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Surgery - DONE > VASCULAR > Flashcards

VASCULAR Flashcards

1
Q

What are some different types of ulcers?

A

Venous

Arterial insufficiency

Neuropathic

Pressure ulcers

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2
Q

How do venous ulcers appear?

A

Shallow, irregular borders, granulating base

MEDIAL MALLEOLUS

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3
Q

What are venous ulcers due to?

A

Valvular incompetence

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4
Q

What are the risk factors for venous ulcers?

A

Increasing age

Varicose veins

Pregnancy

Obesity

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5
Q

What are the features of venous ulcers?

A

Painful

Aching

Itching

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6
Q

How are venous ulcers investigated

A

Duplex ultrasound of veins

ABPI (to assess for arterial component)

Microbiology swabs if infection suspected

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7
Q

What is the conservative management for venous ulcers?

A

Leg elevation

Exercise

Encourage weight reduction

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8
Q

What further management for venous ulcers is there?

A

Compression bandaging (ABPI must be >0.6 before)

Varicose veins should be treated

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9
Q

How do arterial ulcers present?

A

Small, deep lesion with well defined border

No granulation tissue

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10
Q

What are some risk factors for an arterial ulcer?

A

Smoking

Diabetes

HTN

Obesity

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11
Q

What are the features of an arterial ulcer?

A

History of intermittent claudication

Critical limb ischaemia (pain at night)

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12
Q

What are the investigations for arterial ulcers?

A

ABPI

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13
Q

What are the treatment options for arterial ulcer?

A

Smoking cessation, weight loss, increased exercise

Statins, anti platelet (clopidogrel/aspirin) and optimise BP

Surgical (angioplasty maybe with stenting)

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14
Q

When do neuropathic ulcers occur?

A

Result of peripheral neuropathy

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15
Q

What are the risk factors for neuropathic ulcers?

A

Diabetes mellitus

B12 deficiency

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16
Q

What are the features of neuropathic ulcers?

A

History of peripheral neuropathy

Burning / tingling in legs

“Punched out appearance”

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17
Q

What are the investigations of neuropathic ulcers?

A

Blood glucose levels

Serum B12 levels

Microbiology swab (with evidence of infection!!)

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18
Q

What is the management of neuropathic foot ulcers?

A

Optimise diabetic control

Increased exercise

Regular chiropody

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19
Q

What is the definition of an AAA?

A

Dilatation >3cm

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20
Q

What are the risk factors for AAA?

A

Smoking

HTN

Hyperlipidaemia

FH

Male

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21
Q

How do symptomatic patients with AAA present?

A

Abdo pain

Back or loin pain

Pulsatile mass in abdo

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22
Q

Who is offered an abdo US scan for AAA?

A

65 y/o men (with surveillance every 3-5 years)

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23
Q

How is AAA investigated?

A

Ultrasound scan

Follow up CT after confirmation (threshold diameter 5.5cm)

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24
Q

What is the medical management of AAA?

A

Smoking cessation

BP control

Statin and aspirin therapy

Weight loss

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25
Q

What are the main treatment options for AAA?

A

Open repair via midline laparotomy

Endovascular repair (via femoral arteries)

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26
Q

What are the main complications for AAA?

A

Retroperitoneal leak

Embolisation

Aortoduodenal fistula

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27
Q

How does a AAA rupture present?

A

Abdo pain

Back pain

Syncope

Pulsatile abdo mass

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28
Q

What is the management of ruptured AAA?

A

High flow oxygen

IV access (2x large bore cannula)

Urgent bloods (FBC, U&Es and clotting)

Crossmatch

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29
Q

How should BP be managed in a AAA?

A

Raising BP will dislodge clot so keep BP <100 (permissive hypotension)

Transferred to vascular unit

If stable do a CT to determine stability for EVAR

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30
Q

What is a classification system for aortic dissection?

A

Standford classification

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31
Q

What are some risk factors for aortic dissection?

A

HTN

Atherosclerotic disease

Male gender

Connective tissue disorder (Marfan’s)

32
Q

How does an aortic dissection present?

A

Tearing chest pain radiating to back

Tachycardia

Hypotension

33
Q

What are the differential diagnoses for tearing chest pain?

A

MI

PE

Pericarditis

34
Q

What are the blood tests for aortic dissection?

A

FBC

U&Es

LFTs

Troponin

Coagulation profile

35
Q

What is the first line imaging for aortic dissection?

A

CT angiogram

36
Q

What is the initial management for aortic dissection?

A

Oxygen

IV access

Fluid resuscitation

37
Q

What are the complications of aortic dissection?

A

Aortic rupture

Aortic regurgitation

MI

Cardiac tamponade

38
Q

How should aortic dissections be managed?

A

Type A surgically

Type B initially medically (CCB to reduce strain)

39
Q

What are some causes of acute limb ischaemia?

A

Embolisation: AF, post- MI mural thrombus

Thrombosis in situ ruptures

40
Q

What are the 6 P’s of acute limb ischaemia?

A

Pain

Pallor

Pulselessness

Paresthesia

Perishingly cold

Paralysis

41
Q

What are the differentials for loss of sensation and vascular supply to lower limb?

A

Acute DVT

Acute limb ischaemia

42
Q

What is the initial investigation into acute limb ischaemia?

A

Routine bloods

Serum lactate

Thrombophlebitis screen

G&S

ECG

Doppler USS (followed by potential CT angiography)

43
Q

What is the initial management of acute limb ischaemia?

A

High flow oxygen

Therapeutic dose of heparin (maybe prolonged)

44
Q

What are the surgical options for acute limb ischaemia?

A

Embolectomy

Intra arterial thrombolysis

Bypass surgery

45
Q

When will limb ischaemia be irreversible?

A

Mottled, non-blanching appearance

REQUIRED AMPUTATION

46
Q

What is the long term management of patients with acute limb ischaemia?

A

Advise regular exercise, smoking cessation, weight loss

Anti-platelet agent (Clopidogrel / aspirin)

47
Q

What should be monitored for after treatment for acute limb ischaemia?

A

Reperfusion syndrome

48
Q

What are the lab tests for acute limb ischaemia?

A

ABG

Routine blood tests FBC, U&E, clotting, LFTs

49
Q

What is normally the cause of chronic limb ischaemia?

A

Atherosclerosis

50
Q

What are the risk factors for chronic limb ischaemia?

A

Smoking

Diabetes mellitus

HTN

Hyperlipidaemia

51
Q

What are the features of chronic limb ischaemia?

A

• Intermittent claudication relieved by rest

52
Q

How can critical limb ischaemia be differentiated from chronic?

A

Rest pain > 2 weeks duration requiring opiates

Presence of gangrene

ABPI <0.5

53
Q

How should critical limb ischaemia be investigated?

A

Doppler ultrasound

CT angiography

BP, HbA1c, ECG

54
Q

What are the management options for chronic limb ischaemia?

A

Smoking cessation, regular exercise, weight reduction

Statin

Antiplatelet

Optimise diabetes control

55
Q

What are the 2 main treatment options for chronic limb ischaemia?

A

Angioplasty

Bypass grafting

56
Q

What are the complications of chronic limb ischaemia?

A

Sepsis (secondary to gangrene)

Acute on chronic ischaemia

Amputation

57
Q

What typically causes deep venous insufficiency?

A

DVT

Valvular insufficiency

58
Q

What are some risk factors for deep venous insufficiency?

A

Increasing age

Female gender

Pregnancy

Obesity

Smoking

59
Q

What are the features of deep venous insufficiency?

A

Chronically swollen lower limb

Bursting pain on walking

60
Q

What skin changes are there for deep venous insufficiency?

A

Varicose eczema

Haemosiderin skin staining

Lipodermatosclerosis

61
Q

What is the main investigation for diagnosing DVI?

A

Doppler USS

62
Q

What investigation guides treatment for DVI?

A

Foot pulses

ABPI

For suitability for compression therapy

63
Q

What is the management for DVI?

A

Compression stockings

Suitable analgesic control

64
Q

What are the complications of DVI?

A

Swelling

Recurrent cellulitis

Chronic pain

Ulceration

65
Q

What causes varicose veins?

A

Incompetent valves allow blood flow from deep to superficial venous system

66
Q

Name 3 risk factors for varicose veins?

A

Prolonged standing

Obesity

Pregnancy

FH

67
Q

How do varicose veins present?

A

Aching

Itching

Ulceration

68
Q

What is the gold standard for investigations for varicose veins?

A

Doppler ultrasound

69
Q

What is the management of varicose veins?

A

Avoid prolonged standing

Weight loss

Increase exercise

70
Q

When should varicose veins be operated on?

A

Skin changes (pigmentation / eczema)

Venous leg ulcer

71
Q

What are the surgical options for varicose veins?

A

Vein ligation, stripping

Thermal ablation

72
Q

How does a DVT present?

A

Hot and swollen limb

Calf tenderness and firmness

73
Q

What is the Well’s score used to assess?

A

Risk of DVT

74
Q

What gives 1 point in the Well’s score?

A

Active cancer

Paralysis of lower extremities

Bedridden >3 days

Tenderness along deep venous system

Leg swollen

Calf swelling >3cm

Pitting oedema

Contralateral superficial veins (non varicose)

Previous DVT

(An alternative diagnosis is at least as likely = -2)

2 = DVT likely

75
Q

What is the treatment of a DVT?

A

Therapeutic dose of LMWH

76
Q
A
77
Q
A

Surgery - DONE (9 decks)

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