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vascular surgery Flashcards

1
Q

cause of peripheral arterial disease

A

the narrowing of the arteries supplying thelimbs, reducing blood supply to these areas

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2
Q

sx intermittent claudication

A

crampy, achy pain in calf/thigh/buttock
associated with muscle fatigue on exertion
relieved by rest

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3
Q

critical limb ischaemia

A

inadequate blood supply to allow normal function at rest

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4
Q

sx critical limb ischaemia

A

burning pain- worse at night
pain
pallor
pulselessness
paralysis
paraesthesia
perishing cold

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5
Q

acute limb ischaemia cause

A

rapid onset usually due to thrombus

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6
Q

gangrene

A

death of tissue due to inadequate blood supply

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7
Q

cause atherosclerossi

A

chronic inflammation and activation immune system
lipids deposited-> fibrous atheromatous plaques ->stiffened walls =HTN and strain on heart, stenosis=reduced flow, plaque rupture=thrombus causing ischaemia

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8
Q

RF atherosclerossi

A

non-modifiable: age, fhx, m
modifiable: smoking, alcohol, sugar, trans fats, sedentary, obesity, poor sleep, stress
conditions: DM, HTN, CKD, RA, atypical antipsychotics

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9
Q

end results atherosclerosis

A

angina
MI
TIA/stroke
periphral arterial disease
chronic mesenteric ischaemia

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10
Q

leriche syndrome

A

occlusion of distal aorta or proximal common iliac artery

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11
Q

sx leriche syndrome

A

thigh/buttock claudication
absent femoral pulses
male impotence

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12
Q

signs arterial disease

A

skin pallor
cyanosis
dependent rubor
muscle wasting
hair loss
ulcers
poor wound healing
gangrene
reduced skin temp
reduced senssation
increased CRT
buerger changes

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13
Q

buergers test

A

for PAD
1. lift legs to 45 degrees and hold 1-2m
pallor=inadequate blood supply
buergers angle=angle at which leg is pale
2. hang legs over bed sitting up. in PAD go blue then dark red (rubor)

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14
Q

cause arterial ulcers

A

due to ischaemia secondary to inadequate blood supply

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15
Q

features arterial ulcers

A

small
deep
well defined
borders
punched out
peripheral - toes
less bleeding
pain

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16
Q

cause venous ulcers

A

impaired drainage and blood pooling

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17
Q

features venous ulcers

A

after minor injury
large
superficial
irregular sloping borders
gaiter area
less painful

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18
Q

ix PAD

A

ABPI : less than 0.9 in PAD
duplex USS
angiography

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19
Q

ABPI

A

systolic BP ankle : arm

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20
Q

mx intermitten claudication

A

lifestyle
exercise
meds: atorvastatin, clopidogrel, naftidofuryl oxalate (5HT2 receptor antagonist=vasodilation)
surgery: endovascular angioplasty and stent, endarterectomy, bypass

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21
Q

mx critical limb ischaemia

A

vascular surgery to revascularise or amputate

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22
Q

mx acute limb ischaemi

A

endovascular thrombolysis
endovascular thrombectomy
endarterectomy
bypass
amputation

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23
Q

RF VTE

A

immobility
recent surgery
long haul travel
pregnancy
oestrogen: HRT and COCP
malignany
polycythaemia
SLE
thrombophilia (antiphospholipid)

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24
Q

VTE prophylaxis

A

LMWH - enoxaparin
compression stockings (not in PAD)

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25
sx DVT
unilateral calf swelling circumference 10cm below tibial tuberosity is >3cm bigger than other leg dilated superficial veins tender calf oedema colour changes
26
ix DVT
wells score d-dimer doppler USS
27
mx DVT
apixaban or rivaroxaban long term antocoag with DOAC: 3m if reversible cause, 3-6m in cancer, 6, if cause unclear
28
causes raised d-dimer
VTE pneumonia malignancy HF surgery pregnancy
29
ix unprovoked DVT
baseline bloods examine for cancer test for antiphospholipid and hereditary thrombophilias
30
varicose veins
distended superficial veins >3mm due to icompetent valves
31
reticular veins
dilated blood vessels in skin 1-3mm
32
why does chronic venous insufficiency cause skin sx
bloos pools and leaks ->brown discolouration due to haemosiderin, venous eczema, lipodermatosclerosis (fibrotic and tight skin)
33
RF varicose veins
fhx F pregnant obese prolonged standing DVT
34
sx varicose veins
engorged and dilated dragging aching itching burning oedema muscle cramps restless legs
35
tests for chronic venous insufficeincy
tap test cough test trendelenburgs perthes
36
tap test
pressure on SFJ and tap vein = thrill in chronic venous insufficiency
37
cough test
pressure on SFJ and cough = thrill in chronic venous insufficiency
38
trendelenburgs test
lie down lift leg and drain tourniquet stand up prevents varicose veins reappearing if distal to incompetence
39
perthes test
tourniquet to thigh and do calf raises superficial veins disappear means deep veins are functioning
40
ix chronic venous insufficeincy
duplex USS
41
mx varicose veins
wt loss exercise elevate leg compression stocking surgery e.g. endothermal ablation
42
complication varicose veins
heavy bleeding superficial thrombophlebitis DVT chronic venous insufficiency=ulcers
43
cause diabetic ulcers
diabetic neuropathy -> injury -> poor healing due to high glucose and neuropathy
44
complication diabetic ulcers
osteomyeltiis
45
cause pressure ulcers
immobility-> reduced blood supply and drainage -> skin breaks down
46
score for pressure ulcers
waterlow
47
ix ulcers
ABPI bloods: FBC, CRP, HbA1c, anaemia charcol swab biopsy for SCC
48
mx arterial ulcers
manage PAD dont debride or compress
49
mx venous ulcers
clean, debride, dress compression pentoxifylline abx +/- surgery
50
lymphoedema
impaired lymphatic drainage
51
types lymphodema
primary: genetic (presents <30y) secondary: other conditions, often after axillary node clearance
52
lipoedema
build up of fat, feet are spares
53
ix lymphodema
stemmers sign: positive is cant tent skin on 2nd toe/middle finger limb vol: circumference, water displacemenr biolectric impedence spectrometry lymphoscintigraphy: radioactive tracer
54
mx lymphoedema
massage compression bandages skin care lymphaticovenular anastomosis
55
lymphatic filanasis cause
=elephantiasis parasitic worms spread by mosquitos leading to lymphodema and thickening and fibrosis of skin
56
AAA sizing
smal = 3-4.4cm med=4.5-5.4cm large= >5.5cm
57
RF AAA
M age smoking HTN Fhx CVD
58
screening AAA
all M USS 65y F at 70y if have RF
59
presentation AAA
asx abdi pain pulsatile mass
60
sx ruptured AAA
sev abdo pain radiating to back haemodynamic instability collapse LOC
61
ix AAA
USS CT angiogram
62
mx AAA
lifestyle USS yearly if 3-4.4 cm or 3m if >4.5cm repair if sx, growing >1cm/yr cant drive if >6.5cm rupture=surgical emergency
63
aortic dissection
tear in aorta-blood enters between intima and media forming a false lumen
64
stanford classification aortic dissection
A=ascending aorta before brachiocephalic artery B=descending aorta after L subclavian artery
65
DeBakey classification aortic dissection
1. ascendinf aorta and arch II. just ascending aoirta IIIa. descending aorta above diaphragm IIIb. descending aoirta below diaphragm
66
RF aortic dissection
HTN M smoking high cholesterol CABG bicuspid aortic valve ehlers danlos marfans
67
triggers aortic dissection
wt lifting cocaine
68
sx aortic dissection
ripping chest pain that migrates HTN BP difference between arms (>20) radial pulse deficit diastolic murmur syncope focal neuro deficit
69
ix aortic dissection
ECG CXR CT or MRI angiogram
70
mx aortic dissection
surgical emergency morphine BB
71
complications aortic dissection
MI stroke paraplegia cardiac tamponade aortic valve regurg death
72
carotid artery stenosis severity
mild <50% mod 50-69% sev >70%
73
diagnosis carotid artery stenosis
usually after TIA USS CT or MRI angiogram
74
findings O/E carotid artery stenossi
carotid bruit
75
mx carotid artery stenossis
lifestyle aspirin atorvastatin carotid endarterectomy angioplasty and stent
76
risks carotid endarterectomy
stroke nerve injury
77
buerger disease
=thromboangiitis obliterans inflammatory condition in small and medium sized vessels causing thrombus formation
78
RF buergers disease
25-35y M smoking
79
sx Buergers disease
blue fingers and toes pain at night
80
ix buergers disease
angiogram=corkscrew collaterals
81
mx buergers disease
stop smoking IV iloprost (dilates vessel)

finals (31 decks)

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