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MedEd > Vascular Disease > Flashcards

Vascular Disease Flashcards

1
Q

Breakdown of peripheral vascular disease?

A

Acute -> Acute limb ischaemia
Chronic -> intermittent claudication or critical limb ischaemia

Claudication is pain on exertion, ischaemi = pain on rest

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2
Q

Pathophysiology of PVD?

A

Athersclerosis -> stenosis

Acute limb ischaemia = sudden decrease in limb perfusion

Intermittent claudication = cramping pain in calf, thigh buttock after walking for a certain distance

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3
Q

RFs for PVD?

A

Smoking, diabtese, HTN, male, >40, hyperlipidaemia

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4
Q

Presentation of Acute limb ischaemia?

A

6Ps

Pain, pale, pulseless, paralysis, paraethesia, perishingly cold

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5
Q

Presentation of other PVD?

A

Chronic = asymptomatic but hair loss, numbness, brittle, slow growing toenails, ulcers, absent pulse and atrophic skin

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6
Q

What is the sign of PVD?

A

Beurgers Test: Patient flat on bed and legt lift to 45degrees. Limb deceloping pallor indicates arterial insuffieciency. <20 degrees Beurgers indicates severe limb ischaemia.
Patient then swings legs over bed and active hyperaemia seen

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7
Q

Ix for PVD?

A

Full cardiovascular risk assessment = BP, bloods, HR, ECG

Ankle-brachial pressure index (ABPI) is gold standard.
Normal = 0.9-1.2
<0.9 abnormal, <0.5 = critical limb ischaemia

Colour duplex USS or magnetic resonance angiogram

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8
Q

What is Lerihe syndrome?

A

Aortoiliac occlusive disease
Sx: buttock claudication, impotence and absent/weak distal pulses.

1st line is CT angiogram but also use MRA

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9
Q

What are the distal pulses?

A

Femoral, popliteal, posterior tibial and dorsalis pedis

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10
Q

What are neuropathic ulcers associated with?

A

DM

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11
Q

What is the appearance of arterial ulcers?

A 
PUNCHED OUT, deeper than venous
Distal (dorsum of foot and between toes)
Well defined edegs
Pale base (gray granulation tissue)
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12
Q

Signs of arterial ulcers?

A

Hair loss, shiny and pale skin
Calf muscle wasting
Absent pulses
Nigh pain (worse supine and relieved hanging off bed)

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13
Q

Venous ulcers appearance?

A

Large and shallow with sloping, less well defined edges
More proximal than arterial ulcers (gaiter region)
Other symptoms of venous insufficiency e.g. swelling, itching and aching

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14
Q

Signs of venous ulcers?

A

Stasis eczema (retrograde blood flow = inflammatory process with metalloproteinases)

lipodermatosclerosis (panniculitis and pain, skin hardening, redness, swelling and tapering to ankle)
Atrophie blanche (white shing skin with surrounding capillaries and occasionally hyperpigmentation_
Hemosiderin deposition (darker pigmentation)
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15
Q

Ix for arterial ulcers?

A

Gold = Duplex USS of lower limbs
ABPI
prcuatenous angiography
Bloods (fasting serum lipids, HbA1C, BM glucose, FBC)

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16
Q

Ix for venous ulcers?

A

DUplex USS of lower limbs, Measure surface area of ulcer (progression)
Swab for infection
Biopsy = if Marjolin ulcer possibility

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17
Q

WHat is a marjolins ulcers?

A

SqCC from areas of chronic inflammation or injury

18
Q

Mx of venous ulcers?

A

Graded compression stockings
Debridement and cleaning
Abx if infected
Moisurising cream

19
Q

What is an AAA?

A

Localised enlargement of the abdominal aorta where the diameter is >3cm or >50% larger than normal diameter

20
Q

Types of aneurysms?

A

Saccular and fusiform are true

False involves a tear in one layer

21
Q

Rfs for AAA?

A

Smoking, male, connective tissue disorder, old age, HTN, inflammatory disorders

22
Q

Unruptured AAA symptoms?

A

Usually asymptomati, often incidental finding and may have pain in back, adbo or groin

23
Q

Ruptured AAA signs?

A

Sudden severe pain in back, abdo groin
Syncope
Shock

24
Q

Signs of any AAA?

A

Pulsatile and lateraly expansile mass on palpation
Abdo bruit
Grey turners sign (ruptured)
Cullens

25
Q

AAA Ix?

A

Bloods = FBC, clotting, U&Es, LFTS and cross match

Abdo USS (gold standard for if aneurysm or not)

CT angiogram (gold for ruptured or not)

MRA (not if patient has contrast allergy or renal impairment)

26
Q

What is aortic dissection?

A

Condition where tear in aortic intima allows blood to flow into a new false channel between the inner and outer layers of the tunica media

27
Q

Classifications of aortic aneurysms?

A 
Standford = A and B
Debakey = Type 1 -> 3b
A = 1 and 2
1= both ascending and descending aorta
2 = ascending only
b = 3 and 3b
3 = descenfing aorta above diaphragm
3b = above and below diaphragm
28
Q

Rfs for Aortic dissection?

A

smoking, male, connective disorder, HTN, congenital abnormality e.g. coarctation, crack cocaine

29
Q

Symptoms of Aortic dissection?

A

Sudden central tearing pain, can radiate to back.

Symptoms caused by blockage of aorta:
Carotid -> blackout, dysphasia
Cornoary -> angina
Sunclavian - > LOC
Renal artery -> anuria, renal failure
30
Q

Signs of Aortic dissection?

A

HTN, BP difference in arms, murmur on back, signs of aortic regurgitation (high volume collapsing pulse, early diastolic murmur), signs of connective tissue disease

31
Q

Ix for aortic dissection?

A

1) Bloods (FBC, X match, U&E, LFTs, cardiac enzymes)
2) ECG
3) chest Xray (widened mediastinum, loss of contour of aortic knuckle, globular heart)
4) CT Angiogram (gold standard and ordered 1st with suspected

32
Q

What do you see on CT Angiogram?

A

False lumen

33
Q

What are varicose veins?

A

Subcut, permanenyl dilated veins >3mm in diameter when easured in a standing position (most often superificial of the lower limbs)

34
Q

Primary causes of VV?

A

Idiopathic valvular incompetence

35
Q

Secondary cases of VV?

A

AV malformations, DVT and venous outflow obstructions

Venous outflow obstructions = pregnancy, ascites, ovarian cysts, peliv malignancy

36
Q

Symptoms of VV?

A

Vidible dilation of veins, leg aching with prolonged standing, swelling and itching and bleeding

37
Q

Signs of VV?

A

Veins feel tender or hard
Tap test = Tap VV distally and feel thrill ocer sapheno-femoral junction
Auscultation for bruits
Trendelenburg test

38
Q

What is trendelenburg test?

A

Patient supine with leg liften and veins emptied. Tourniquet above knee and standing, veins shuld refillin 30-35 seconds. Rapid filling indicated Deep vein valvular filling. Occlusion removed = superficial valvular problem
Doppler to show saphenofemoral incompetence

39
Q

Ix for VV?

A

Duplex USS (also to exclude DVT)

40
Q

Mx for VV?

A

Conservative = Compression stockings and lifestyle changes e.g. weight loss, exercise and leg elevation

Endovascular treatment = radiofrequency ablation, endovenous laser ablation, microinjection sclerotherapy

Sruegry = stripping of long saphenous vein, saphenofemoral ligation, avulsion of varicosities

41
Q

Complication of VV?

A

Venous ulcer, stasis eczema, lipodermatosclerosis, hemosiderin deposition

Sclerotherapy = skin stainining and local scarring

Surgery = haemorrhage, infection, recurrence, paraesthesia, peroneal nerve injury

MedEd (32 decks)

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