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Cardiovascular System > Venous and Lymphatic Disease > Flashcards

Venous and Lymphatic Disease Flashcards

1
Q

What are varicose veins?

A

Dilated and tortuous, often a superficial vein and commonly found in lower libs

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2
Q

Describe the course of the long saphenous vein

A

Dorsal venous arch drains into the LSV, which passes anterior to the medial mallows and up the medial aspect of the leg

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3
Q

What is the saphenofemoral junction?

A

Where the LSV perforate the cribriform fascia and empties into the femoral vein (deep system)

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4
Q

Describe the course for the small saphenous vein

A

The plantar venous arch drains into the SSV which travel posterior to the lateral mallows, up the posterior aspect of the leg and drain into the popliteal vein (deep system)

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5
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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6
Q

What are causes of valvular failure?

A

Surgical or traumatic disruption of the valve
DVT
Hormonal changes in pregnancy
Large pelvic tumour

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7
Q

Why can a DVT cause valvular failure?

A

Initially causes obstruction to flow, but although the vein reanalyses through the thrombus, this canal will be a high-pressure valvular flow

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8
Q

Why do hormonal changes in pregnancy cause valvular failure?

A

Can weaken veins and valves, leading to venous incompetence

The enlarged uterus can cause mechanical obstruction to venous flow within the deep system

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9
Q

Why do large pelvic tumours cause valvular failure?

A

Cause mechanical obstruction to venous flow within the deep system, leading to increased pressure

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10
Q

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

A

Once one valve has failed, venous pressure increases causing dilatation of the diastole vein and further valvular incompetence

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11
Q

What are risk factors for valvular disease?

A 
Age 
Female
Pregnancies
DVT
Standing for long periods of time (occupation)
FH
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12
Q

What are symptoms of valvular disease?

A 
Burning 
Itching 
Heaviness
Tightness 
Swelling 
Discolouration 
Phlebitis 
Bleeding 
Disfiguration 
Eczema 
Ulceration
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13
Q

What is phlebitis?

A

Inflammation of a vein

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14
Q

What are the examination techniques for assessing varicose veins?

A 
Observation
Palpatation
Special tests:
tap test
touniquet test
doppler
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15
Q

What is the tap test for testing for varicose veins?

A

Place one hand over the saphenofemoral junction
Other hand on LSV above knee

Tap the junction - if feel impulse at LSV then indicate incompetence

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16
Q

What the the Tourniquet Test for varicose veins?

A
  1. Lie patient flat and drain superficial veins by raising leg and stroking veins towards trunk
  2. Apply touniquet over saphenofemoral junction
  3. Ask patient to stand
  4. If veins do not fill, and observe for any signs of varicose veins reappearing
  5. If the varicose veins do not fill back up, this indicates the problem is above the tourniquet level, but if it fills back up, this indicates the problem is below the tourniquet level
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17
Q

Describe the doppler test for varicose veins

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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18
Q

What investigation should be carried out for varicose veins and why?

A

Ultrasound - demonstrates the valves, the anatomy (tortuous) and can be used to show dynamic blood flow i.e. reflux

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19
Q

Describe CEAP classification of chronic venous disease C0

A

No visible or palpable signs of venous disease

20
Q

Describe CEAP classification of chronic venous disease C1

A

Teleangiectasies or reticular veins

21
Q

Describe CEAP classification of chronic venous disease C2

A

Varicose veins

22
Q

Describe CEAP classification of chronic venous disease C3

23
Q

Describe CEAP classification of chronic venous disease C4a

A

Pigmentation or eczema

24
Q

Describe CEAP classification of chronic venous disease C4b

A

Lipodermatosclerosis or atrophie blanch

25
Q

Describe CEAP classification of chronic venous disease C5

A

Healed venous ulcer

26
Q

Describe CEAP classification of chronic venous disease C6

A

Active venous ulcer

27
Q

What are the 3 etiological classifications?

A

Ec: congenital
Ep: primary
En: no venous cause

28
Q

What are the 3 anatomical classifications?

A

As: superficial
Ap: perforating
Ad: deep veins
An: no venous location

29
Q

What are the 3 pathophysiology classifications?

A

Pr: reflux
Po: obstruction
Pr, o: reflux and obstruction
Pn: no venous patholophysiology

30
Q

When should treatment be offered?

A 
Bleeding varicose veins 
Symptomatic varicose veins 
Recurrent symptomatic VV
Lower limb skin changes of chronic venous insufficiency 
Superficial venous thrombosis 
Venous leg ulcer - active or healed
31
Q

What are the 3 steps to surgery?

A
  1. Endovenous treatment
  2. Ultrasound guided foam sclerotherapy
  3. Open surgery

If intervention unsuitable (obstructed DVT or pregnancy): compression hosiery

32
Q

How is endovenous treatment carried out?

A
  1. LSV or SSV cannulated
  2. Catheter inserted distal to sapheno-femoral/popliteal junction
  3. Local anaes. infiltrated in superficial tissues around vein
  4. Cather injures vein wall with heat or laser -> fibrosis and occlusion of the vein
33
Q

What are complications with endovensou treatment?

A

Skin burns
Paraesthesiae
Phlebitis
DVT

34
Q

What is foam sclerotherapy?

A

A chemical is injected into affected vein and the foam damages the venous walls -> fibrosis and occlusion

35
Q

What are the complication with foam sclerotherapy?

A

The vein should be occluded (with pressure) to prevent foam migrating: can cause stroke, TIA or MI
Thrombophlebitis
Skin pigmentation

36
Q

How is the open surgery carried out?

A
  1. Under GA, groin incision made and then saphenogemoral junction exposed
  2. instrument passed through saphenous vv, then strip vv out
  3. Small superficial varicose veins are removed
37
Q

What are possible complications of open surgery?

A

Anaethetic risk
Wound infection
Damage to nearby nerves
Bleeding

38
Q

What can causes venous insufficiency?

A

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

39
Q

Describe the pathophysiology of venous insufficiency

A
  1. Venous insufficiency
  2. Venous HPT
  3. Endothelial leak
  4. Oedema
    (5. Increased perfusion distance
  5. Impaired healing
  6. Inflammation
  7. Fibrinogen, tissue damage)
  8. Impaired tissue perfusion

Can go from 4 -> 9

40
Q

What are symptoms of chronic venous insufficiency?

A 
Oedema 
Telangiectasia 
Eczema 
Haemosiderin pigmentation 
Hypopigmentation 
Lipodermatosclerosis 
Ulceration
41
Q

What are venous ulcers?

A

Breach in the skin between knee and ankle joint, present for > 4weeks

42
Q

What are characteristic of venous ulcers?

A 
Gaiter area 
Granulomatous (red) base
Shallow
Irregular margins 
Exudative, oedematous 
Painless, pulses present
43
Q

What are investigations for venous insufficiency?

A

History
Examination
ABPI (ankle-brachial pressure index) - excludes arterial disease

44
Q

What is the treatment for venous insufficiency?

A

Wound care
Elevation
Compression bandaging
Shockwave therapy

45
Q

What are primary causes for lymphoedema?

A

Congenital
Praecox: around puberty
Tarda: age > 35

46
Q

What are secondary causes for lymphoedema?

A

Malignancy
Surgery
Radiotherapy
Infection

47
Q

What is the treatment for lymphoedema?

A

Elevation

Drainage

Cardiovascular System (37 decks)

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