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Core Conditions AJL (minus renal and respiratory) > Vascular > Flashcards

Vascular Flashcards

1
Q

Who does peripheral vascular disease affect?

A

Black > other ethnicities

All ages but more common in the over 60s

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2
Q

What causes peripheral vascular disease?

A

Atherosclerosis causing stenosis of arteries

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3
Q

What are the risk factors for peripheral vascular disease?

A 
Smoking
⬆️ age
Hypertension
Hyoercholesterolaemia
Obesity
Diabetes
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4
Q

What are the symptoms of peripheral vascular disease?

A 
Intermittent claudication
- calf = femoral disease
- buttock = iliac disease
Critical ischaemia
- ulceration
- gangrene
- rest pain
- impotence
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5
Q

What is the Fontaine classification of peripheral vascular disease?

A
  1. Asymptomatic
  2. Intermittent Claudication
  3. Rest pain
  4. Ulceration/gangrene
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6
Q

What are the signs of peripheral vascular disease on examination?

A
  • 6 Ps (pain, pallor, paraesthesia, pulselessness, perishingly cold, paralysis)
  • atrophic skin
  • punched out ulcers
  • cap refill >15secs
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7
Q

What investigations are necessary to diagnose peripheral vascular disease?

A

Bloods

  • FBC (polycythaemia, anaemia)
  • ESR/CRP (exclude arteritis)
  • U&Es (renal disease)
  • lipids (dyslipidaemia)

Examination of pulses
ABPI
- intermittent claudication = 0.5-0.9
- critical limb ischaemia =

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8
Q

What are the treatments of peripheral vascular disease?

A

Treat risk factors - stop smoking, ⬇️ BP, ⬇️ cholesterol (statins), anti platelets (clopidogrel) to prevent progression

Manage claudication

  • exercise = improve collateral circulation
  • vasoactive drugs: naftidrofuryl

Surgical

  • percutaneous transluminal angioplasty
  • reconstruction - bypass graft
  • amputation
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9
Q

How common is AAA?

A

Prevalence 1.3-12.7% in UK

Present in 5% of popn >60

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10
Q

Who does AAA affect?

A

5x more frequent in men

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11
Q

What are the causes of AAA?

A

Atheroma
Trauma
Infection (sylhilis, TB, HIV)
Connective tissue disorders (marfans or EDS)

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12
Q

What is the pathology of a AAA?

A

True aneurysm = affects all layers

Pseudoaneurysm = blood collection in adventitia only

Degeneration of elastic lamellae and smooth muscle loss

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13
Q

What is the definition of a AAA?

A

Artery with dilatation >50% of its original diameter

> 3cm in size = AAA

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14
Q

What are the risk factors for AAA?

A 
⬆️ age
Family history
Smoking 
Gender (male)
Hypertension
Hyperlipidaemia 
COPD
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15
Q

What are the symptoms of an unruptured AAA?

A

Asymptomatic

Abdo/back pain

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16
Q

What are the symptoms of a ruptured AAA?

A

Intermittent/continuous abdominal pain

- radiates to back and iliac fossae and groin

17
Q

What are the signs of AAA on examination?

A

Unruptured = pulsatile and expansile abdominal mass

Ruptured: collapse, shock

18
Q

What investigations are necessary to diagnose AAA?

A

Bloods

  • FBC, clotting screen, U&Es, LFT
  • crossmatch
  • ESR/CRP for inflammation

ECG

Imaging: CXR, USS, CT, MRI angiography

19
Q

What are the treatments for AAA?

A

Controlling risk factors (stop smoking, ⬇️BP, lipid lowering medication)

Screening - men >65

Monitoring - regular measurement; action required >5.5cm across

Elective surgery - only if >5.5cm, expanding at >1 cm/year or symptomatic

Stenting

20
Q

Who does varicose veins affect?

A

More common in women

21
Q

What causes varicose veins?

A

Incompetent vein valves = venous hypertension and dilatation of superficial veins

Primary causes:

  • unknown
  • congenital valve absence

Secondary causes:

  • obstruction
  • valve destruction
  • arteriovenous malformation
  • constipation
  • overactive muscle pumps
22
Q

What are the risk factors for varicose veins?

A 
Gender
Genetics
Age
Occupation (Prolonged standing)
Obesity
Pregnancy
23
Q

What are the symptoms of varicose veins?

A 
Pain 
Cramps
Tingling
Heaviness
Restless legs
24
Q

What are the signs of varicose veins on examination?

A 
Oedema
Eczema
Ulcers
Haemosiderin staining (hyper pigmentation)
Haemorrhage
Phlebitis
Lipodermatosclerosis
25
Q

What are the possible differential diagnoses of varicose veins?

A

DVT
Superficial phlebitis
Cellulitis

26
Q

What investigations are necessary to diagnose varicose veins?

A

Examination:

  • inspect for discolouration
  • palate veins (hardness = thrombosis, tenderness = phlebitis)

Doppler ultrasound scanning

Trendelenbergs test

27
Q

What are the treatments of varicose veins?

A

Education:

  • elevate legs
  • support stockings
  • lose weight
  • regular exercise

Endovascular treatments:

  • radio frequency ablation - catheter inserted into vein to close vein
  • endovenous laser ablation
  • injection sclerotherapy - foam injected to seal veins

Surgery:
Vein stripping

28
Q

What are the causes of Femoral embolism?

A

Clot breaks off from elsewhere and lodged in femoral artery

29
Q

What are the risk factors for femoral embolism?

A

Abnormal heart rhythm (AF)
Injury or damage to an artery wall
Conditions that increase blood clotting (high platelet count)
Mitral stenosis
Endocarditis
Atherosclerosis of aorta
Modifiable - smoking, obesity, hypertension, inactivity, stressed, ⬆️ cholesterol, hypertension

30
Q

What are the symptoms and signs of femoral embolism?

A

6 Ps

31
Q

What investigations are necessary to diagnose femoral embolism?

A

Angiography
Doppler
MRI

32
Q

What are the treatment options for a femoral embolism?

A 
Anticoagulant therapy (warfarin/heparin)
Antiplatelets (aspirin/clopidogrel)
Painkillers
Thrombolytics (streptokinase)
Surgery ➡️ balloon catheter insertion
33
Q

How common is peripheral vascular disease?

A

Present in 7% middle aged men

Present in 4.5% middle aged women

Core Conditions AJL (minus renal and respiratory) (10 decks)

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