Vasculitis Flashcards
acute limb ischaemia
presentation?
sudden decrease in limb perfusion
how is intermittent claudication different to critical limb ischaemia?
intermittent is on exertion - so certain degree of walking then it starts
critical limb ischaemia
this happens at rest
what are the 6 P’s of acute limb ischaemia?
pain pulseless parasthesia perishingly cold pale paralysis
examination sign of peripheral vascular disease
reduced blood flow
hair loss
brittle slow growing toenails
atrophic skin
numbness in feet /leg
ulcers
absent pulses
woke up with pain in my leg and when i put my leg over bed it makes pain better what si this?
critical limb ischaemia
buergers test at 45 degree
PVD at what angle is pallor
at less than 20 degree
severe limb ischaemia it is buergers angle
what is reactive hyperaemia ?
when does it occur?
arteriolar dilatation response to anabolic
anaerobic
turns red
when you assess buergers angle then drop legs over side of bed
what is the gold standard diagnostic test for PVD
ABPI
0.9>1.2
ABPI less than 0.5% so ankle pressure is half of what it is at your arm then that is quite bad chronic limb ischaemia
Ix - PVD?
colour duplex Ultrasound
magnetic resonance angiography - NO CONTRAST
Sx
buttock claudication
impotence
absent / weak distal pulses
blood does not flow past iliac arteries
posterior tibial, femoral, dorsalis, popliteal
so cramping of buttocks
LERICHE SYNDROME
occlusion of aortoiliac arteries
punched out appearance
distal
bottom of foot or between toes
grey granulation tissue
hair loss
shiny/pale skin
night pain
arterial ulcer
arterial ulcer
absent pulses
night time pain
shallow ulcer
not defined edges
gaiter region
swelling, itching , aching?
venous ulcers
venous insufficieny signs
stasis eczema ; metaloproteinases
redness
lipodermatosclerosis : upside champagne
inflammation of layer of fat , tapering less fat next to ankle
atrophie blanche - leakage of buildup of products between veins
hemosiderin deposition : decreased blood flow: blood leaks out > oedema and pigmenattion
ulcers gold standard diagnostic tool?
duplex USS of lower limb
valve damage / arterial narrowing
ABPI:
venous ulcer Ix
duplex USS
ABPI
likely to get infected so swab
biopsy
why would you want to biopsy a venous ulcer?
Marjolins ulcer
squamous cell carcinoma - chronic inflammation
venous ulcer Mx
graded compression stockings
debridement and. cleaning
abx
moisturising cream
ruptured AAA signs/symptoms
sudden, severe pain back/abdomen / groin
grey turner [bruising in flanks]
shock
pulsatile and laterally expansile mass on palpation
abdominal bruit
why can you hear an aortic bruit?
if there is stenosis or non linear blood flow then you can hear that on ausculatate
Ix - AAA
bloods
cross match if surgery
abdo uss: can show >3mm in diameter so if aneurysm present
CT angiogram / MRA if contrast allergy or renal impairment with contrast]
how can you diagnostically tell if AAA is ruptured?
CT angiogram / Magnetic resonance angiogram if allergic to contrast or if renal impairment
aortic dissection
defn
where is the tear?
tear in the aortic intima allows blood to flow into a new false channel between inner and outer layers of tunica media
most common aortic dissection
type A - stamford classification before/after aortic arch but not reaching diaphragm
htn
blood pressure difference
aortic regurg
murmur on the back
what condition does this examination signs point to ?
aortic dissection
chest xray findings for aortic dissection?
loss of aortic knuckle
widened mediastinum
globular heart
gold standard Ix for aortic dissecrion?
ct angiogram
aortic regurgitation murmur
early diastolic
decrescendo murmur
heard on left sternal edge
sit up straight and lean forward
where do you see varicose veins?
superficial lower limb veins
subcut dilated veins>3mm
varicose vein
tap test
tap VV distally and feel thrill over sapheno - femoral junction
as valves are incompetent and allowing proximal to distal blood flow
trendelenburn test
aim?
site of valvular incompetence
varicose veins Ix gold standard
exclude dvt
duplex USS
Mx
varicose veins
conservative
obesity,- lose weight, exercise , leg elevation
Mx
varicose veins
endovascular treatment
radiofrequency - closes vein
stops superficial vein which is fine
laser ablation- uses laser instead of heat
microinjection sclerotherapy- liquid or foam into vein
compresses vein > decreases blood helps return normal blood flow
foam > damages endothelium > kills vein
surgical MX of varicose veins
saphenous vein
stripping of long saphenous veins - most commonly affected
so you just take the vein out
saphenofemoral ligation
surgical mx of varicose vein
tie off
long saph vein only
complications of varicose veins
hemosiderin deposition - blood products leak out and stain skin
stasis eczema
lipodermatosclerosis : champagne sign, gets skinny at ankle where there is less fat
venous ulcer
sclerotherapy + surgery
peroneal nerve injury, parasthesia , recurrence , infection, haemmorrhage
skin staining
local scarring
gangrene
wet
dry
gas
what does clostridium perfringens cause?
gas gangrene
risk factor for gangrene
diabetes - neuropathy immunossupression steroid use PVD ulcers
dry gangrene
common
wet gangrene
painful black tissue
pus, odour due to anaerobes
painful black tissue
OVERLYING oedema
gas bubbles crepitus gas formed by infection
DVT risk
virchows triad
stasis
hypercoaguble
venous damage
dvt investigation
doppler uss
d dimer
ecg,cxr and abg for pe suspected
Mx of DVT
if provoked
unprovoked
3 month DOACs
6 months DOACs
