Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3 Surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

Give 5 risk factors for peripheral artery disease

A
  • smoking
  • diabetes
  • hypertension
  • hyperlipidaemia
  • increased age
  • FHx
  • obesity
  • inactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the clinical features of peripheral artery disease

A
  • cramping like pain in calf, thigh or buttocks after walking a fixed distance, releived after standing still/ resting for a minute
  • hairloss
  • skin changes
  • thickened nails
  • weak pulses, pale, cold feet
  • pain at night, relieved by dangling foot out of the bed
  • beurgers angle <20 degrees= severe ischaemia
  • ulceration and gangrene (stage 4)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the definition of critical limb ischaemia?

A
  • rest pain going on for 2 weeks despite analgesia or presence of ischaemia lesions or gangrene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

give 3 differentials for peripheral vascular disease

A
  • spinal stenosis: pain going down legs on walking variable distances or prolonged standing, relieved by sitting down for 3-10 mins
  • acute limb ischaemia
  • sciatica
  • lower limb arthritis
  • MSK strain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How should suspected peripheral artery disease be investigated?

A
  • Bloods: fbc (anaemia will precipitate symptoms), lipids, hba1c, u&e (many need contrast so need renal function check)
  • Ankle brachial pulse pressure index (<0.9 or >1.3 pathological)
  • duplex USS of lower limb arteries
  • CT w/ contrast (angio) if arterial tree not well visualised on USS or disease is very proximal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is intermittent claudication managed?

A
  • CVS risk factor modification
  • supervised exercise programme
  • antiplatelet therapy with aspirin or clopidogrel
  • angioplasty if supervised exercise programme as not helped
  • prescribe naftidrofuryl oxalate if they dont want referal for surgery
  • bypass if claudication distance is short and angioplasty fails
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Give a complication of peripheral artery disease

A
  • sepsis secondary to infected (wet) gangrene
  • acute on chronic ischaemia
  • amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the clinical features of chronic mesenteric ischaemia (usually due to atherosclerosis)

A
  • abdo pain 10 mins - 4hrs after eating
  • weightloss
  • vascular comorbidities
  • loose stool, N+V, generalised tenderness and bruits may also be present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is chronic mesenteric ischaemia managed?

A
  • antiplatelet
  • CVS risk factor reduction
  • mesenteric angioplasty and stending
  • end arterectomy or bypass less often used
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the difference between deep venous insufficiency and varciose veins?

A

deep venous insufficiency is when the veins of the deep venous system become incompetent, usually due to DVT or valvular insufficiency

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

How may deep venous insufficiency present?

A
  • chronically swollen lower limbs
  • aching, pruritis in lower limbs
  • burting pain and tightness on walking which is relieved by elevation
  • venous ulcers (usually medial malleolus)
  • varicose eczema, thrombophelbitis, haemosiderin staining, lipodermatosclerosis
  • post thrombotic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is deep venous insufficiency investigated?

A
  • duplex USS and assesment of venous reflux, stenosis and DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is deep venous insufficiency managed?

A
  • compression stockings and analgesia
  • treat ulcers
  • elevate feet where possible to reduce symptoms and disease progression
  • little evidence for valvulopasty of venous stents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 3 types of varicose veins?

A
  • trunk: dilated, tortuous from long or short saphenous vein or their branches
  • reticular: permanently dilated bluish intradermal veins, usually 1-3mm in diameter
  • telangiectasia: a confluence of permanently dilated intradermal veins of less than 1mm in diameter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 3 causes of varicose veins?

A
  • primary/ simple: valvular failure resulting in dilated superficial veins in lower limb
  • secondary: when superficial veins carry reverse flow (which dilates them) as a collateral mechanism compensating for obstructed neighbouring veins
  • AV fistula
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the most common presenting complaints of varicose veins?

A
  • cosmetic deformity
  • discomfort: localised to vein site, aching, tension, heaviness and itching, particularly if hot or standing long time
  • nocturnal cramps
17
Q

Describe the 4 common skin changes with varicose veins

A
  • varicose eczema: eczema along vein site
  • haemosiderin staining: extravascularised RBCs make the skin browny/ red around the vein
  • lipodermatosclerosis: inflammation leads to skin induration and fibrosis of SC fat
  • Atrophe blanche: white scarring in lower leg due to venous hypertension
  • thrombophlebitis: bruising and pain along vein length due to inflammation
  • also: venous ulcers
18
Q

When should varicose veins be referred to vascular surgeons?

A
  • symptomatic
  • lower limb skin changes
  • superficial vein thrombosis (hard,painful veins)
  • venous leg ulcer (break in skin below knee, not healed in 2 weeks)
19
Q

What are the 2 surgical options fo varicose veins in leicester

A

Open surgery: long saphenous stripping, saphenfemoral disconnection, multiple avulsions
Endovascular laser ablation: of long or short saphenous veins, under local, combined with foam scleropathy to improve cosmetic appearance

20
Q

How may AAA present?

A
  • with rupture: hypotension, shock, LOC, severe central abdo/ back pain
  • asymptomatic, picked up on screening (all men over 65 get an USS)
  • pulsatile masses in abdomen
21
Q

How are non ruptured AAA managed?

A
  • USS/ CT angio
  • if <4cm, do yearly duplex USS to monitor
  • if 4-5.4 cm 6 monthly USS monitoring
  • when >5.5cm, expanding >1cm a year or symptomatic surgery is considered
  • CVS risk reduction
22
Q

What are the two surgical options for unruptured AAA repair?

A
  • open repair: prosthetic graft is inserteed via midline laparotomy (used in younger pts)
  • endovascular repair: needs 1.5cm normal aorta below renal vessels, lifelong monitoring and more thorough pre op assessment but fewer complications, better survival rate and recovery times.
23
Q

What may cause leg ulcers

A
  • venous disease
  • arterial disease (AV malformations, atheroslcerosis)
  • vasculitis (SLE, RA, scleroderma, wengers)
  • lymphatic insufficiency
  • neuropathic (usually diabetes)
  • haematological (sickle cell)
  • trauma (burns, pressure sore, cold injury)
  • neoplasm (BCC, SCC, melanoma)
  • others: sarcoid, pyoderma
24
Q

Describe the pathophysiology of venous ulcers

A
  • chronic venous hypertension (due to varicose veins, DVT, CVI)
  • get odema in lower limb
  • results in impaired tissue perfusion as oxygen and metabolites have to diffuse greater distances to get to tissue cells
  • become ischaemic when walking
  • then reperfusion injury when rest
  • more inflammation- more odema- more tissue fibrosis
  • ulceration is last after the other skin changes
25
Q

How should venous ulcers be managed?

A
  • 4 layer compression bandaging if arterial circulation is ok
  • leg elevation
  • improve mobility
  • reduce obesity and improve nutrition
  • varicose vein surgery if thats the cause
  • skin grafting in selected pts
  • monitor for infection
26
Q

What are the 6 signs of acute limb ischaemia

A 
pale, pulseless, paraesthesia, perishingly clold, paralysis
acute onset (mins- hrs) if embolic, insidious (hrs- days) if thrombotic
27
Q

What causes acute limb ischaemia

A
  • 60% are thrombosis of atheromatous plaque
  • 30% are emboli from AF, post MI, AAA, prosthetic heat valves
  • 10% untreated compartment syndrome
28
Q

How is an acute limb ischaemia managed?

A
  • arrange, bloods (inc lactate, G&S), ECG, duplex USS, CT angio, urgent vascular review
  • theraputic dose heparin
  • if the limb is viable, there are may interventions they may have: percutaneous catheter directed thrombolysis, surgical embolectomy or endovascular revascularisation
  • if irreversible they need urgent amputation
  • long term they need clopidogrel or aspirin, treat cause and modify RFs
29
Q

How should a DVT be managed?

A
  • wells score- USS or/ and D dimer
  • Treatment dose LMWH
  • warfarin or apixaban for at least 3 months
  • CVS RF modification
  • if cant get USS within 4 hrs, give IV anticoag for 24 hrs in interim
  • if unprovoked do CXR, FBC, serum calcium, LFTs, urinalysis, examine for cancer +/- CT CAP and mammogram
30
Q

How may carotid artery disease present?

A
  • asymptomatic but bruit picked up
  • TIA (transient cerebral or monocular visual loss)
  • CVA (usually hemisensory/ motor deficit affecting face arm and leg or loss of higher cortical function (dysphagia, neglect))
31
Q

How is carotid artery disease investigated?

A
  • carotid artery duplex USS
  • CT or MRI angio where the artery isnt easy to asses on USS (calcification or thick neck) or if distal/ proximal disease suspected
32
Q

How is carotid disease managed?

A
  • CVS risk factor modification
  • antiplatelets (aspirin or clopidogrel)
  • carotid endarterectomy (if symptomatic severe stenosis as reduces stroke risk, used if pt fit for surgery)

Y3 Surgery (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions