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Week 4 - knee OA and knee replacement > Vascular Tree and peripheral pulses > Flashcards

Vascular Tree and peripheral pulses Flashcards

1
Q

what makes up the vascular tree?

A

arterial and venous components
60000 miles of blood vessels in our body
circulating system of blood
closed pressure reservoir

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2
Q

how does the shape of arteries change?

A

decrease in size as they get further from the aorta

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3
Q

what are arteries?

A

elastic vessels carry oxygenated blood from the heart, permitting flow produced by heart pump

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4
Q

what are veins?

A

distensible vessels that return oxygen depleted blood back to the heart and lungs

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5
Q

what are capillaries?

A

microscopic vessels in tissues that permits blood from arteries to veins between

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6
Q

what are the 3 layers of blood vessels from outer to inner?

A

tunica adventitia
tunica media
tunica intima

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7
Q

which layer is generally variable between different types of vessels?

A

tunica media

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8
Q

generally what makes up the tunica media?

A

smooth muscle cells which provide the elasticity, generally involved with remodelling

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9
Q

what is the tunica intima?

A

single layer of epithelium, chemicals are produced and receptors for vascular processes reacting to blood composition

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10
Q

what is the tunica externa?

A

strength and support to the vessel, nutrient support to the arteries and veins.

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11
Q

what is collateral circulation?

A

-expansion of vascular anastomoses
-smaller branches anastomose more frequently than larger branches and can result in extensive networks allowing ongoing perfusion
-particularly important in chronic lower limb ischaemia where collteralisation allows blood flow in non textbook pathways

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12
Q

where is the femoral triangle?

A

the groin

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13
Q

what 3 structures form the femoral triangle?

A

-inguinal ligament
-sartorius
-adductor longus

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14
Q

what lies in the femoral triangle?

A

femoral nerve
femoral artery
femoral vein
empty space
lympatics

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15
Q

what does the femoral artery do?

A

branches supply soft tissue the skin and muscles of leg

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16
Q

why is the femoral artery often exposed during surgery?

A

because it is the main inflow vessel of the leg, care is taken to preserve the small branches to ensure collateral supply is not compromised

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17
Q

where is the popliteal fossa?

A

back of the knee

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18
Q

what is the popliteal fossa?

A

bound my muscles
-semimebranosus
-biceps femmoris
-medial and lateral heads of gastrocnemius

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19
Q

what lies in the popliteal fossa

A

popliteal artery, vein and nerve

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20
Q

what are peripheral pulses?

A

result from contraction of the left ventricle of the heart and blood is ejected into the arterial tree
-results in pressure wave
-pulse presents palpable arterial palpation after each heartbeat

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21
Q

where can pulses be felt?

A

where an artery can be compressed against bone

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22
Q

what can be assessed via a pulse?

A

rate, rhythm, arterial wall

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23
Q

what are the main pulses of the body?

A

-carotid
-brachial
-radial
-ulnar
-femoral
-popliteal
-posterior tibial
-dorsalis pedis

24
Q

where is the femoral pulse?

A

mid inguinal point, halway between superior iliac spine and pubic symphysis

25
Q

where is the popliteal pulse?

A

above the knee in the popliteal fossa, found by holding the bent knee

26
Q

where is the dorsalis pedis pulse?

A

top of the foot, immediately lateral to the tendon of extensor hallicus longus

27
Q

where os the posterior tibial pulse?

A

medial side of the ankle, 2cm inferior and 2cm posterior to medial malleolus

28
Q

where is the axillary pulse found?

A

located inferiorly on the lateral wall of the axilla

29
Q

where is the brachial pulse found?

A

located on medial aspect of the arm near the elbow

30
Q

where is the radial pulse located?

A

lateral spect of the wrist and also the anatomical snuff box

31
Q

where is the ulnar pulse felt?

A

located on the medial aspect of the wrist

32
Q

where is the carotid pulse located?

A

medial to anterior border of sternocleidomastoid muscle, above the hyoid bone and lateral to the thyroid cartilage

33
Q

what is the ankle brachial pressure index?

A

assessment for peripheral arterial disease
-pressure index/ratio of ankle BP = brachial BP
can be indicative of PAD

34
Q

what is caveat?

A

heavily diseased arteries may become incompressible due to rigidity, giving falsely elevated BP readings

35
Q

what is burgers test?

A

-where we can asses the colour and filling of the foot in both elevated and normal foot position
-a normal arterial supply will mean the foot remains a pink colour in all positions
-when arterial supply is reduced the foot becomes pale in elevation and veins empty and foot becomes bright red when moved back

36
Q
A
37
Q

what are the most difficult pulses to feel generally?

A

the popliteal

38
Q

what does lower limb ischemia look like?

A

-skin looks thin shiny in scaly
-skin necrosis
-lack of hair
-weak slow growing nails
-unreliable temp changes
-posterior colour changes
-redness in feet

39
Q

what is atherosclerosis?

A

most common type of arterial disease and characterised by arterial wall thickening, elasticity loss and plaque formation
arterial calcification
hardening of the arteries
principle cause of death world wide

39
Q

what are the risk factors for atherosclerosis?

A

-increasing age
-sex (male)
-family history
-smoking
-diabetes
-hyperlipidaemia
-hypertension
-obesity
-pro thrombotic tendencies

40
Q

what is the pathophysiology of atherosclerosis?

A

chronic inflammatory response of vascular wall to endothelial damage, involves activation of endothelial cells and recruitment of monocytes and macrophages where lipid profiles accumulate to form foam cells
these can mature to become more unstable plaque within a core which can be at risk of rupture. narrows artery
deposition of ECM proteins and calcific change can follow

41
Q

what is intermittent claudication?

A

-exertional leg pain, typically in calf
-resolves quickly with rest
assessment includes
-walking distance 10-500m
-impact on daily activities
-risk factors
-other medical conditions
-arterial imaging/intervention

42
Q

what is chronic limb ischaemia?

A

-rest pain, ulceration, gangrene
-life threatening condition
-limb threatening condition

43
Q

what are the treatment options for chronic limb ischaemia?

A

open surgery - endarterectomy, bypass
endovascular - balloon angioplasty, stent

44
Q

what is an endartectomy?

A

relates to clamping and opening of an artery to allow the removal of the plaque disease and then it to be patched back together

45
Q

when is an endarterectomy commonly performed?

A

common femoral artery
carotid artery

46
Q

when is a peripheral bypass generally done?

A

if disease is more extensive
bypassed using a patients own leg vane or prostatic graft
can be anatomical (in line with patients circulation) or not (crossing groin or taking a blood supply from axillary and passing a graft down to groin)

47
Q

what is an angioplasty?

A

less invasive
change shape of an artery by puncturing it and passing a wire through the disease and inflating a balloon to widen the lumen and restore flow

48
Q

what is stenting?

A

used in combination with angioplasty, this keeps the artery open with the metal stent or one covered by a fabric to ensure the flow through the lesion is maintained

49
Q

what is an open aneurysm repair?

A

replace diseased segment with a plastic graft, carries significant risk of 30 days. offers durable treatment for otherwise fit patients

50
Q

what is an Ednovascular aneurysm repair (EVAR)?

A

less invasive, stent graft through the aneurysm which acts as a windsock to funnel blood through the aneurysm and take pressure away from sack and reducing risk of rupture

51
Q

what is embolism?

A

blockage of blood vessel by solid, liquid or gas ad a site distant from its origin
90% of emboli are thrombus

52
Q

what are some other types of embolism?

A

air (the bends
amniotic fluid
medical equipment
tumour cells

53
Q

what are thromboemboli?

A

-from systemic veins -> lungs
-from heart -> aorta ->renal, mesenteric, or lower limb arteries
-from atheromatous crotid arteries ->brain
-from atheromatous abdominal aorta -> lower limb arteries

54
Q

what is carotid artery stenosis?

A

-internal carotid artery supplies brain (along with vertebral arteries)
-common carotid bifurcation is common site of atherosclerosis causing luminal narrowing and potential embolisation to the brain
-subsequent cerebral ischaemia can result in transient ischaemic attack or thromboembolic stroke

Week 4 - knee OA and knee replacement (6 decks)

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