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Systems: Cardiovascular > Venous and Lymphatic Disease > Flashcards

Venous and Lymphatic Disease Flashcards

1
Q

How do varicose veins arise?

A

Valvular dysfunction

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2
Q

Where is the most common site for Varicose veins?

A

Long saphenous (80-87%)

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3
Q

How many women have varicose veins?

A

20-25%

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4
Q

How many men have varicose veins?

A

10-15%

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5
Q

What are the symptoms and signs of varicose veins?

A
  • Cosmesis
  • Localised or generalised discomfort in the leg
  • Noctural cramps
  • Swelling
  • Acute haemorrhage
  • Superficial thromboplebitis (red inflamed skin)
  • Pruritus (itching)
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6
Q

What is the treatment of varicose veins?

A

Surgery

  • High tie,stripping,multiple stab avulsions
  • Injection (scleropathy)
  • compression
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7
Q

What are the contra-indications to have surgery for varicose veins?

A
  • previous DVT (collaterals)
  • Arterial insufficiency
  • Patient Co-Morbidity
  • Morbid obesity
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8
Q

Wha complications can happen for surgery of VV?

A

common

  • Minor haemorrhage
  • thrombophlepbitis, haematoma
  • Would problems, severe pain

less common
-sural/saphenous nerves
Rare:
-Damage to deep veins , arteries, nerves, DVT

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9
Q

What are the three minimally invasive treatments of main treatments of main trunk varicosities

A
  • Foam Sclerotherapy
  • -Chemical reaction with endothelium
  • Endothelial laser ablation (thermal)
  • Radiofrequency ablastion (thermal)
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10
Q

What does PIN stand for when treating varicose veins?

A

(Perforate invaginate) stripping

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11
Q

What are the potential advantages of local anaesthetic minimally invasive treatment options?

A
  • Reduce surgical trauma (bruising,scarring)-less pain
  • Reduce time off work
  • Do not require an operating theatre
  • potential to increase patient throughput
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12
Q

What are the results of minimally invasive treatments for varicose veins?

A
  • Short to medium term just as effective clinically as surgery
  • Long term results awaited
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13
Q

What is the laser (ELVA) technique? (4 points)

A
  1. Micro puncture needle inserted into the incompetent long short saphenous veins using ultrasound
  2. Guidewire introduced, and manoeurvred to saphenous junction with deep vein using ultra sound
  3. Catheter and laser fibre intoduced over guidewire to 1cm below junction
  4. Closure (VNUS) -heats to 85 degrees
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14
Q

What is the technique for foam scleropathy?

A
  1. Needle inserted into the incompetent veins under ultrasound control
  2. Foam injected, prevented from entering deep venous system
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15
Q

What are the symptoms and signs of Chronic venous insufficiency?

A
  • Ankle Oedema
  • telangectasia -superficial changes
  • Venous eczema
  • Haemosiderin pigmentation (iron brown pigmentation)
  • Hypopigmentation “atrophie blanche”
  • Lipodermatosclerosis- narrow around ankles
  • Venous ulceration
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16
Q

What is the pathophysiology of CVI?

A
  • Venous hypertension
  • Venous engorgement and stasis
  • Imbalance of Starling forces and fluid exudate
17
Q

Explain how CVI happens?

A
  • Standing motionless- pressure at foot 90mmHg Active movements:pressure falls to 30mmHg Known as ambulatory pressure
  • High AVP Failure of muscle pump, valves or outflow obstruction
18
Q

Describe the Aetiology of CVI?

A

Failure of calf muscle pump

  • Superficial venous reflux
  • Deep venous reflux
  • Venous obstruction
  • Neuromuscular
  • Obesity
  • Inactive
19
Q

What is the definition of a leg ulcer?

A

-Breach in the skin between knee and ankle jointpresent for over 4 weeks

20
Q

What is the differential for a leg ulceration?

A
  • Almost 80% purely venous in origin
  • Up to 20% have significant arterial disease
  • Diabetes, rheumatoid arthritis, vasculitis, CT disease
21
Q

What can be found upon clinical examination of leg ulceration?

A

Signs of CVI

Oedema

22
Q

What investigations should be preformed in regards to leg ulceration?

A
  • ABPI (ankle brachial pressure index)

- Duplex

23
Q

What is the definition of a leg ulcer?

A

Breach in the skin between knee and ankle joint, present for over four weeks

24
Q

What is the differential diagnosis of leg ulcers?

A
  • Almost 80% purely venous in origin
  • Up to 20% have significant arterial disease
  • Diabetes, rheumatoid arthritis, vasculitis, CT disease
25
Q

Where anatomically are venous ulcers found?

A

Above medial malleoli
Above lateral malleoli
(less painful)

26
Q

Where can arterial ulcers be found?

A
  • Over toe joints
  • Under heel
  • Over Malleoli
  • Anterior shin
27
Q

Where can neuropathic ulcers be found?

A
  • Over toe joints
  • Under metatarsal head
  • Underheel
  • Over malleoli
  • Innerside of first metarsal head
28
Q

How can you tell venous from arterial ulcers?

A

venous are pinker because of the better blood supply

29
Q

How do you treat CVI

A
  • Multi-layer graduated, elastic, high-grade compression therapy– (Exclude arterial disease)
  • Dressings -non adherent dressings if painful- hydrocolloid/foam dressing
  • Systemic & topical therapy -Not proven
  • Exercise– calf muscle pump
30
Q

Describe the 3 types of primary lymphoedema?

A
  • Congenital
  • Praecox (before 30)
  • Tarda (after 30)
31
Q

Describe how you can get secondary lymphoedema?

A
  • Malignancy
  • Surgery
  • Radiotherapy
  • Infection (filariasis/tuberculosis/pyogenic)
32
Q

How do you treat lymphoedema?

A
  • Elvation and manual drainage
  • Pneumatic compression
  • Compression bandages

Systems: Cardiovascular (31 decks)

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