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MBBS 3: Surgery > Vascular Disorders > Flashcards

Vascular Disorders Flashcards

1
Q

What is peripheral vascular disease of the lower extremities?

A

Decreased patency of the arterial supply to the lower extremities leading to claudication, ischemia and potentially limb loss

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2
Q

What is atherosclerosis?

A

Thickening and hardening of arteries

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3
Q

What is plaque?

A

Plaque may partially or totally block the blood’s flow through an artery
- Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood
- Over time, plaque hardens and narrows arteries

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4
Q

What happens when plaque occurs in atherosclerosis?

A
  1. Hemorrhage into the plaque
  2. Plaque ruptures and a blood clot (thrombus) forms on surface
    - Affects large and medium-sized arteries
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5
Q

How can plaque form from damage to the arterial wall?

A

by:
1. High levels of cholesterol and triglyceride in the blood
2. High blood pressure
3. Tobacco smoke
- Cellular debris will adhere to plaques (cholesterol etc.)
- Endothelium becomes thick and the diameter of the artery is reduced

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6
Q

Complications of atheroslerosis?

A
  1. Heart attack = ↓ blood supply to heart
  2. Stroke = ↓ blood supply to brain
  3. Gangrene = ↓ blood supply to arms and legs
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7
Q

Etiology of PVD?

A
  1. Vasculitis
  2. Buerger’s Disease (Thromboangiitis obliterans)
  3. Extrinsic compression (neoplasm)
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8
Q

Buergers disease?

A
  • affects younger or middle age cigarette smokers
  • It is characterized by narrowing or occlusion of arteries and veins of extremities
    Rx – cessation of smoking
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9
Q

Takayasu arteritis?

A

Systemic inflammation characterized damage to the large and medium arteries and branches
e.g. Aortic arch, brachiocephalic trunk
- Rx - NSAID

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10
Q

Pathophysiology of PVD?

A

Narrowing of the lumen of the arterial supply to the lower extremity leads to decreased blood flow

Decreased blood flow → Decreased O2 supply → Anaerobic metabolism → Increased Lactic Acid → Pain with increased muscle use

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11
Q

Tissues become ischemic as a result of decreased blood flow leading to?

A
  1. pain at rest
  2. poor wound healing
  3. painful ulceration
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12
Q

Consequences of disease progression?

A

As disease progresses patients are sometimes unable to ambulate and gangrene may set in with eventual need for amputation

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13
Q

What is gangrene?

A

dead tissue caused by an infection or lack of blood flow
- occurs in the extremities of skin
e.g. toes, fingers and limbs

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14
Q

Gangrene risk factors?

A
  1. Hypertension
  2. Cigarette smoking
  3. Diabetics or overweight
  4. Sedentary lifestyle
  5. Hyperlipidemia
  6. Increased age
  7. History of other atherosclerotic disease (coronary artery disease or carotid stenosis)
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15
Q

What is wet gangrene?

A

dead tissue that has been infected by bacteria
e.g. gangrenous diabetic foot

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16
Q

Clinical presentation of wet gangrene?

A
  1. claudication
  2. ischemic rest pain
  3. ischemic ulceration
17
Q

Clinical presentation of claudication?

A

Claudication requires a sustained walk
1. cramping/burning muscular pain
2. localized to a muscle group
e.g. buttocks, hips, calves, thighs, feet
3. reproducible
4. relieved with rest
5. no symptoms with standing
- Distribution of pain may suggest anatomic location of disease

18
Q

Clinical presentation of pseudo claudication?

A
  1. cramping/burning and tightness muscular pain
  2. localized to single muscle group buttocks, hips, calves, thighs or feet
  3. not induced by exercise
  4. distance to symptoms is variable
  5. symptoms when standing
  6. relief when position is changed
18
Q

Clinical presentation of Ischemic rest pain?

A

Deep bone pain in toes at rest
May or may not be relieved by dependency
Indicative of limb threat

19
Q

Clinical presentation of Ischemic ulcertaion?

A

ulcer on toes/between toes/dorsum of foot
localized skin necrosis
often noticed after trauma with persistent wound that will not heal

20
Q

What is toe gangrene?

A

Blackened toe/s
often foul smelling
indicative of dead tissue
limb at extreme risk

21
Q

Things to note in physical exam in PVD?

A
  1. Pulse exam
  2. skin
  3. ankle brachial index
22
Q

Pulse exam in PVD?

A

Palpable vs. non-palpable
Audible by Doppler vs. not audible
Compare limbs
Pulse exam helps define level of disease
May also examine pulses after exercise
Skin

23
Q

Skin on examination in PVD?

A

Thin, brittle, shiny with thick opaque toes
Often cool
No toe hair
Poor capillary refill

24
Q

Ankle/Brachial index in PVD?

A

Ratio of Systolic Blood Pressure Ankle: Arm

Normal ratio >1.0
Claudication 0.8-1.0
Ischemic Rest Pain <0.8

Results may be skewed by diabetes

25
Q

Imaging done in PVD?

A

Arteriography
Duplex Ultrasound
Magnetic Resonance

26
Q

Arteriography?

A

Advantages
Gold standard for demonstrating anatomy of disease
Provides therapeutic opportunities:

Disadvantages
Invasive: risk of hemorrhage, aneurysm, infection
Contrast load is nephrotoxic

27
Q

Duplex ultrasound?

A

Advantages
Noninvasive
Fast/cheap
Few complications

Disadvantages
Dependent on ultrasonographers ability
Poor visualization below the knee

28
Q

Magnetic resonance?

A

Advantages
Good resolution
Allows visualization of surrounding structures
Noninvasive with few complications

Disadvantages
Efficacy has not been demonstrated
Cost/availability

29
Q

Treatment of claudication?

A

STOP SMOKING
Exercise program
Control diabetes, lower cholesterol
75% improve with non-operative management

30
Q

Treatment for Ischemic rest pain/ulcer/gangrene?

A

Must first determine how patient uses limb
Angioplasty vs. Revascularization
Gangrene or blackened toes require amputation but revascularization may preserve level and use of limb.

31
Q

Diagnosis of acute ischemia?

A

Rapid onset
Pain
Pallor
No pulse
Numbness or paralysis
- the cold foot

32
Q

Therapy for acute ischemia?

A
  1. Angioplasty to disrupt thrombus
    - using a balloon to stretch open a narrowed or blocked artery
  2. Surgery to reestablish vascular integrity
  3. Thrombolysis with or without surgery
    - Eminase (anistreplase) Retavase (reteplase) Streptase (streptokinase, kabikinase)
  4. embolectomy
  5. Anticoagulation to assist in blood thinning
  6. Amputation if all of the above options fail
33
Q

Name venous diseases?

A
  1. Venous Insufficiency
    - Varicose veins
    - Ulceration
  2. Lower Extremity Deep Vein Thrombosis
    - Pulmonary embolism
  3. Upper Extremity Deep Vein Thrombosis
34
Q

What is deep pain thrombosis?

A

occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs.

35
Q

Risk factors for DVT?

A

Major injury.
Minor injuries— one not requiring surgery, a plaster cast, hospitalization, or extended bed rest at home for at least four days).

Intravenous drug use—Direct trauma, irritation, and infection may be responsible for the high incidence of DVT noted in young drug users who inject these agents directly into their femoral veins
Pregnancy—Pregnancy is associated with an increased risk of thrombosis that may be due in part to obstruction of venous return by the enlarged uterus, as well as the hypercoagulable state associated with pregnancy.
Past history

MBBS 3: Surgery (42 decks)

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