited Thrombophilias: (Factor V Leiden, antithrombin deficienct, protein C/S deficiency, prothrombin varient, dysfibrinogenaemia (rare)
Acquired thrombophilia: antiphospholipid/lupus anticoagulant (autoimmune)
40
Q

Stasis factors

A 
Age
Venous insufficiency/varicose veins
Obesity
Immobility (>3 days bed rest)
Continous travel (3h+flight/car in prev 4 weeks)
Hospitalisation
41
Q

Vessel wall injury factors

A

Trauma/surgery
Indwelling venous catheter
Chemical irritation/chemo

42
Q

Moderate DVT risk factors

A 
Inherited thrombophilia
Malignancy
Pregnancy
Oestrogen therapy
Indwelling central line, Congestive HF
Arthroscopic knee surgery
43
Q

Most significant Risk factors for DVT

A 
Trauma to lower leg/pelvis
Major trauma
Hip/knee arthroplasty
Major general surgery
Spinal cord injury
44
Q

Measurement of calf swelling

A

10cm distal to tibial tuberosity

45
Q

Wells score for DVT

A

Points for localised tenderness, leg swelling/calf swelling, collateral veins on affected leg, pitting oedema, cancer Hx, bedrest Hx, DVT Hx, paralysis/paresis/immobilisation of leg recently. -2 points if alternative diagnosis more likely.

DVT likely if 2 points or more.
If not, then D dimer can be used.

46
Q

Diagnosis

A

Doppler USS. Use if Wells >2, High clinical suspicion or low Wells but positive D dimer

47
Q

May Thurner syndrome

A

Right common iliac artery compresses left common iliac vein

CP1 (8 decks)

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