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Vascular Mushkies Flashcards

1
Q

Venous examination?

A
  1. Inspection = skin changes & scars + site & size of varicosities
  2. Palpation
  3. Auscultation
  4. Doppler
  5. Completion
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2
Q

Chronic venous insufficiency skin changes?

A

HAS LEGS

  1. Haemosiderosis
  2. Atrophie Blanche
  3. Swelling
  4. Lipodermatosclerosis
  5. Eczema
  6. Gaiter Ulcers
  7. Stars, venous
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3
Q

Site of varicosities?

A
  1. Medial and above knee = great saphenous
  2. Posterior and below knee = short saphenous
  3. Few varicosities + prominent skin changes = calf perforators
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4
Q

Palpation in venous examination?

A
  1. Pitting oedema
  2. Varicosities (tenderness = thrombophlebitis, induration = thrombosis)
  3. Saphena varix @ SFJ
  4. Tap test = tap proximally and feel for impulse distally
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5
Q

Auscultation in venous examination?

A

Bruit over varicosity = AVM

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6
Q

Doppler in venous examination?

A
  1. Place probe @ SFJ/SPJ and squeeze calf
  2. Normally hear only half second whoosh when pressure is released
  3. Long whoosh suggests valve incompetence
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7
Q

Completion of venous examination?

A
  1. Trendelenburg/Tourniquet test
  2. Examine abdomen + PR
  3. Pelvis in females
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8
Q

Tourniquet/Trendelenburg test?

A
  1. Position pt supine, elevate leg and milk veins
  2. Apply tourniquet as high up as possible or compress SFJ
  3. Stand pt
  4. Controlled = incompetence ABOVE tourniquet, release tourniquet to confirm filling
  5. Uncontrolled = incompetence BELOW tourniquet, e.g. SPJ or calf perforators, repeat test with tourniquet just below knee
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9
Q

SFJ location?

A

2 finger breadths below and lateral to pubic tubercle

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10
Q

Great saphenous vein passes where respective to malleolus?

A

Anterior to medial malleolus

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11
Q

Varicose veins defn?

A

Tortuous, dilated veins of the superficial venous system due to underlying valve incompetence

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12
Q

CEAP classification acronym?

A
  1. Clinical Signs
  2. Etiology
  3. Anatomy
  4. Pathophysiology
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13
Q

3 main sites where valve incompetence occurs?

A
  1. SFJ = 3cm below and 3cm lateral to pubic tubercle
  2. SPJ = popliteal fossa
  3. Perforators = draining GSV (great saphenous vein)
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14
Q

Causes of varicose veins classification?

A

Primary and Secondary

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15
Q

Primary causes of varicose veins?

A
  1. Prolonged standing
  2. Pregnancy
  3. Obesity
  4. OCP
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16
Q

Secondary causes of varicose veins?

A
  1. Valve destruction = DVT, thrombophlebitis
  2. Obstruction = pelvic mass, DVT
  3. AVM
  4. Syndromes
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17
Q

Syndromes that cause varicose veins?

A
  1. Klippel-Trenaunay-Weber syndrome = abnormality of the deep venous system –> varicose veins, port wine stain, bony + soft tissue hypertrophy of the limbs
  2. Parkes-Weber Syndrome = multiple AVMs with limb hypertrophy
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18
Q

Symptoms of varicose veins?

A
  1. Cosmetic
  2. Pain, cramping, heaviness
  3. Tingling
  4. Bleeding = may be severe
  5. Swelling
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19
Q

Varicose veins definitive Ix?

A

Duplex US

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20
Q

Mx of varicose veins?

A
  1. Conservative = lose weight, exercise, avoid prolonged standing, compression stockings, emollients
  2. Minimally invasive therapies
  3. Surgery
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21
Q

Minimally invasive therapies for varicose veins?

A
  1. Injection sclerotherapy with 1% Na tetradecyl sulphate

2. Endovenous laser or RFA

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22
Q

Indication for minimally invasive therapies for varicose veins?

A

Small below knee varicosities not involving the GSV or SSV

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23
Q

Post-op Mx of minimally invasive therapies for varicose veins?

A
  1. Compression bandage for 24hrs

2. Compression stockings for 1 month

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24
Q

Indications for surgery for varicose veins?

A
  1. SFJ incompetence
  2. Major perforator incompetence
  3. Symptomatic = ulceration, skin changes, pain
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25
Q

Surgical procedures for varicose veins?

A
  1. Trendelenberg = saphenofemoral ligation
  2. SSV ligation = in popliteal fossa
  3. Multiple avulsions
  4. Cockett’s operation = perforator ligation
  5. SEPS
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26
Q

SEPS?

A

Subfascial endoscopic perforator surgery

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27
Q

Varicose vein surgery post-op Mx?

A
  1. Bandage tightly and elevate for 24hrs

2. Discharge w/ compression stockings and told to walk daily

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28
Q

Complications of varicose vein surgery?

A
  1. Early = haematoma, wound sepsis, nerve damage e.g. long saphenous
  2. Late = superficial thrombophlebitis, DVT, recurrence (10% at 5 years)
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29
Q

Test for deep venous occlusion?

A

Perthes test = high tourniquet around pts leg + walking for 5 mins –> swelling and pain

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30
Q

Causes of post-phlebitic syndrome?

A
  1. Reflux following DVT = 90%

2. Obstruction following DVT = 10%

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31
Q

Venous gangrene?

A

Rare complication of DVT in the iliofemoral segment with 3 phases:

  1. Phlegmasia alba dolens = white leg
  2. Phlegmasia cerulea dolens = blue leg
  3. Gangrene secondary to acute ischaemia
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32
Q

Lipodermatosclerosis?

A

An inflammatory sclerosing panniculitis occurring secondary to chronic venous insufficiency

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33
Q

Ix of deep venous disease?

A
  1. Duplex US
  2. Venography
  3. Ambulatory venous pressures
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34
Q

Surgical Mx of post-phlebitic limb?

A
  1. Reflux = valvuloplasty of damaged valves (Kistner Operation), or transplant of axillary vein with valve into deep venous system of leg (Trahere transplantation)
  2. Obstruction = Palma oberation (use contralateral GSV and anastomose to femoral vein to bypass iliofemoral obstruction)
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35
Q

Arterial examination?

A
  1. Inspection
  2. Palpation
  3. Auscultation
  4. Buerger’s angle
  5. Completion
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36
Q

Arterial examination inspection?

A
  1. Colour = pallor or cyanosis
  2. Trophic changes = muscle atrophy, dry shiny skin, nail dystrophy and loss of hair
  3. Ulcers = between toes, base of 1st and 5th metacarpals, heel
  4. Gangrene
  5. Scars
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37
Q

Arterial examination palpation?

A
  1. Temperature
  2. Pulses = present as present, reduced or absent
  3. Capillary refill <2s
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38
Q

Lower limb pulses?

A
  1. Aorta = just above umbilicus
  2. Femoral = mid-inguinal point
  3. Popliteal = b/w heads of gastrocnemius
  4. Dorsalis pedis = lateral to extensor hallucis longus, absent in 5%
  5. Posterior tibial = postero-inferior to medial malleolus
  6. Graft + distal pulses = is the graft patent
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39
Q

Arterial examination auscultation?

A
  1. Aorta and renal vessels
  2. Iliac = midway from umbilicus to inguinal ligament
  3. Femoral
  4. Course of SFA if popliteal cant be palpated
  5. Grafts
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40
Q

Buerger’s Angle and Test?

A
  1. Lift leg to 45 degrees and observe for pallor and venous guttering, <20 = severe ischaemia
  2. Buerger’s test = reactive hyperaemia on lowering the leg secondary to vasodilation of the microcirculation in response to ischaemia
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41
Q

Arterial examination completion?

A
  1. Pulses
  2. ABPI
  3. DM neuropathy and valve disease
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42
Q

2 presentations of chronic limb ischaemia?

A
  1. Intermittent claudication

2. Critical limb ischaemia

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43
Q

Intermittent claudication fx?

A
  1. Cramping pain after walking a fixed distance
  2. Pain rapidly relieved by rest
  3. Calf pain = superficial femoral disease (commonest)
  4. Buttock pain = iliac disease (internal or common)
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44
Q

Critical limb ischaemia fx?

A
  1. Ankle artery pressure <50mmHg
  2. Rest pain >2 weeks = esp. at night, usually felt in the foot, pt hangs foot out of bed
  3. Tissue loss = ulceration, gangrene
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45
Q

Classification system for chronic limb ischaemia?

A

Fontaine Classification

  1. Asymptomatic
  2. Intermittent claudication
  3. Rest pain
  4. Ischaemic ulcers or gangrene
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46
Q

What is Leriche’s syndrome?

A

Aortoiliac Occlusive Disease, presenting with triad of:

  1. Buttock claudication and wasting
  2. Erectile dysfunction
  3. Absent femoral pulses
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47
Q

Intermittent claudication path, site, pain and examination?

A
  1. Path = arterial insufficiency
  2. Site = calf or buttock
  3. Pain = set distance, reproducible, worse up stairs, cramping, eased by standing rest
  4. Examination = evidence of PVD
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48
Q

Spinal claudication path, site, pain and examination?

A
  1. Path = nerve compression
  2. Site = ill defined/whole leg
  3. Pain = positional onset, better up stairs, burning pain, eased sitting forward
  4. Examination = normal
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49
Q

RFs for chronic limb ischaemia?

A
  1. Modifiable

2. Non-modifiable

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50
Q

Modifiable RFs for chronic limb ischaemia?

A
  1. Smoking
  2. BP
  3. DM
  4. Lipids
  5. Exercise
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51
Q

Non-modifiable RFs for chronic limb ischaemia?

A
  1. FHx
  2. PMH
  3. Male
  4. Age
  5. Ethnicity
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52
Q

Fontaine 1 ABPI?

A

0.8-1

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53
Q

Fontaine 2 ABPI?

A

0.6-0.8

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54
Q

Fontaine 3 ABPI?

A

0.3-0.6

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55
Q

Fontaine 4 ABPI?

A

<0.3

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56
Q

Normal ABPI?

A

> 1

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57
Q

CKF/DM calcification ABPI?

A

> 1.4

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58
Q

Chronic limb ischaemia Ix?

A
  1. Bedside = ABPI, ECG
  2. Bloods = FBC (anaemia may worsen Sx), U&E (renovascular disease), glucose, lipids
  3. Imaging = Duplex US, CT/MR angiogram, digital subtraction angiography
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59
Q

Mx of chronic limb ischaemia?

A
  1. Conservative
  2. Medical
  3. Interventional
  4. Surgical
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60
Q

Conservative mx of chronic limb ischaemia?

A
  1. Walk through pain = exercise programmes
  2. Foot care
  3. Stop smoking
  4. Weight loss
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61
Q

Medical mx of chronic limb ischaemia?

A
  1. HTN
  2. Statin
  3. Antiplatelets
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62
Q

Interventional mx of chronic limb ischaemia?

A
  1. Angioplasty +/- stenting

2. Chemical sympathectomy

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63
Q

Surgical mx of chronic limb ischaemia?

A
  1. Endarterectomy
  2. Bypass grafting
  3. Amputation
64
Q

Bypass grafting indications?

A
  1. V. short claudication distance (<100m)
  2. Sx greatly affecting QoL
  3. Rest pain
65
Q

Practicalities of bypass grafting?

A
  1. Need good proximal supply and distal run off
  2. Saphenous vein grafts preferred below the IL
  3. More distal grafts have increased rates of thrombosis
66
Q

Classification of bypass grafting?

A
  1. Anatomical = fem-pop, fem-distal, aortobifemoral

2. Extra-anatomical = axillo-fem/bifem, fem-fem crossover

67
Q

AAA palpation?

A

Pulsatile and expansile mass on deep palpation in the epigastrium

68
Q

AAA defn?

A

Abnormal dilatation of the abdominal aorta to >50% of its normal diameter, or >3cm

69
Q

AAA Ix?

A
  1. US
  2. CT/MRI
  3. Angio
70
Q

Complications of AAA surgery?

A

1, Death

  1. MI
  2. Renal failure
  3. Spinal/mesenteric ischaemia
  4. Distal trash from thromboembolism
  5. Anastomotic leak
  6. Graft infection
  7. Aortoenteric fistula
71
Q

Operative mortality of AAA?

A
  1. AAA = Emergency (50%), Elective (5%)

2. EVAR = 1%

72
Q

Popliteal aneurysm Fx?

A
  1. Represent >80% of all non-aortic aneurysms
  2. Lump behind the knee, >2cm
  3. 50% present with distal limb ischaemia (thromboembolism)
  4. <10% rupture
73
Q

Mx of popliteal aneurysm?

A
  1. Acute = embolectomy or fem-distal bypass

2. Stable = excision bypass

74
Q

Indications for surgical mx of popliteal aneurysm?

A
  1. Symptomatic
  2. Containing thrombus
  3. > 2cm
75
Q

Aneurysm defn?

A

Abnormal dilatation of a blood vessel to >50% of its normal diameter

76
Q

Aneurysm classification?

A
  1. True
  2. False
  3. Dissection
77
Q

True aneurysm?

A

Dilatation of a blood vessel involving all layers of the wall and >50% of its normal diameter

  1. Fusiform = AAA
  2. Saccular = Berry
78
Q

False aneurysm?

A

Collection of blood around a vessel wall that communicates with the vessel lumen

  1. Usually iatrogenic e.g. puncture, cannulation
  2. Fibrous tissue forms around haematoma –> false sac which communicates with the vessel lumen
79
Q

Dissection?

A

Vessel dilatation caused by blood splaying apart the media to form a channel within the vessel wall

80
Q

Causes of aneurysms?

A
  1. Congenital

2. Acquired

81
Q

Congenital causes of aneurysms?

A
  1. ADPKD –> Berry

2. CTD = Marfans, ED

82
Q

Acquired causes of aneurysms?

A
  1. Atherosclerosis
  2. Inflammatory = Takayasu’s, HSP
  3. Infection = Mycotic (SBE), Tertiary Syphilis, Samonella typhi
  4. Trauma = penetrating
83
Q

Infection associated with AAA?

84
Q

Complications of aneurysms?

A
  1. Rupture
  2. Thrombosis
  3. Distal embolisation
  4. Pressure = DVT, oesophagus, nutcracker syndrome
  5. Fistula = IVC, intestine
85
Q

Aneurysm screening?

A

UK men offered one time US screen at 65 years

86
Q

Most common location for false aneurysm?

A

Common femoral artery following puncture for a radiological procedure

87
Q

Mx of false aneurysm?

A
  1. US compression
  2. Thrombin injection
  3. Surgical repair
88
Q

Amputation examination?

A
  1. Inspection
  2. Palpation
  3. Move
  4. Completion
89
Q

Amputation inspection?

A
  1. Stump anatomical level
  2. Stump health
  3. Evidence of chronic vascular disease
90
Q

Amputation palpation?

A
  1. Soft tissue under skin should move freely over the bone

2. Proximal pulses

91
Q

Amputation movement?

A
  1. Actively flex and extend the joint above the amputation (many pts have fixed flexion deformity after BKA)
  2. Ask to see prosthesis and see pt walk in it
92
Q

Amputation exam completion?

A

Examine other limb for signs of PVD

93
Q

Indications for amputations?

A

4Ds

  1. Dead = PVD (90%), thrombangiitis obliterans
  2. Dangerous = sepsis, malignancy
  3. Damaged = trauma, burns, frostbite
  4. Damned nuisance = pain, neurological damage
94
Q

Complications of amputation?

A
  1. Early = death, haemorrhage, infection (cellulitis, gangrene, osteomyelitis)
  2. Late = scar contractures (fixed flexion), phantom limb pain (gabapentin/mirror box), poor stump shape inhibiting prosthesis
95
Q

2 possible carotid artery disease findings?

A
  1. Carotid endarterectomy scar = beneath angle of the mandible, parallel to the SCM
  2. Carotid bruit = along course of common carotid, medial to the SCM in the anterior
96
Q

Complications of carotid stenosis?

A
  1. TIA

2. Stroke

97
Q

Carotid endarterecomy complications?

A
  1. Haematoma
  2. MI
  3. Nerve injury
98
Q

What nerves an be injured by a carotid endarterectomy?

A
  1. Hypoglossal
  2. Greater auricular = numb ear lobe
  3. RLN = hoarse voice, bovine cough
99
Q

Inspection and palpation of diabetic foot?

A
  1. Inspection = bilateral arterial disease, amputations esp. digits, charcot joints, ulceration
  2. Palpation = pulses may be preserved due to calcification, decreased sensation in stocking distribution
100
Q

Diabetic foot syndrome features?

A
  1. Macrovascular disease
  2. Microvascular disease
  3. Neuropathy
  4. Infection and osteomyelitis
101
Q

Aetiology of diabetic ulcers?

A
  1. Neuropathic = 45-60%
  2. Ischaemia = 10%
  3. Mixed neuroischaemic = 25-45%
102
Q

Considerations for diabetics undergoing angiography?

A
  1. Often have a degree of renal impairment which can be dramatically worsened with contrast agents
  2. Metformin must be stopped prior to the procedure to prevent lactic acidosis
103
Q

Gangrene defn?

A

Irreversible tissue death from poor vascular supply

104
Q

Classification of gangrene?

A
  1. Pregangrene = tissue on the brink of gangrene
  2. Dry = tissue death only
  3. Wet = tissue death + infection
105
Q

Causes of gangrene?

A

DERTI

  1. DM = commonest
  2. Embolism and thrombosis = foot trash in AAA repair
  3. Raynaud’s
  4. Thrombangiitis obliterans
  5. Injury = extreme cold, heat, trauma or pressure
106
Q

Thrombangiitis obliterans aka?

A

Buerger’s disease

107
Q

Mx of gangrene?

A
  1. Take cultures
  2. Debridement (including amputation)
  3. Benzylpenicillin +/- clindamycin
108
Q

What is synergistic gangrene?

A

Involved both aerobes and anaerobes, progresses rapidly to necrotizing fasciitis and myositis

109
Q

2 types of synergistic gangrene?

A
  1. Fournier’s = perineum

2. Meleney’s = post-op ulceration

110
Q

Gas gangrene defn?

A
  1. AKA Clostridial myonecrosis

2. RFs = DM, trauma, malignancy

111
Q

Presentation of gas gangrene?

A
  1. Toxaemia
  2. Crepitus from surgical emphysema
  3. Bubbly brown pus
112
Q

Mx of gas gangrene?

A
  1. Debridement +/- amputation
  2. Benzylpenicillin +/- metronidazole
  3. Hyperbaric O2
113
Q

Raynaud’s phenomenon?

A

Characteristic cold induced changed associated with vasospasm

114
Q

Raynaud’s disease?

A

Primary Raynaud’s phenomenon occurring in isolation

115
Q

Raynaud’s syndrome?

A

Secondary Raynaud’s phenomenon association with other disease

116
Q

Colour changes in Raynaud’s?

A

White –> Blue –> Crimson

117
Q

Pathogenesis of raynauds?

A
  1. Overactive a-sympathetic receptors OR

2. Fixed obstruction in vessel wall

118
Q

Secondary causes of Raynaud’s?

A

BADCAT

  1. Bloods = polycythaemia, cryoglobulinaemia, cold agglutinin
  2. Arterial = atherosclerosis, thrombangiitis obliterans
  3. Drugs = BB, OCP, ergotamine
  4. Cervical rib = thoracic outlet obstruction
  5. AI = SLE, RA, SS
  6. Trauma = vibration injry
119
Q

Mx of Raynauds?

A
  1. Conservative = wear gloves and avoid cold, stop smoking
  2. Medical = Nifedipiine, IV prostacyclin
  3. Surgical = cervical sympathectomy, amputate gangrenous digits
120
Q

DDx (NOT CAUSES) of thoracic outlet obstruction?

A
  1. Arterial = Raynauds
  2. Venous = Axillary vein thrombosis or trauma
  3. Neuro = cervical spondylosis, Pancoasts tumour
121
Q

Arm signs of thoracic outlet obstruction?

A

Reduced venous outflow

  1. Pitting oedema
  2. Cyanosis
  3. Pallor
122
Q

Hand signs of thoracic outlet obstruction?

A

Reduced arterial inflow

  1. Raynauds
  2. Patchy gangrene
  3. Fingertip necrosis
123
Q

Hand and arm signs of thoracic outlet obstruction?

A

Neurological complications

  1. Complete claw hand
  2. T1 sensory loss
  3. Radicular pain
124
Q

Aetiology of thoracic outlet obstruction?

A
  1. Congenital = cervical rib

2. Acquired = clavicular fracture, pathological enlargement of 1st rib

125
Q

Peripheral ulcer examination?

A
  1. Inspection
  2. Palpation
  3. Completion
126
Q

Inspection of peripheral ulcer?

A

3S + BEDS

  1. 3S = size, site, shape
  2. Base = granulation tissue, slough, floor (bone, tendon, fascia)
  3. Edge = sloping, punched out, undermined, rolled, everted
  4. Discharge = serous, purulent, asnguinous
  5. Surroundings = cellulitis, excoriations, sensate, LNs
127
Q

Sloping peripheral ulcer?

A

Healing (usually venous)

128
Q

Punched out ulcer?

A

Ischaemic or neuropathic

129
Q

Undermined ulcer?

A

Pressure necrosis or TB

130
Q

Rolled ulcer?

131
Q

Everted ulcer?

132
Q

Peripheral ulcer palpation?

A
  1. Lib pulses

2. Sensation around the ulcer

133
Q

Completion of peripheral ulcer examination?

A
  1. Neurovascular examination

2. ABPI must be >0.8 for compression bandaging

134
Q

Causes of a peripheral ulcer?

A
  1. Venous = 75%
  2. Arterial = 2%
  3. Mixed arteriovenous = 15%
  4. Neuropathic
  5. Pressure
  6. Vasculitis e.g. PAN
  7. Malignancy = SCC, Marjolins
  8. Systemic = Pyoderma gangrenosum
135
Q

Venous ulcer inspection?

A

3S BEDS

  1. Site = medial malleolus
  2. Size = can be large
  3. Shape = uneven
  4. Base = shallow, pink granulation tissue
  5. Edge = sloping edge
  6. Discharge = seropurulent
  7. Surroundings = HAS LEGS, varicose veins
136
Q

Venous ulcer palpation?

A
  1. Painless
  2. Warm surrounding
  3. Sensate
137
Q

Causes of venous ulcer?

A
  1. Valvular disease
  2. Varicose veins
  3. Deep vein reflux
  4. Outflow obstruction e.g. post-DVT
  5. Muscle pump failure
  6. Stroke
  7. Neuromuscular disease
138
Q

Venous ulcer Ix?

A

1, Bedside = ABPI, duplex US

3. Biopsy

139
Q

Venous ulcer Mx?

A
  1. Conservative = leg ulcer clinic, RFs, anaglesia, bed rest, elevate leg, manuka honey (topical antiseptic)
  2. 4 layer compression bandaging if ABPI > 0.8
  3. Surgical = split-thickness skin grafts
140
Q

Ischaemic ulcer inspection?

A

3S + BEDS

  1. Site = between toes, base of 1st and 5th metatarsals, heel
  2. Size = mm-cm
  3. Shape = often circular
  4. Base = deep (may be down to bone), may be slough but no granulation tissue
  5. Edge = punched out
  6. Discharge = minimal
  7. Surroundings = pale, trophic changes
141
Q

Causes of ischaemic ulcer?

A
  1. Large vessel = atherosclerosis, thrombangiitis obliterans

2. Small vessel = DM, PAN, RA

142
Q

Ischaemic ulcer Mx?

A
  1. Conservative = analgesia (ladder), RFs

2. Medical = RFs, IV prostaglandins, chemical lumbar sympathectomy

143
Q

Chemical lumbar sympathectomy?

A
  1. Chemical ablation of L1-L4 paravertebral ganglia
  2. Inhibit sympathetic mediated vasocontriction
  3. Relief of pain
  4. Often unsuccessful in DM
144
Q

Neuropathic ulcer inspection?

A

3S + BEDS
1. Site = pressure areas, between toes, base of 1st and 5th metatarsals, heel
2. Size = variable
3 . Shape = corresponds to shape of pressure point
4. Base = may be deep with bone exposure
5. Edge = punched out
6. Discharge = minimal
7. Surroundings = normal skin, Charcot’s joints

145
Q

Neuropathic ulcer palpation?

A
  1. Normal temperature and peripheral pulses

2. Absent sensation around ulcer, absent ankle jerks

146
Q

Cause of neuropathic ulcer?

A

Any cause of peripheral neuropathy

147
Q

Pathophysiology of neuropathic ulcer?

A
  1. Sensory neuropathy = distal limb damage not felt by pt
  2. Motor neuropathy = wasting of intrinsic foot muscles and an altered foot shape
  3. Autonomic neuropathy = decreased sweating –> cracked, dry foot
148
Q

Lymphoedema pitting?

A

Initially pitting, later non-pitting

149
Q

Unilateral limb swelling Ddx?

A
  1. Infection
  2. Inflammation
  3. DVT
  4. Venous insufficiency
  5. Lymphoedema
150
Q

Causes of bilateral limb swelling?

A
  1. Increased venous pressure = RHF, venous insufficiency, CCBs
  2. Reduced oncotic pressure = hepatic failure, nephrotic syndrome, protein losing enteropathy
  3. Lymphoedema
  4. Myxoedema = hypothyroidism
151
Q

Lymphoedema defn?

A

Collection of interstitial fluid due to blockage or absence of lymphatics

152
Q

Classification of causes of lymphoedema?

A

Primary or Secondary

153
Q

Primary causes of lymphoedema?

A
  1. Congenital absence of lymphatics, may or may not be familial
  2. Milroy’s syndrome
154
Q

Milroy’s syndrome?

A

Familial AD subtype of congenital lymphoedema, often presenting with unilateral limb swelling and hydrocele

155
Q

Secondary causes of lymphoedema?

A

FIIT

  1. FIbrosis = e.g. post-radiotherapy
  2. Infection = TB
  3. Infiltration = Ca (prostate, lymphoma), Lymphatic Filariasis (Wuchereria bancrofti)
  4. Trauma = block dissection of lymphatics
156
Q

Mx of lymphoedema?

A
  1. Conservative = skin care, Grade 3 compression stockings, treat/prevent cellulitis
  2. Physio = raise leg as much as possible
  3. Surgical = debulking operation, bypass procedures

Medicine and Surgery Mushkies (52 decks)

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