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Cardiovascular system > venous and lymphatic disease > Flashcards

venous and lymphatic disease Flashcards

1
Q

what is a varicose vein?

A

a dilated and tortuous often superficial vein

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2
Q

what assists the flow of blood back to the heart?

A
  • valves
  • calf mucle pump
  • perforating veins drain blood into the deep system
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3
Q

what are the causes of valvular failure?

A
  • surgical or traumatic disruption of valve
  • DVT
  • hormonal changes in pregnancy causing weakness in veins and valves. and compression from enlarged uterus
  • pelvic tumour causing pressure on veins
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4
Q

how does the failire of one venous valve affect other valves?

A

once one valve has failed there is increased pressure in the distal vein and further valvular incompetence

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5
Q

what are the risk factors for varicose veins?

A 
age
female
pregnancies
DVT
standing for long periods (occupation)
family history
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6
Q

what is are the symptoms of varicose veins?

A 
Burning
Itching
Heaviness
Tightness
Swelling
Discolouration
Phlebitis
Bleeding
Disfiguration
Eczema
Ulceration
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7
Q

what is phlebitis?

A

inflammation of a vein

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8
Q

what are the examination techniques for assessing varicose veins?

A

-observation
- palpatation
- special tests:
tap test
touniquet test
doppler

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9
Q

what is the tap test for testing for varicose veins?

A
  • one hand over saphenofemoral junction
  • other hand just above knee
  • tap at junction and if tap is feet at knee then there is valvular incometence
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10
Q

describe the tourniquet test for assessing valvular incompetence in the lower limbs?

A
  1. lie patient flat and drain superficial vains by raising leg and stroking veins towards truck.
  2. apply touniquet over saphenofemoral junction
  3. ask patient to stand
  4. if veins do not fill the touniquet is acting as a vein instead of the normal valve
  5. repeat at 10 cm intervals down the leg to find the level of incompetence
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11
Q

describe the doppler test for determoining venous valvular incompetence?

A
  1. hold doppler probe ver sphenofemoral junction
  2. squeeze calf muscles
  3. in patient with competent veins there is a whoosh sound
  4. in patient with incompetent saphenofemoral junction there will be 2 waves as blood flows upwards and then refluxes downwards again
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12
Q

what are the clinical faetures of CEAP classification of chronic venous disease C0?

A

no visible or palpable signs of venous disease

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13
Q

what are the clinical faetures of CEAP classification of chronic venous disease C1?

A

telangiectasies or reticular veina

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14
Q

what are telangiectasies?

A

widened venules causing threadlike red lines or patterns on the skin

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15
Q

what are the clinical faetures of CEAP classification of chronic venous disease C2

A

varicose veins

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16
Q

what are the clinical faetures of CEAP classification of chronic venous disease C3?

A

oedema

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17
Q

what are the clinical faetures of CEAP classification of chronic venous disease C4a?

A

pigmentation or eczema

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18
Q

what are the clinical faetures of CEAP classification of chronic venous disease C4b?

A

lipodermatosclerosis or arthrophie blanche

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19
Q

what is lipodermatosclerosis?

A

a skin change of the lower legs that often occurs in patients who have venous insufficiency. It is a type of panniculitis (inflammation of subcutaneous fat). Two-thirds of affected patients are obese.

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20
Q

what are the clinical faetures of CEAP classification of chronic venous disease C5?`

A

healed venous ulcer

21
Q

what are the clinical faetures of CEAP classification of chronic venous disease C6?

A

active venous ulcer

22
Q

what is the aetiological classification of venous disease Ec?

A

congenital

23
Q

what is the aetiological classification of venous disease Ep?

24
Q

what is the aetiological classification of venous disease Es?

25
Q

what is the aetiological classification of venous disease En?

A

no venous cause identified

26
Q

what is the anatomical classification of venous disease As?

A

superficial veins

27
Q

what is the anatomical classification of venous disease Ap?

A

perforating veins

28
Q

what is the anatomical classification of venous disease Ad?

A

deep veins

29
Q

what is the anatomical classification of venous disease An?

A

no venous location of identified

30
Q

what is the pathophysiological classification of venous disease Pr?

31
Q

what is the pathophysiological classification of venous disease Po?

A

obstructed

32
Q

what is the pathophysiological classification of venous disease Pr,o?

A

reflux and obstruction

33
Q

what is the pathophysiological classification of venous disease Pn?

A

no venous pethophysiological identifiable

34
Q

when should management for varicous veins be offered?

A

Bleeding varicose veins
Symptomatic varicose veins (including aching, discomfort, swelling, heaviness and itching)
Recurrent symptomatic varicose veins
Lower limb skin changes of chronic venous insufficiency
Superficial venous thrombosis
Venous leg ulcer – active or healed

35
Q

what are the first secons and thirdline treatments for varicose veins?

A

First line: Endothermal (heat) (endovenous) treatment
Second line: Ultrasound guided foam sclerotherapy
Third line: Open surgery

36
Q

when is intervension for varicose veins not possible and what is the non-interventional treatment?

A

if deep venous system is obstructed e.g. DVT or pregnancy

compression hosiery

37
Q

how is endovenous treatment carried out?

A
  1. catheter passed upvein to just distal of saphenofemoral junction under ultrasound guidance
  2. catheter causes injury to wall with heat or laser
  3. this causes fibrosis and occlusion of the vein
38
Q

what are the complications of endovenous treatment of varicose veins?

A

skin burns
paraesthesiae
phlebitis
DVT

39
Q

describe foam sclerotherapy for varicose veins?

A
  1. under US guidance chemical foam injected into vein
    2; this dmages vein walls
    cauing fibrosis and occlusion
40
Q

what are rge comlicatoins of foam sclerotherapy?

A

stroke, TIA and MI if proximal vein not occluded
thrombophlebitis
skin pigmentation

41
Q

what is are causes of venous insufficiency?

A

Failure of calf muscle pump
Superficial venous reflux
Deep venous reflux (surgery, DVT, congenital)
Venous obstruction (heart failure, portal hypertension, obesity)

42
Q

describe the pathophysiology of chronic venous insufficiency?

A
  1. venous insufficiecy
  2. venous hypertension
  3. endothelial leak
  4. oedema
  5. increased perfusion distance
  6. impaired healing
    7 inflammation
  7. fibrinogen, tissue damage
  8. impaired tissure perfusion
43
Q

what are the features of chronic venous insufficiency?

A 
oedema
telangiectasia
eczema
Haemosiderin pigmentation (brown pigment from the breakdown of haemoglobin)
Hypopigmentation
Lipodermatosclerosis
Ulceration
44
Q

what are the characteristics f venous ulcers?

A 
Gaiter area
Granulomatous (red) base
Shallow
Irregular margins
Exudative, oedematous
Painless, pulses present
45
Q

what are the investigations carried out for chronic venous insufficiency?

A

history
examination
ABMI-ankle-brahcial pressure index

46
Q

what is the treatment of chronic venous insufficiency?

A

Wound care – little role for systemic antibiotics
Elevation
Compression bandaging
Shockwave therapy

47
Q

what are the 3 types of primary lymphoedema?

A

congenital
praecox (around puberty)
tarda (age >35)

48
Q

what are the 4 secondary causes of lymphoedema?

A

malignancy
surgery
radiotherapy
infection

49
Q

what are the treatments for lymphoedema?

A

elevation

drainage

Cardiovascular system (40 decks)

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