Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Y3 surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

What is an ulcer? What are the three different types?

A

Abnormal breaks in the skin or mucous membranes
1) Venous ulcers
2) Arterial ulcers
3) Neuropathic ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the differences between the types of ulcers

A

Venous ulcer – shallow ulcers with a granulated base, often with other clinical features of venous insufficiency present
Neuropathic ulcers – painless ulcers over areas of abnormal pressure, often secondary to joint deformity in diabetics
Arterial ulcers – found at distal sites, often with well-defined borders & other evidence of arterial insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the pathophysiology of venous ulcers

A

Valvular incompetence/venous outflow obstruction leads to impaired venous return
Resultant venous hypertension causes trapping of WBCs in capillaries & formation of fibrin cuff hinders oxygen transportation into the tissue
WBCs become activated, with release of inflammatory mediators -> tissue injury, poor healing & necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List risk factors for venous ulcers

A

Increasing age
Pre-existing venous incompetence/history of VTE
Pregnancy
Obesity/physical inactivity
Severe leg injury/trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List clinical features of venous ulcers

A

Painful (particularly worse at the end of the day) & often found in the gaiter region of the legs
Associated symptoms of chronic venous disease: aching, itching, bursting sensation
Examination: varicose veins, ankle/leg oedema, features of venous insufficiency (varicose eczema/thrombophlebitis, haemosiderin skin staining)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List investigations for venous ulcers

A

Clinical diagnosis
Underlying venous insufficiency confirmed by Duplex ultrasound
Ankle brachial pressure index: assess for any arterial component to the ulcers
Swab cultures if suspecting an associated infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Outline the management for venous ulcers

A

Conservative management – leg elevation & increased exercise
Lifestyle changes
Abx only with clinical evidence of wound infection
Mainstay – multicomponent compression bandaging changed once/twice every week (ABPI must be > 0.6 before bandaging)
Concurrent varicose veins – treated with endovenous techniques/open surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe an arterial ulcer

A

Ulcer caused by a reduction in arterial blood flow, leading to decreased perfusion of the tissues & subsequent poor healing
Form as small deep lesions with well-defined borders & necrotic base (commonly occur distally at sites of trauma and in pressure areas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List risk factors for an arterial ulcer

A

Smoking
Diabetes mellitus
Hypertension
Hyperlipidaemia
Increasing age
Positive family history
Obesity
Physical inactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List clinical features of arterial ulcers

A

Preceding history of intermittent claudication/critical limb ischaemia
Ulcer may be painful & often develops over a long period of time, with little to no healing
Other signs: cold limbs, thickened nails, necrotic toes & hair loss
Examination – limbs will be cold & have reduced/absent pulses
(NOTE: in pure arterial ulcers, sensation is maintained)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List investigations for arterial ulcers

A

Ankle brachial pressure index measurement: quantify the extent of any peripheral arterial disease
Imaging: duplex ultrasound, CT angiography/magnetic resonance angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the management for arterial ulcers

A

Urgently referred for a vascular review:
1) Conservative: lifestyle changes
2) Medical: CVS risk factor modification (statin therapy, antiplatelet agent), optimisation of BP and glucose
3) Surgical: angioplasty/ bypass grafting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe a neuropathic ulcer

A

Occurs as a result of peripheral neuropathy
Loss of protective sensation -> repetitive stress & unnoticed injuries forming -> painless ulcers forming on the pressure points on the limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List risk factors of neuropathic ulcers

A

Develop with any condition with peripheral neuropathy:
1) Diabetes mellitus
2) B12 deficiency
Foot deformity
Concurrent peripheral vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List clinical features of neuropathic ulcers

A

History of peripheral neuropathy/symptoms of peripheral vascular disease
Examination: neuropathic ulcers are variable in size and depth (punched out appearance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List investigations for neuropathic ulcers

A

Blood glucose levels & serum B12 should be checked
Signs of infection: microbiology swab & any evidence of deep infection may warrant an x-ray
Important to assess the extent of peripheral neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the management of neuropathic ulcers

A

Specialised diabetic foot clinics – managed by MDT
Diabetic control should be optimised
Improved diet & increased exercise should be encouraged
Regular chiropody to maintain good foot hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Charcot’s foot?

A

Neuroarthropathy whereby a loss of joint sensation results in continual unnoticed trauma & deformity occurring -> predisposes people to neuropathic ulcer formation
Patients present with swelling, distortion, pain & loss of function
Requires a specialist review for consideration of off-loading abnormal weight & sometimes immobilisation of the affected joint in plaster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an abdominal aortic aneurysm?

A

Dilation of the abdominal aorta greater than 3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

List risk factors of AAA

A

Atherosclerosis
Trauma
Infection
Connective tissue disease
Inflammatory disease (Takayasu’s aortitis)
Smoking, hypertension, hyperlipidaemia, family history, male gender & increasing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List clinical features of an AAA

A

Many are asymptomatic/ simply detected on incidental finding or screening
Can present with: abdominal pain, back/loin pain, distal embolisation
Examination – pulsatile mass can be felt in the abdomen (above the umbilical level)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe the screening programme for AAA

A

Abdominal US for all men in their 65th year
Most men with a detected AAA will spend 3 to 5 years in surveillance prior to reaching the threshold for elective AAA repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the medical management of an AAA

A

AAA < 5.5 cm, can be monitored via duplex USS
- 3 to 4.4cm = yearly USS
- 4.5 to 5.4cm = 3 monthly USS
CVS risk factors should be reduced as appropriate: smoking cessation, improve BP control, commence statin and aspirin therapy & weight loss/increased exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe the surgical management of an AAA

A

Should be considered for:
- AAA > 5.5cm
- AAA expanding at >1cm/year
- Symptomatic AAA
Main treatment options are open repair/endovascular repair:
1) Open repair: midline laparotomy/long transverse incision, exposing the aorta & clamping the aortic proximally & iliac arteries distally, before segment is removed & replaced with a prosthetic graft
2) Endovascular repair: introducing a graft via femoral arteries & fixing the stent across the aneurysm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
List complications of an AAA
AAA rupture Retroperitoneal leak Embolisation Aortoduodenal fistula
26
Describe the clinical features of a ruptured AAA
Abdominal pain Back pain Syncope Vomiting Examination: haemodynamically compromised with a pulsatile abdominal mass & tenderness Classic triad (50% of patients) – flank/back pain, hypotension & a pulsatile abdominal mass
27
Describe the management of a ruptured AAA
Immediate high flow O2, IV access & urgent bloods taken with crossmatch Any shock should be treated very carefully (aim to keep the BP < 100mmHg) Patient should be transferred to local vascular unit: - Unstable – require immediate transfer to theatre for open surgical repair - Stable – require a CT angiogram to determine whether the aneurysm is suitable for endovascular repair
28
What are varicose veins?
Tortuous dilated segments of vein associated with valvular incompetence Arise from incompetent valves -> results in venous hypertension & dilatation of the superficial venous system
29
List causes of varicose veins
Primary – idiopathic Secondary – DVT, pelvic masses or arteriovenous malformations
30
List risk factors of varicose veins
Prolonged standing Obesity Pregnancy Family history
31
Describe the clinical features of varicose veins
Typically present initially with cosmetic issues – unsightly visible veins/discolouration of the skin Aching/itching Skin changes, ulceration, thrombophlebitis or bleeding Examination – varicosities will be present in the course of the great and/or short saphenous veins, clinical features of venous insufficiency (ulceration, varicose eczema, haemosiderin deposition)
32
List investigations for varicose veins
Gold standard – duplex ultrasound - Assess valve incompetence at the great/short saphenous veins & any perforators
33
Describe the non-invasive treatments for varicose veins
Patient education – avoid risk factors Compression stockings if interventional treatment is not appropriate (need to be worn for the rest of the patients life) Any venous ulceration – four-layer bandaging
34
Describe surgical treatment for varicose veins
Should be referred if they meet the following NICE criteria: - Symptomatic primary or recurrent varicose veins - Lower-limb skin changes - Superficial vein thrombosis - Venous leg ulcer Treatment options include: vein ligation, stripping & avulsion, foam sclerotherapy & thermal ablation
35
List complications of untreated varicose veins
Worsen over time Typical complications seen post-operatively include haemorrhage, thrombophlebitis, DVT, disease recurrence & nerve damage
36
What is aortic dissection?
Tear in the intimal layer of the aortic wall, causing blood to flow between & splitting apart the tunica intima and media Aortic dissections from the initial intimal tear can progress distally, proximally/in both directions from the point of origin
37
List the two classification systems for aortic dissection
Stanford DeBakey
38
List risk factors for aortic dissection
Hypertension Atherosclerotic disease Male gender Connective tissue disorders Bicuspid aortic valve
39
Describe the clinical features of aortic dissection
Tearing chest pain, classically radiating through to the back Tachycardia, hypotension, new aortic regurgitation murmur or signs of end-organ hypoperfusion
40
List differential diagnoses of aortic dissection
Myocardial infarction Pulmonary embolism Pericarditis MSK back pain
41
List investigations for aortic dissection
Baseline blood tests, ECG Imaging: CT angiogram, transoesophageal ECHO
42
Describe the management of aortic dissections
Urgent initial assessment – start high flow oxygen & gain IV access, fluid resus should be done cautiously Type A dissections – managed surgically in the first instance Any uncomplicated type B dissections – usually be managed medically All patients need lifelong antihypertensive therapy & surveillance imaging
43
List complications of aortic dissections
Aortic rupture Aortic regurgitation Myocardial ischaemia Cardiac tamponade Stroke or paraplegia
44
Define acute limb ischaemia
Sudden decrease in limb perfusion that threatens the viability of the limb Complete/even partial occlusion of the arterial supply to a limb
45
Describe the aetiology of acute limb ischaemia
1) Embolisation – thrombus from a proximal source travels distally to occlude the artery 2) Thrombosis in situ 3) Trauma, including compartment syndrome
46
List the signs and symptoms of acute limb ischaemia
Pain Pallor Pulselessness Paraesthesia Perishingly cold Paralysis
47
List investigations for acute limb ischaemia
Routine bloods – serum lactate, a thrombophilia screen & a group and save along with an ECG Bedside Doppler ultrasound scan, followed by potential CT angiography If limb is considered salvageable, a CT arteriogram can provide more information regarding the anatomical location of the occlusion & can help decide the operative approach
48
Describe the initial and conservative management for acute limb ischaemia
Initial management – surgical emergency: start patient on high-flow oxygen & ensure adequate IV access Conservative management – prolonged course of heparin
49
Describe the surgical management of acute limb ischaemia
If cause is embolic: - Embolectomy via a Forgarty catheter - Local intra-arterial thrombolysis - Bypass surgery If cause is thrombotic: - Local intra-arterial thrombolysis - Angioplasty - Bypass surgery Irreversible limb ischaemia – urgent amputation/taking a palliative approach
50
Describe the long term management of acute limb ischaemia
Reduction of the CVS mortality risk – promoting regular exercise, smoking cessation & weight loss Most cases should be started on an anti-platelet agent Cases resulting in amputation will require OT, PT with long term rehab plan
51
List complications of acute limb ischaemia
Reperfusion injury Compartment syndrome Release of substances from damaged muscle cells – hyperkalaemia, acidosis & significant AKI
52
Describe chronic limb ischaemia
Form of peripheral arterial disease that results in a symptomatic reduced blood supply to the limbs Typically caused by atherosclerosis, rarely vasculitis & commonly affect the lower limbs
53
List risk factors for chronic limb ischaemia
Smoking Diabetes mellitus Hypertension Hyperlipidaemia Increasing age A strong family history Obesity Physical inactivity
54
Describe the clinical features of chronic limb ischaemia
Fontaine classification: - Stage I: asymptomatic - Stage II: intermittent claudication - Stage III: ischaemic rest pain - Stage IV: ulceration or gangrene, or both Examination: affected limbs will be colder, may be evidence of arterial ulcers, patients will typically have reduced/absent peripheral pulses
55
What is critical limb threatening ischaemia?
Advanced form of chronic limb ischaemia Defined in three ways: 1) Ischaemic rest pain > 2 weeks duration 2) Presence of ischaemic lesions/gangrene 3) ABPI less than 0.5 Examination: limbs may be pale and cold with week or absent pulses, limb hair loss, skin changes & thickened nails
56
List investigations of chronic limb ischaemia
Ankle-brachial pressure index Doppler ultrasound CT angiography/MR angiography CVS risk assessment
57
Describe the medical management for chronic limb ischaemia
CVS risk factor modification: lifestyle advice, statin therapy, anti-platelet therapy, optimise diabetes control Local supervised exercise programme
58
Describe the surgical management of chronic limb ischaemia
Surgical intervention can be offered in suitable patients - Risk factor modification has been discussed - Supervised exercise has failed to improve symptoms Any patients with critical limb ischaemia should be urgently referred for surgical intervention Two main surgical options: -angioplasty with/without stenting -bypass grafting, typically used for diffuse disease/in younger patients
59
List complications of chronic limb ischaemia
Sepsis Acute-on-chronic ischaemia Amputation Reduced mobility & quality of life
60
What is deep venous insufficiency?
Chronic disease that can result in significant morbidity Commonly caused by either DVT or valvular insufficiency, and together with varicose veins Occurs as a result of the failure of the venous system – valvular reflux, venous hypertension and obstruction
61
List causes of deep venous insufficiency
Primary – underlying defect to the vein wall/valvular component (includes congenital defects & connective tissue disorders) Secondary – defects occur secondary to damage (post-thrombotic disease, post-phlebitic disease, venous outflow obstruction & trauma)
62
List risk factors of DVI
Increasing age Female gender Pregnancy Previous DVT or phlebitis Obesity Smoking
63
Describe the clinical features of deep venous insufficiency
Chronically swollen lower limbs – aching, pruritic & painful May report venous claudication Examination: varicose eczema, thrombophlebitis, haemosiderin skin staining, lipodermatosclerosis or atrophie blanche Varying degree of dependent pedal oedema & may also have venous ulcers
64
List investigations for DVI
Doppler ultrasound scan, allowing the assessment for the extent of venous reflux Routine blood tests Documentation of foot pulses & ABPI
65
Describe the management of DVI
Early treatment may reduce long-term complications Conservative management – compression stockings & suitable analgesic control Surgical management is less successful (some evidence that patients who had deteriorating symptoms had a mild clinical improvement)
66
Describe the complications of DVI
Swelling, recurrent cellulitis, chronic pain and ulceration More serious but less common complications – DVT, secondary lymphoedema & varicose veins Marjolin ulcer – rare type of cutaneous SCC developing at the site of severe/recurrent inflammation

Y3 surgery (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions