Venous disease & lymphatic disorders Flashcards
List the underlying diseases/disorders associated with vasopastic changes in the extremities
Reynaud’s phenomenon
- General term describing episodic digital vasopasm in the absence of an identifiable associated disorder
Reynaud’s syndrome
- Reynaud’s phenomenon occuring secondary to another condition
- Secondary causes:
- Connective tissue disorders
- Systemic sclerosis, mixed connective tissue disease, SLE, Sjogren’s syndrome, polyarteritis nodosa
- Macrovascular disease
- Atherosclerosis, thoracic outlet obstruction, Buerger’s disease
- Occupational trauma
- Vibration white finger, repeated extreme cold or chemical exposure
- Drugs
- B-blockers, cytotoxic drugs
- Others
- Malignancy, Arteriovenous Fistula
- Connective tissue disorders
What are the clinical characteristics of Rayaund’s phenomenon?
What hapens as fingers return to normal?
Duration of onset?
Raynaud’s phenomenon can be brought on by cold exposure, or emotional stress and there are three phases:
- Pallor: due to digital artery spasm
- Cyanosis: due to accumulation of deoxygenated blood
- Rubor (blush): erythema due to reactive hyperaemia (an excess of blood in the vessels)
As the fingers return to normal, there may be numbness, a burning sensation and severe pain. Attacks are usually <45 min in duration but can last for hours, with very sever cases involving tissue infarction and loss of digits
What are varicose veins?
- Abnormally dilated and lengthened superficial veins
- Commonly in the lower limbs
How are varicose veins classified?
How do they differ? - what are they due to?
They can be primary (idiopathic) or secondary
Primary (idiopathic)
- Most common cause
- Twice as common in women
- Likely to be due to primary superficial valve defect, with familial elements
- There is no deep venous incompetence
Secondary
- Superifical varicosities occur secondary to deep venous incompetence
- Previous DVT: although occluded veins recanalise, their valves remain incompetent
- Raised systemic venous pressure: due to compression (pelvic tumour, pregnancy), arterio-venous fistula or severe tricuspid incompetence
What are the complications that may occur from varicose veins?
Symptoms:
- Most patients are most affected by the unsightly appearance
- Can cause tiredness, aching or throbbing of the legs
- Oedema of the ankles, particularly on standing for long periods
- Ithing and noctural cramps are reported
- Signs of deep venous insufficiency -painful:
- Haemosiderosis (iron overload disorder resulting in the accumulation of hemosiderin), eczema, lipodermatosclerosis (t is an inflammation of the subcutaneous fat)
Outline the normal venous physiology
Describe the roles of supericial and deep veins of the lower limb
- There are two venous systems taking blood from the lower limb back to the trunk, the superficial venous system and the deep venous system
- The deep venous system comprises a nuber of veins the accompany the major arteries of the lower limb and drain the muscular compartment
- The superficial venous system comprises the medial long (great) saphenous vein which drains to the saphenofemoral junction and the laterally placed short saphenous vein which drains into the popliteal vein
- The superfical system drains the skin and superficial tissues
- The two systems are joined at the saphenofemoral and saphenopopliteal junctions
- Perforating veins are additional communications between the two systems
What is the role of the valves in the veins of the lower limb?
How does the blood return to the heart from the lower limb?
- All the leg veins have valves to prevent backflow
- Venous return to the heart is driven by pressure from the muscular pumps below and inspiration decreasing intrathoracic pressure
- As the calf muscles contracts the deeps veins are squeezed and emptied to force blood upwards
- As the muscle relaxes, blood from the superficial system will flow into the deep veins via the perforators which will again be squeezed upwards as the calf muscles contract once more
How do hand held doppler and duplex-scanning tests work in diagnosing venous disease?
- Handheld Doppler ultrasound identifies backward reflux of blood.
- Colour duplex scans (using B mode and Doppler ultrasounds) produce a colour picture of blood flow – blue forward, red back – and thus the presence of valvular incompetence.
Define lymphedema
Swelling which results from an increased quantity of fluid in the intertitial space of soft tissues, due to failure of lymphatic drainage
It causes chronic non-pitting oedema, commonly affecting the leg and progressing with age
What are common causes of lymphoedema?
Primary lymphoedema:
- A result of an inherited deficiency of lymphatic vessels
- E.g. Milroy’s disease
Secondary lymphoedema:
- Due to obstruction of lymphatic vessels
- E.g. Filaria infection, repeated cellulitis, malignancy, post operative
