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CP3 SURGERY > Vascular - Venous pathology > Flashcards

Vascular - Venous pathology Flashcards

1
Q

What are the 2 venous systems taking blood from the lower limbs back to the trunk?

A

Superficial + deep vv system

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2
Q

Superficial vv system

A

Medial: long great saphenous vv
Lateral: short saphenous vv

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3
Q

Where does the long great saphenous vv drain into

A

Into saphenofemoral jct

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4
Q

Where does the short saphenous vv drain into

A

popliteal vv

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5
Q

What does the deep venous system drain?

A

The muscle compartment

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6
Q

What does the superficial vv system drain?

A

Skin + surrounding tissues

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7
Q

Where are the superficial and deep vv systems joined?

A

Saphenofemoral + saphenopopliteal jct

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8
Q

What comprises the additional communications between the deep + superficial vv systems

A

Periforating vv

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9
Q

What prevents backflow in the leg vv

A

valves

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10
Q

Which vv do not have valvves (2)

A

Vena cava

COmmon iliac vv

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11
Q

What drives vv return to the heart?

A

Pressure from mm pumps below

_+ inspiration decreasing intrathoracic P

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12
Q

What does vv disease in deep vv lead to?

A

Deep venous insufficiency

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13
Q

What does vv disease in superficial vv lead to

A

Simple varicose vv

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14
Q

What are both varicose vv and deep vv insufficiency a result of?

A

Valvular incompetence

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15
Q

Def varicose vv

A

Abnormally dilated and lengthened superficial vv

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16
Q

What are the 2 types of varicose vv

A

Primary (idiopathic)

Secondary

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17
Q

What is the most common type of varicose vv

A

Primary

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18
Q

M:F 1’ varicose vv

A

1:2

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19
Q

What are 1’ varicose vv due to

A

1’ superficial valve defects with familial elements

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20
Q

What do 2’ varicose vv occur 2’ to

A

Deep vv incompetence

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21
Q

Causes of 2’ varicose vv

A

Prev DVT

Raised systemic vv P (b/c compression)

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22
Q

Sx of varicose vv (4)

A

Unsightly
Tired, aching, throbbing legs
Oedema ankles, partic after standing for long periods
Signs of deep vv insufficiency

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23
Q

Are varicose vv usually painful

A

No

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24
Q

When are varicose vv painful

A

If thrombophlebitis is present

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25
Q

What is thrombophlebitis

A

Inflamm of superficial vv due to venous stasis

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26
Q

Why does deep vv insufficiency occur

A

Valves of deep vv system are incompetent, so calf can’t efficiently return blood to thoracic cavity

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27
Q

What is 1’ deep vv insufficiency due to

A

Congenital absence valves

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28
Q

What is 2’ deep vv insufficiency due to

A

DVT –> valvular damage or AVF raising vv pressure

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29
Q

Features deep vv insufficiency (8)

A 
Limb aching/discomfort
Oedema lower leg
Superficial varicose vv 
Haemosiderin deposition 
Eczema over pigmented area --> pruritis 
Atrophic blanche
Lipodermatosclerosis 
Ulceration
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30
Q

Ix deep vv insufficiency

A

Duplex sonography

Or venography

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31
Q

Different Ix for diagnosing vv diseaase

A

Hand held doppler
Duplex scanning - using B mode
Venography
Trendelenberg

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32
Q

What does hand-held doppler do

A

ID reflux at saphenofemoral/saphenopoliteal jct

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33
Q

What does dupplex scanning (b mode) do

A

Diagnose valvular and perforating vv incompotence as well as large vv occlusion

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34
Q

How does venography work

A

Tourniquet placed around ankle to occlude superficial vv, then contrast injected into foot

35
Q

Tx indications varicose vv (4)

A

Grossly dilated/ Sx varicosities
Haemorrhage
Concomitant deep vv insuffiency
Incompetent perforator vv

36
Q

Tx options varicose vv (5)

A 
1 - lifestyle advice 
2 - graded stocking 
3 - endothermal ablation - Tx of choice
4 - Sclerotherapy 
5 - surgery
37
Q

What lifestyle advice can you give for Mx varicose vv (3)

A

Avoid prolonged standing
Exercise regularly
Lose W

38
Q

What is the gold standard Mx of varicose vv

39
Q

Complications of varicose vv

A

Haemorrhage (from minor trauma)

Phelbitis

40
Q

Sx of phlebitis

A

VV becomes harder + tender + erythema + systemic upset

41
Q

Most common sites of DVT (5)

A 
Anterior tibiial 
Posterior tibial 
Perineal 
Superior femoral
Popliteal vv
42
Q

RF DVT (9)

A 
Age
Immobility 
Pregnancy 
OCP
Malignancy 
Obesity
Surgery 
Prev DVT
43
Q

CF DVT (7)

A 
Mostly silent 
Calf tenderness + firmness 
Oedema 
Erythema + calor 
Distention superficial vv
Superficial thrombophlebitis 
Homans sign
44
Q

What is Homans sign + why doesn’t it be tested

A

Pain on dorsiflexion ankle

Shouldn’t be tested in case of dislodging

45
Q

How can iliofemoral thrombosis PS

A

Severe pain

46
Q

PS PE (3)

A

Sudden onset unexplained dyspnoea
Pleuritic chest pain
Haemoptysis

47
Q

Ix DVT

A

D-dimer
Compression USS
Thrombophilia screen

48
Q

Is D-dimer sensitive or specific to DVT’s

49
Q

Other conditions –> raised D-DImer

A

Infection
Pregnancy
Malignancy
Post0op

50
Q

Preventing DVT’s post op (4)

A

STOP COCP 4w pre-op
Mobilise ASAP
If immobile - herapinize pt
Support hosiery

51
Q

Tx of proven DVT

A

LMWH - then stop when INR 2-3

Heparin

52
Q

How long to take WARFARIN for - provoked DVT

53
Q

How long to take Warfarin for - unprovoked DVT

54
Q

How long to take Warfarin for - rec DVT/known thrombophilia

55
Q

DDx - pt who ps w/ bilateral leg swelling

A 
Lymphoedema 
Cellulitis 
Varicose vv 
Phlebitis 
Acute aa ischaemia 
HF
Hyponatraemia
56
Q

Chronic vv insufficiency - VVV LAPS

A 
Varicose vv 
Venous ulcers
Venous stars
Lipodermatosclerosis 
Atrophy blanche 
Pitting oedema 
Scars
57
Q

Venous ulcer appearance

A

Shallow with irregular borders + granulating base

Esp over medial malleolus

58
Q

Arterial ulcer appearance

A

Often small deep lesions with well defined borders and a necrotic base

59
Q

Neuropathic ulcer appearance

A

Punched out appearance, most commonly on site of P in foot (glove + stocking distribution)

60
Q

What is cellulitis

A

Infection of skin + underlying soft tissue

61
Q

What are PE’s usually caused by?

A

DVT’s in legs

62
Q

PS PE

A

Sudden onset breathlessness
Pleuritic pain
Haemoptyisis

63
Q

How many days post surgical do PE’s tend to occur

64
Q

Def massive PE (5%)

A

> 60% pulmonary circulation is blocked

65
Q

Outcome of massive PE

A

Rapid CV collapse

66
Q

Def major PE (10% )

A

Middle sized pulm aa is blocked

67
Q

Sx Major PE (3)

A

Breathlessness
Pleuritic chest pain
Haemoptysis

68
Q

Def minor PE (85%)

A

Small peripheral vessels are blocked

69
Q

What is a premonitory embolus

A

Massive PE may ensue following a minor PE

70
Q

Signs PE (3)

A

DVT
Raised JVP
Cyanosis if embolus is large

71
Q

Ix - suspected PE (9)

A 
FBC, U+E, clotting, D-dimer
ABG 
CXR
ECG
Echo 
CTPA
72
Q

CXR findings PE (3)

A

Often norm
Or dilated pulm aa
Wedge shape opacities

73
Q

ECG findings PE

A

Tachy C
RBBB
RV strain - SI, QIII, TIII = rare

74
Q

What is SI, QIII, TIII

A

Large S wave lead I
Q wave lead III
T wave inversion III

75
Q

What is the gold standard Ix PE

76
Q

Mx massive PE

A 
A-E
IV morphine + anti-emetic
LMWH
If SBP >90 --> Warfarin 
If <90 - start vasopressors first
77
Q

Def lymphoedema

A

Swelling which results from an increased quantity of fl in the interstitial space of soft tissues, due to failure of lymphatic drainage

78
Q

Congenital cause of primary lymphodema?

A

Milroys - congen abnormality of lymphatic vessels

79
Q

2’ causes of lymphoedema

A 
B/c obstruction of lymphatic vessels
Filaria infection
Repeated cellulitis 
Malignancy 
Post op
80
Q

What is Stemmer’s sign

A

Pinch + lift skin on 2nd toe to establish presence of lymphoedema

81
Q

Ix lymphoedema

A

Lymphoscintography

82
Q

Mx lymphoedema

A

Elevation
Compression stockings
Massage

83
Q

Risks of angiography (5)

A 
Contrast reaction 
Haematoma 
Pseudoaneurysm 
AVF formation 
Aa occlusion

CP3 SURGERY (19 decks)

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