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vascular Flashcards

1
Q

PAD what is it?

A

build-up of fatty deposits in the arteries restricts blood supply to leg muscles

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2
Q

PAD clinical picture?

A

pts feel pain on walking for a certain amount of time. typically cramping in calf. occurs when walking as there is an increased demand for o2 but narrowed arteries due to atherosclerotic plaques means that muscles can’t get enough - so anaerobic resp so cramps. thisis called intermittent claudication

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3
Q

PAD what can it lead to?

A

CLTI - critical limb threatening ischaemia

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4
Q

CLTI risk factors?

A
  • smoking
  • T2DM
  • HTN
  • hyperlipidaemia - what would u look for on examination? x3
  • inc age
  • fhx
  • obesity
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5
Q

CLTI what is the clinical progression of the disease?

A
  • PAD - intermittent claudication
  • pain @ rest ie night
  • pt hangs leg out of bed for relief
  • eventually this stops helping so the pt starts to sleep in a chair
  • this leads to oedema of the legs
  • gait area ulcers form
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6
Q

CLTI tests?

A

beurgers test - what is this?

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7
Q

CLTI differential diagnoses?

A
  • spinal stenosis - ?

- acute limb ischaemia - <14 days duration

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8
Q

CLTI investigations?

A
  • ABPI
  • arterial duplex (doppler & USS)
  • further imaging? CTA
  • cardiovascular risk assessment inc? x4
  • CLTI & <50yrs w/o sig risk factors? thrombophilia screen + homocyteine levels (why?) checked
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9
Q

CLTI medical management?

A
  • lifestyle advice eg? x3
  • statin therapy - dose, drug & freq?
  • anti platelet therapy - dose, drug & freq?
  • diabetes control
  • exercise
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10
Q

CLTI when does NICE say to give surgical intervention?

A

i) risk factor modification has been discussed

ii) supervised exercise has failed to improve symptoms

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11
Q

CLTI surgical management?

A
  • angioplasty w or w/o stenting (balloon squashes plaque)
  • bypass grafting - great saphenous vein etc from other leg grafted to plauqed artery and used to bypass blockage - for diffuse disease or younger pts
  • amputation for those unsuitable for revascularisation or w gangrene -> sepsis
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12
Q

CLTI complications?

A
  • sepsis
  • acute on chronic ischaemia
  • amputation
  • reduced mobility
  • reduced QOL
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13
Q

AAA definition?

A

dilatation of AA >3cm

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14
Q

AAA risk factors?

A
  • smoking
  • HTN
  • hyperlipidaemia
  • fhx
  • male
  • inc age
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15
Q

AAA clinical features?

A
  • abdo pain
  • back pain
  • distal embolisation causing limb ischaemia - causes cyanoses big toe
  • aortoenteric fistula
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16
Q

AAA on examination?

A

pulsatile mass in epigastric region

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17
Q

AAA how can they be found?

A
  • normally incidental finding eg man comes in for BPH, CT of kidneys shows AAA
  • screening - men in 65th yr
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18
Q

AAA differential diagnoses?

A
  • renal colic - most common differential - why?
  • diverticulitis
  • IBD
  • IBS
  • GI haemorrhage
  • appendicitis
  • ovarian torsion/rupture
  • splenic infarctions
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19
Q

AAA investigations?

A

USS

CT w contrast if 5.5cm

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20
Q

AAA medical management?

A

duplex USS:

  • 3-4.4cm - yearly
  • 4.5- 5.4cm - 3 monthly
  • CVD risk factors reduced appropriately eg ? x4
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21
Q

AAA when is someone considered for surgery?

A
  • AAA > 5.5cm
  • AAA expanding at >1cm/year
  • symptomatic AAA
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22
Q

AAA surgical management?

A
  • open repair - what does this consist of?

- EVAR - what does this consist of?

23
Q

AAA complications?

A
  • rupture
  • retroperitoneal leak
  • embolisation
  • aortoduodenal fistula
24
Q

ruptured AAA how does it present?

A

abdo pain, back pain, syncope, vomiting

25
ruptured AAA on examination?
haemodynamically compromised w pulsatile abdo mass & tenderness
26
ruptured AAA classic triad?
- flank/back pain - hypotension - pulsatile abdo mass
27
ruptured AAA initial management?
- ABCDE - high flow O2 - IV access (2x large bore cannulae) - bloods (FBC, U&Es, clotting) - cross match for 6 units - keep BP <100mmHg - why?
28
ruptured AAA surgical management?
- unstable - theatre for open repair | - stable - CTA to see if AAA is suitable for EVAR
29
VENOUS ULCERS pathophysiology?
- valvular incompetence/venous outflow obstruction leads to impaired venous return - causes venous HTN - this traps WBCs in caps - fibrin cuff around vessel forms which reduces o2 to tissue - WBCs activated due to hypoxia and release inflammatory mediators - tissue injury, poor healing & necrosis
30
VENOUS ULCERS risk factors?
- inc age - varicose veins - pregnancy - obesity - leg injury
31
VENOUS ULCERS clinical features?
- painful - particularly at the end of the day - shallow w irregular boarders & granulating base over medial malleolus - associated symptoms of chronic venous disease eg ?? x3 occur before the ulcer appears
32
VENOUS ULCERS on examination?
- varicose veins - ankle/leg oedema - varicose eczema - thrombophelbitis - haemosiderin skin staining - lipodermatosclerosis - atrophie Blanche
33
VENOUS ULCERS investigations?
- ABPI - duplex US - swab cultures if infected
34
VENOUS ULCERS conservative management?
- leg elevation - inc exercise - why? - lifestyle chnages eg x2?? - abx when infected - main management: multicomponent compression bandaging changed once/twice a week **** ABPI must be >0.6 before bandage - surgical management of varicose veins
35
VARICOSE VEINS risk factors?
- prolonged standing - obesity - pregnancy - fhx
36
VARICOSE VEINS clinical features?
- cosmetic issues eg x2? - aching - itching - if left untreated? thrombophelbitis/ulceration/bleeding
37
VARICOSE VEINS on examination?
- great/short saphenous veins | - clinical features of venous insufficiency eg x3?
38
VARICOSE VEINS investigations?
- venous duplex US
39
VARICOSE VEINS non invasive treatments?
- pt education : avoiding prolonged standing, weight loss, inc exercise - compression stockings only if interventional treatment is not appropriate - why? - four layer bandaging for ulceration - why?
40
VARICOSE VEINS surgical treatment occurs when the follwoing NICE criteria are met...
- symptomatic primary or recurrent varicose veins - lower limb skin changes eg x2? - superficial vein thrombosis characterised by? - venous leg ulcer - below the knee which hasnt healed in 2 wks
41
VARICOSE VEINS surgical treatment?
- vein ligation, stripping & avulsion - what does this consist of? - foam scleotherapy - what does this consist of? - thermal ablation - what does this consist of?
42
VARICOSE VEINS complications?
- haemorrhage - thrombophlebitis - dvt - recurrence - nerve damage
43
ARTERIAL ULCERS how do they present?
small deep lesions with well-defined borders and a necrotic base. most commonly distally at sites of trauma & pressure areas eg heel
44
ARTERIAL ULCERS risk factors?
same as PAD - smoking - T2DM - HTN - hyperlipidaemia - inc age - fhx - obesity
45
ARTERIAL ULCERS clinical features?
- preceding hx of intermiitent claudication or CLTI - painful ulcer than develops over a long period of time w little to no healing (so no granulation tissue) - cold limbs - thickened nails - necrotic toes - hair loss
46
ARTERIAL ULCERS on examination?
- cold limbs - reduced/absent pulses - sensation maintained
47
ARTERIAL ULCERS investigations?
- ABPI - arterial duplex US - CTA
48
ARTERIAL ULCERS vascular review consists of what 3 managements?
- conservative - lifestyle changes eg? - medical - CV risk factor modification eg? - surgical - angioplasty or bypass grafting
49
NEUROPATHIC ULCERS pathophysiology?
occur due to peripheral neuropathy where there is a loss of protective sensation. this leads to repetitive stress and unnoticed injuries forming resulting in painless ulcers forming on pressure points on the limb
50
NEUROPATHIC ULCERS risk factors?
- T2DM | - B12 deficiency
51
NEUROPATHIC ULCERS clinical features?
- hx of peripheral neuropathy - symptoms of peripheral vascular disease - burning/tingling in legs - indicates ? - single nerve involvement - eg? - amotrophic neuropathy - ??
52
NEUROPATHIC ULCERSon examination?
- variable in size and depth - "punched out" appearance - occur at sites of pressure on the feet eg x2?? - peripheral neuropathy (glove & stocking) w warm feet & good pulses
53
NEUROPATHIC ULCERS investigations?
- BM/HbA1c - ABPI - arterial duplex US - skin swab - x ray for osteomyelitis
54
NEUROPATHIC ULCERS management?
- - diabetic control - HbA1c <7%, improved diet, exercise, CV risk factors managed - encourage good foot hygiene & appropraite footwear - abx for infection - debridement - amputation

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