Brainscape's Knowledge GenomeTM

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


See full index

Stage 3 > Vascular: Peripheral arterial disease, acute limb ischaemia, gangrene > Flashcards

Vascular: Peripheral arterial disease, acute limb ischaemia, gangrene Flashcards

1
Q

What is peripheral arterial disease?

A

Significant narrowing of arteries distal to the arch of the aorta, most often due to atherosclerosis

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

What are the risk factors for peripheral arterial disease?

A

1) Smoking
2) Diabetes
3) Hypertension
4) Hyperlipidaemia - high total cholesterol and low HDL are independent risk factors
5) Physical inactivity
6) Obesity

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

What are the symptoms of peripheral arterial disease?

A

1) Walking impairment
2) Pain in buttocks and thighs relieved at rest

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

What are the signs of peripheral arterial disease?

A

1) Pale, cold leg
2) Hair loss
3) Arterial ulcers
4) Poorly healing wounds
5) Weak or absent pulses

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

What initial investigations should be done for a patient suspected of having peripheral arterial disease?

A

Full cardiovascular risk assessment
1) BP
2) FBC
3) Blood glucose
4) Lipids
5) ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the first line investigation for peripheral arterial disease?

A

Ankle brachial pressure index (ABPI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is ABPI performed?

A

By using a doppler probe to find the systolic brachial BP of the arms and comparing them to the ankle BP in the feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is the ABPI calculated?

A

Ankle BP (on side of interest)/brachial pressure (on side of interest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a normal ABPI?

A

0.9-1.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the ABPI level in mild peripheral arterial disease?

A

0.8-0.9

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

What is the ABPI level in moderate peripheral arterial disease?

A

0.5-0.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the ABPI level in severe peripheral arterial disease?

A

< 0.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does an ABPI > 1.2 suggest?

A

Abnormal thickening of vascular walls - diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In which patients can a normal ABPI not rule out peripheral arterial disease and therefore they will need further investigation?

A

Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which further investigations can be done in peripheral arterial disease?

A

1) Duplex arterial ultrasound
2) MR arteriogram
3) CT arteriogram
4) Digital subtraction angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is a duplex arterial ultrasound used in peripheral arterial disease?

A

1) For those who might be suitable for revascularisation
2) Can determine the site, severity and length of stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is an MR arteriogram used in peripheral arterial disease?

A

For those who are candidates for revascularisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is an CT arteriogram used in peripheral arterial disease?

A

For those who are candidates for revascularisation + unsuitable for MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is digital subtraction angiography used in peripheral arterial disease?

A

Usually performed at the time of intervention or for monitoring disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are conservative measures for peripheral arterial disease?

A

Risk factor modification
1) Referral for a supervised exercise programme
2) Smoking cessation
3) Weight management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the two aims of medical in peripheral arterial disease?

A

1) Managing cardiovascular risk
2) Managing pain with appropriate analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is cardiovascular risk medically managed in peripheral arterial disease?

A

1) Clopidogrel 75mg OD - aspirin second line
2) Atorvastatin 80mg ON
3) Optimise glycaemic control
4) Manage hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which medication is given specifically in peripheral arterial disease to manage cardiovascular risk?

A

Clopidogrel (antiplatelet)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which specific medication can alleviate pain in peripheral arterial disease?

A

Naftidrofuryl oxalate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is naftidrofuryl oxalate?

A

A vasodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When should naftidrofuryl oxalate be prescribed in peripheral arterial disease?

A

For analgesia only if supervised exercise is ineffective and the patient does not want to be referred for angioplasty or bypass surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the equivalent of intermittent claudication in the heart?

A

Angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What should patients with intermittent claudication be referred for when risk factor modification has been introduced and supervised exercise programme has not lead to any improvement?

A

Endovascular or surgical revascularisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is critical limb ischaemia defined?

A

1) Rest pain
2) Tissue loss
3) Ankle artery pressure < 50 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How should patients presenting with critical limb ischaemia be managed?

A

Refer urgently to the vascular MDT for endovascular or surgical resvascularisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What revascularisation method is recommended for small discrete stenosis?

A

Endovascular revascularisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What revascularisation method is recommended for larger more extensive stenosis?

A

Surgical bypass

33
Q

What are indications for potential amputation?

A

1) Critical limb ischaemia unsuitable for other interventions
2) Intractable pain
3) Unresolving ulcer
4) Severe loss of function

34
Q

Which surgery would result in a vertical groin scar and a distal lower limb scar?

A

Femoro-popliteal bypass

35
Q

Which surgery would result in two vertical groin scars?

A

Femoral-femoral bypass

36
Q

Which surgery would result in a pectoral scar and a vertical groin scar?

A

Axillo-femoral bypass

37
Q

Which surgery would result in an oblique iliac scar and a vertical groin scar?

A

Ileo-femoral bypass

38
Q

In what age group to arterial ulcers typically present?

A

Elderly men

39
Q

Where do arterial ulcers typically occur?

A

1) Distally e.g. heel or toe tips
2) Lateral side of the ankle

40
Q

What are the features of arterial ulcers?

A

1) Small
2) Deep
3) Punched out margin
4) Do not bleed/ooze

41
Q

What do arterial ulcers typically occur with?

A

Other features of peripheral arterial disease - weak distal pulses, skin/hair atrophy

42
Q

How is acute limb ischaemia defined?

A

Severe, symptomatic hypoperfusion of a limb occurring for < 2 weeks

43
Q

How quickly does acute limb ischaemia need to be treated?

A

Surgical emergency - needs to be correct asap, ideally within 4-6h

44
Q

What are the 6 Ps of acute limb ischaemia (signs and symptoms)?

A

1) Pulseless
2) Painful
3) Pale
4) Paralysis
5) Paresthesia
6) Perishingly cold

45
Q

What does it mean if the limb has lost motor and sensory function in critical limb ischaemia?

A

That the limb is almost certainly unsalvageable

46
Q

What are the causes of acute limb ischaemia?

A

1) Thrombosis (40%) - rupture of atherosclerotic plaques
2) Embolism (40%) - most commonly in a patient with AF
3) Vasospasm - e.g. Raynaud’s
4) External vascular compromise - trauma, compartment syndrome

47
Q

Which cause of acute limb ischaemia is most common in a patient with AF?

A

Embolism

48
Q

What is a vasospasm cause of acute limb ischaemia?

A

Raynaud’s phenomenon

49
Q

What are causes of external vascular compromise that can lead to acute limb ischaemia?

A

1) Trauma
2) Compartment syndrome

50
Q

What are the key features of acute limb ischaemia secondary to thrombosis?

A

1) Sub-acute onset
2) Patients have features of peripheral vascular disease in the contralateral limb

51
Q

What are the key features of acute limb ischaemia secondary to embolisation?

A

1) More acute onset
2) Often occurs due to AF

52
Q

How do you acutely manage acute limb ischaemia?

A

ABCDE
1) B - oxygen
2) C - IV fluids + analgesia, take bloods for FBC, U&E, group & save + clotting
3) ECG - important to see if patient is in AF, suggesting an embolic cause

53
Q

Why is an ECG important to do in acute limb iscahemia?

A

To see if the patient is in AF, suggesting an embolic cause

54
Q

How is acute limb ischaemia managed?

A

1) ABCDE
2) Urgent refer to vascular surgery
3) Keep patient NBM in preparation for surgery
4) IV heparin (to prevent thrombus propagation may be administered) - typically after senior review

55
Q

Which anticoagulant is administered in acute limb ischaemia typically after senior review?

A

IV heparin - to prevent thrombus propagation

56
Q

What does the definitive management of acute limb ischaemia depend on?

A

1) Complete or incomplete limb ischaemia
2) Whether cause is thrombotic or embolic

57
Q

How do you manage incomplete acute limb ischaemia due to thrombotic causes (+ the limb is likely to remain viable for 12-24h)?

A

1) Angiography - to map the occlusion site and plan intervention
2) Endovascular procedures e.g. angioplasty, thrombectomy, intra-arterial thrombolysis

58
Q

What is the purpose of angiography in acute limb ischaemia?

A

To map the occlusion site and plan intervention

59
Q

Which endovascular procedures are an option to treat incomplete acute limb ischaemia due to thrombotic causes?

A

1) Angioplasty
2) Thrombectomy
3) Intra-arterial thrombolysis

60
Q

How do you manage complete acute limb ischaemia due to thrombotic causes?

A

Urgent bypass surgery (angiography + thrombolysis delays Mx)

61
Q

How do you manage complete or incomplete acute limb ischaemia due to embolic causes?

A

Immediate embolectomy

62
Q

How is angiography used in acute limb ischaemia due to embolic causes?

A

Post-embolectomy to confirm the adequacy of the procedure

63
Q

What can be considered in acute limb ischaemia due to embolic causes if embolectomy fails?

A

On-table thrombolysis

64
Q

What may be required in acute limb ischaemia due to embolic causes if the limb is non-viable?

A

Amputation

65
Q

Why is immediate embolectomy required in acute limb ischaemia due to embolic causes?

A

The leg is typically threatened

66
Q

What is dry gangrene?

A

Ischaemic gangrene (necrosis)

67
Q

What causes dry (ischaemic) gangrene?

A

Secondary to chronically reduced blood flow

68
Q

How is dry (ischaemic) gangrene classified?

A

According to pathophysiology

69
Q

What are the causes of dry (ischaemic) gangrene?

A

1) Atherosclerosis - in association with peripheral arterial disease
2) Thrombosis - in association with vasculitis + hypercoagulable states
3) Vasospasm - in association with cocaine use and Raynaud’s

70
Q

What are two causes of vasospasm?

A

1) Cocaine
2) Raynaud’s

71
Q

How does dry gangrene present?

A

1) The necrotic area is well demarcated from the surrounding tissue
2) Patients do not show signs of infection

72
Q

How is dry gangrene managed?

A

Auto-amputation occurs in most cases

73
Q

What is wet gangrene?

A

Infectious gangrene

74
Q

What are causes of wet (infectious) gangrene?

A

1) Necrotising fasciitis (infection of the subcutaneous fascia and fat)
2) Gas gangrene
3) Gangrenous cellulitis

75
Q

Which pathogen causes gas gangrene?

A

Clostridium perfringens

76
Q

Which patients are vulnerable to gangrenous cellulitis?

A

Immunocompromised

77
Q

How does wet gangrene present?

A

1) Necrotic area is poorly demarcated from the surrounding tissue
2) Patients are pyrexial/septic

78
Q

How is wet gangrene managed?

A

1) Surgical debridement or amputation
2) Broad spectrum IV abx

Stage 3 (61 decks)

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