Vascular Overview Flashcards
what is an aneurysm
Degeneration / weakening of arterial wall
Risk of rupture in intraluminal pressure > tensile strength of vessel wall
pathophysiology of _
decrease blood flow to extremity / organ secondary to formation of atherosclerotic plaques
Stenosis
decreased blood flow
decreased pressure
what is atherosclerosis
Accumulation of lipids around heart and major vessels
consequences of atherosclerosis
Hardening of vessels’
Integrity of endothelium
Narrowing & stenosis
Altered haemodynamics
Changes Intima + Media layers of vessel
risk factors of atherosclerosis
Genetics
Smoking
Diabetes
Hypertension
Obesity
Diet
list stages of atheroslcerosis
- build up of fibrous tissue surrounded by layer of cholesterol and lipid
causes changes in initima and media - clacification - calcification of border surrounding fibrous tissue
- haemorrhage
- ulceration - initima layer blood vessel bursts
- thrombosis
peripheral vascular disease symptoms
Pain / cramps LL - walking / exercise / rest
Intermittent claudication
Numbness or coldness feet
Discoloration toes cyanosis / pallor
Tingling & weakness
Infection
what causes pain/cramps of patient with peripheral vascular disease when walking/exercising
if there is an obstruction of blood vessel cannot excrete metabolic byproducts
symptoms on activity of intermittent claudication
Increased requirements of exercising muscle
Insufficient blood supply through narrowed vessel Symptoms produced by significant narrowing of arteries supplying limb
what is critical limb ischaemia
Persistent recurring pain requiring regular analgesia > 2/52
Ulceration or gangrene foot
Absent peripheral pulses
90% require surgical
gangrene definition
the destruction of living tissue due to obstruction of the blood and oxygen supply.
what bacteria causes gangrene
Clostridium (gas gangrene) or a combination of streptococci and staphylococci.
causes of dry gangrene
caused by gradual loss of blood
Causes
Diabetes
Atherosclerosis
Frostbite
what is dry gangrene
Skin painful / dark
Dead skin dry & drops off
Not life threatening
describe moist gangrene
More serious - fatal
Loss of blood supply
Dead cells leak fluid
Affected tissue becomes moist
Bacteria flourish
Skin swollen / blisters
Can spread quickly
what is gas gangrene
Most deadly form
Occurs in wounds affected by bacteria
Low O2 environment
Release of gas / poisons into body
Fever / brown pus gas bubbles
Rapid death
abdominal aortic aneurysm
Localised enlargement lumen abdominal aorta
Pulsatile swelling abdomen
how is abdominal aortic aneurysm monitored
use ultrasound
above 4cm may rupture
possible complications of diabetes
Small vessel damage
Retinopathy
Renal failure
Peripheral neuropathy
Sensory deficits hands / feet
PVD / Small artery disease
Ischaemia
what is varicose veins
Enlarged dilated tortuous veins in the lower limb
mechanism of varicose veins
Valve failure venous hypertension venous ulceration
investigation of veins
venography
management of varicose veins
Compressive stockings
Endovenous laser ablation
chronic venous insufficiency
Lower limb venous return impaired
causes of chronic venous insufficiency
Venous hypertension
Swelling & ulceration
Varicose ulcer
thrombophlebitis
Saphenous veins often associated with varicosities
DVT
Thrombus forms in vein
Secondary inflammation
symptoms of thrombophlebitis
Localized inflammation vein wall + secondary thrombosis
Pain / tender / red / swollen
Rest / elevation / analgesics / NSAID
Signs of DVT
Risk - post op / immobilisation
Pain / swelling / red area calf
Positive Honan’s sign
US / Venogram
Rx of DVT
prevent PE / anti-coagulated / elastic stockings / heparin
Vascular examination methods
Doppler US
Abdominal US
Ankle pressures
Exercise testing
Arteriography
Ambulatory pressure monitoring
Angiography
Angioplasty
Insert small catheter with balloon advanced through vessel to site of blockage then inflated
Bypass Graft
Vein (often saphenous vein) graft from other part
of body / artificial material
used to create a detour
around the blocked artery
Endarterectomy
Area of blockage identified
Incision / Opening of vessel
Diseased segment or atherosclerotic plaque removed
indications of endarterectomy removed
Symptomatic plaque throwing emboli
Critical stenosis
causes of amputation
PVD e.g. atherosclerosis
Diabetes
Trauma, compound fracture, cold frostbite
Tumour
Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Severe burns / blast injury, compression injury
Congenital limb deficiency
surgical considerations
UL - preservation of elbow joint
LL - preservation of knee joint
Greater success with functional prosthetic use
pre operative assessment
Physical domains
Psychological considerations
Social aspects
physio pre-operation
operation
Level of amputation
Incision
Post op PCA IDC Wound drain Dressings
Stump handling
Pain / phantom limb sensation
Positioning
Rehabilitation - MDT
Prosthetics
chest physio
joint mob
strengthening
falls prevention
what psychological issues may patient face with amputation
impact
Response to loss
Motivation
Depression 30%
Psychological morbidity
Social isolation
adjustment
Loss / illness behaviour
Past medical Hx
Cause
PTSD
family/social support
Post op complications
Wound breakdown
Infection
Pressure areas
Stump oedema
Pain
physio post op amputation
Prevention of contractures & wound management a priority
Mobility / strengthening 2 - 3 days
Acceptance of limb – all members of MDT
what possible physio interventions for post op amputation
Chest physiotherapy
Movement
Stretching & positioning
Strengthening
Bed mobility
Transfers & appropriate aids
Balance & mobility
Falls prevention
LL amputation physio active movements
Hip - flexion / extension / adduction / abduction
Static quadriceps
Knee flexion
Bed mobility
Bridging / rolling / moving up down bed / sit forward / use of UL
prevention method for ll contractures post op below knee amputation
Active extension
Care with dressings
Avoid trauma
Pain may flexion
Passive ROM
Extended position
Stump board
prevention method for ll contractures post op ABOVE knee amputation
Monitor hip flexion & abduction
Encourage hip extension / adduction
Neutral hip position
Minimise prolonged sitting
Prone lying
Physio role for wheelchair use in post op amputation
Transfer technique - safety
How to manoeuvre wheelchair
Use of brakes / foot plates / arm rests
Wheel drive
Specialised pressure relief cushion?
Liaise with OT / IWA
seating/cushion
cause of residual limb oedema
bad bandaging
trauma post op
joint problems
loss of muscle pump
arterial disease
poor venous return
other conditions e.g kidney disease, diabetes, ccf
Consequences of residual limb oedema
delayed healing = infection = scar tissue = fitting difficultie s
fitting difficulties = pressure points = residual limb breakdown
Residual limb oedema - management
Elevation
Exercise - ROM ‘ankle / hip’
Bandaging - tissue support
Shrinker socks - healed limb with oedema (image)
Rigid dressing - POP
Pneumatic mobility aids
Intermittent variable air pressure application
Implementation exercise programme for primary amputee
RO wound drain
Therapy environment
Adequate analgesia
Rehabilitation
EARLY referral to prosthetic dept.
Implementation exercise programme for Established amputee
Residual limb breakdown
Surgical revision
Fracture
Recurrence tumour
Other medical conditions
Social problems
management of a present contracture
Positioning
Stretching
Active movement
Pain management
Ice & mobilisation
US
Serial splinting
gait re-ed for amputation
Encourage mobility on ward / at home
Also difficult access with wheelchair
In the event of stump breakdown
Avoid excessive hopping in early stage
Alternatively toe-heel swivel
types of prosthetic construction
Cosmetic
Endoskeletal
Exoskeletal
Construction temporary prosthesis
Thigh corset
Suspension
Knee joint
Socket
Base
Checks
Components of prosthesis
Prosthetic socket
Auxillary suspension
Prosthetic joints
Interjoint segments
LL - base / foot to contact floor
UL - hand / other terminal device
Cosmetic covering
components of prosthetic socket
Shape
Suspension
Materials
Check socket
Liners & socks
prosthetic referral considerations
Motivation / participate in rehab
Level of mobility
Independent transfers
Independent ADL / self -care
Dexterity
Eyesight
Cognition
Social support / Accommodation
QoL
what is followed after prosthetic fitting
Rehabilitation
Gait re-education with physiotherapist
Modifications to prosthesis / adjustments
Final finish & Cosmesis
Final limb
Fully rehabilitated
Discharge
Follow up as necessary
patient advice for prosthesis
Care of residual limb
Hygiene / stump socks
Prevent complications
Periods spent not wearing prosthesis
Back care
Footwear
General health & weight
describe hindquarter level of LL prosthesis
Whole pelvis intact
Tolerance in standing
Support for abdominal / pelvic contents
Total tissue contact socket
Shoulder strap
Hip & knee joint
transfemoral, prosthesis
13cm - to knee joint
Suspension Rigid Pelvic Band
Knee + foot component
types of knee disarticulation
Gritti-stokes
Transcondylar
Supracondylar
transtibial level prosthesis
Patellar Tendon Bearing socket
Foot component
what is symes prosthesis
Disarticulation of ankle
Heel pad preserved
mid tarsal chopart prosthesis
partial foot amputation
Disarticulation between talus / calcaneus proximally & navicular / cuboid distally
transmetatarsal lisfranc
Shoe filler
Partial foot prosthesis
causes of upper limb amputation
Trauma
RTA, Industrial / agricultural accident
Disease
Malignancy / Embolism / Vascular
Congenital limb deficiency
