Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MD2 Foundation > Venous Disease including Chronic Ulcers > Flashcards

Venous Disease including Chronic Ulcers Flashcards

1
Q

What is chronic venous disease?

A

Venous return impaired > sustained venous hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is telangiectasia?

A

Small dilated vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can fusion of the ankle cause calf muscle pump failure?

A

Can’t dorsiflex and plantarflex > calf muscle pump doesn’t work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where are you more likely to have a deep vein thrombosis: in the superficial or deep system?

A

Deep system, especially below knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What do the perforating veins in the legs do?

A

Join superficial and deep system

Functional valves prevent reflux from deep to superficial to deep

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the white cell trapping hypothesis?

A

WBCs larger and less deformable than RBCs
When perfusion pressure reduced by venous hypertension, WBCs plug capillaries and RBCs build up behind
WBC activation
Endothelial adhesion by WBCs release proteolytic enzymes and oxygen free radicals > endothelial and tissue damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the fibrin cuff hypothesis?

A

Increased venous pressure directly transmitted to capilllaries > capillary elongation and increased endothelial permeability
Larger molecules like fibrinogen become deposited into tissues > fibrin
Accumulation of fibrin acts as barrier to oxygen > tissue hypoxia > ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is CEAP classification?

A 
Standardises severity of venous disease
C - clinical classification
E - aetiological classification
A - anatomic classification
P - pathophysiological classification
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you differentiate between venous and arterial pain in the leg?

A 
Venous
- To relieve pain, have to elevate leg
- Takes 20 min
Arterial
- If pain after exercise > rest
- If pain at rest > dangling leg (use gravity)
- Takes 5 min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are varicose veins?

A

Elongated, tortuous, dilated veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are primary varicose veins?

A

Affecting superficial/perforating veins in absence of deep incompetence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are secondary varicose veins?

A

Associated with deep venous incompetence from recanalisation of previous deep vein thrombosis
Venous obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can cause a venous obstruction, leading to secondary varicose veins?

A 
Mechanical obstruction
- Big gut
- Big hernia
- Pregnancy
Vein thrombosis
Orthopaedic injuries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for chronic venous disease?

A

Genetics

Previous deep vein thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the clinical presentation of chronic venous disease?

A 
Cosmetic
Pain
Swelling
Thrombophlebitis
Bleeding
Skin changes
Ulceration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is thrombophlebitis?

A

Inflammation of vein wall with associated thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What cosmetic issues can patients present with?

A

Telangiectasia
Reticular veins
Varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What sort of pain do patients complain of?

A

General leg ache/heaviness

Venous claudication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What sort of swelling can patients present with?

A

Early ankle pitting oedema

Later becomes indurated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What sort of skin changes can patients present with?

A

Varicose eczema
Pigmentation
Lipodermatosclerosis
Atrophie blanche

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does lipodermatosclerosis often look like?

A

Inverted champagne bottle

  • Narrow ankle
  • Bulging leg higher up
22
Q

What should you do if you see a red leg?

A

Don’t assume red leg = cellulitis

Look for other signs of infection

23
Q

What is atrophie blanche?

A

Confluence of white, depressed scars

24
Q

What investigations are done in chronic venous disease?

A

Venous duplex

Descending venography

25
Q

What is the conservative treatment of chronic venous disease?

A 
Elevate legs
- Not ideal in long-term management
Avoid standing still
- Not ideal in long-term managemt
Dressings for ulceration
Graduated compression stockings
26
Q

Who are class 1 compression stockings good for?

A

People with early venous disease
Preventative; eg: after ankle fusion
Possibly for some elderly patients because many can’t put on tighter socks

27
Q

What sort of treatment is going to fix the underlying problem in chronic venous disease?

A

Surgery

28
Q

What is sclerotherapy?

A

Inject something to shut down vein
Done under ultrasound
Less invasive

29
Q

What surgical treatments are available for chronic venous disease?

A

Sclerotherapy
Open surgery
Endovenous laser therapy
Radiofrequency ablation

30
Q

95% of ulcers are of what type?

A

Ischaemic
Neuropathic
Stasis/venous
Can be mixed aetiology

31
Q

What other causes of ulcers are there?

A 
Infective
- Syphilis
- Mycobacterium
- Osteomyelitis
Neoplastic
- Squamous cell carcinoma
- Basal cell carcinoma
- Melanoma
- Metastatic
- Kaposi's sarcoma
Systemic disease
- Pyoderma gangrenosum
Traumatic
- Thermal burns
- Radiation
- Bites
32
Q

What is pyoderma gangrenosum?

A

Condition causing tissue to become necrotic, causing deep ulcers on, usually on legs

33
Q

How do you identify ischaemic ulcers on history?

A

Painful - but not always; eg: if have severe neuropathy
History of claudication/rest pain
Cardiovascular risk factors
Previous peripheral vascular surgery

34
Q

How do you identify ischaemic ulcers on exam?

A

Location
- Distal periphery
- Over dorsum of foot/pretibia
Punch-out edges = clearly demarcated edge, quite deep
Ulcer base = poorly developed grey granulation tissue
Surrounding skin pale/mottled with no signs of inflammation
Little bleeding when debrided
- Slow weeping bleed

35
Q

What are the signs of chronic arterial insufficiency?

A 
Atrophic nails/skin
Venous guttering
Slow capillary return
Absent pulses
Beurger's positive
36
Q

What is Beurger’s sign?

A 
Elevate leg
Drop legs (both for comparison)
Bright rubor of skin as blood returns to limb
37
Q

How does red ischaemic skin feel in temperature?

A

Usually cooler > compare to area on contralateral limb

38
Q

How do you identify neuropathic ulcers on history?

A

Painless
- May not feel pain directly
- If neuropathic person suddenly feels pain > most likely deep tissue infection
History of diabetes/other causes of neuropathy

39
Q

Other than diabetes, what are the causes of neuropathy?

A 
Alcohol
Stroke
Myesthenia gravis
Illicit drug use
Chemotherapy
HIV
Syphilis
Multiple sclerosis
Congenital
Sometimes severe B12 deficiency
40
Q

How do you identify neuropathic ulcers on exam?

A 
Deep
Location: pressure points/calluses
- Plantar surface of metatarsophalangeal joints
- Bunion/bunionette areas
- Dorsum of interphalangeal joints
- Base of 5th metatarsal
- Callused posterior rim of heel pad
Signs of neuropathy
- Hypoaesthesia
- Proprioception
- 2-point discrimination
- Vibratory perception
Features of distorted foot architecture
- Hyperextension of metatarsophalangeal joints
- Hyperflexion of interphalangeal joints
- Charcot's deformity
41
Q

Why does distorted foot architecture lead to ulcers?

A

Because of motor neuropathy
Small muscles of foot become weaker
Larger muscles deform foot
Loss of muscle bulk > loss of padding in foot

42
Q

How do you identify venous ulcers on history?

A 
History of venous insufficiency?
- Varicose veins
- Superficial thrombophlebitis/deep vein thrombosis
- Variceal bleeding
Previous venous surgery
43
Q

How do you identify venous ulcers on exam?

A 
Larger and irregular edge
Shallow
Location: over gaiter area
- Commonly medial malleolus
Moist granulating base
Surrounded by zone of inflammation and stasis dermatitis
Associated signs of venous insufficiency
44
Q

What is the gaiter area?

A

Lower part of leg, above ankle

45
Q

What are the signs of venous insufficiency?

A 
Varicose veins
Pitting oedema
Varicose eczema
Pigmentation
Lipodermatosclerosis
Atrophie blanche
46
Q

What investigations can be done for ulcers?

A 
Blood tests
Swab
X-ray +/- bone scan +/- MRI
Duplex
CT angiography
Digital subtraction angiography
Punch biopsy
47
Q

What blood tests can be performed for ulcers?

A 
Full blood exam
Urea and electrolytes
CRP
Glucose
HbA1c
Vasculitis screen
ESR
Thrombophilic screen
48
Q

How do you get a good swab of an ulcer?

A

Clean wound

Get to red area

49
Q

What is more accurate: a swab, or a punch biopsy?

A

Punch biopsy

50
Q

What is the treatment for ulcers?

A 
Bed rest
Elevation/dependency
IV antibiotics
Dressings
Debridement
Treat underlying aetiology
- Try and do this first otherwise management won't work

MD2 Foundation (42 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions