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Medicine 1 Cardiovascular > Venous & Lymphatic Disease - Presentation, Investigation & Therapy > Flashcards

Venous & Lymphatic Disease - Presentation, Investigation & Therapy Flashcards

1
Q

What are varicose veins?

A

Swollen and enlarged veins that usually occur in the legs and feet

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2
Q

What are swollen and enlarged veins that usually occur in the legs and feet called?

A

Varicose veins

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3
Q

What percentage of the population is estimated to be affected by varicose veins?

A

33%

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4
Q

What is A?

A

Saphenofemoral junction

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5
Q

What is B?

A

Superficial iliac circumflex vein

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6
Q

What is C?

A

Anterior lateral tributary

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7
Q

What is D?

A

Femoral vein

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8
Q

What is E?

A

Deep femoral vein

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9
Q

What is F?

A

Anterior tributary vein

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10
Q

What is G?

A

Dorsal venous arch

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11
Q

What is H?

A

Posterior arch vein

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12
Q

What is I?

A

Greater saphenous vein

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13
Q

What is J?

A

Posterior medial tributary

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14
Q

What is K?

A

Pudendal vein

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15
Q

What is L?

A

Deep and superficial inferior epigastric vein

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16
Q

What is A?

A

Posteromedial superficial thigh vein

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17
Q

What is B?

A

Vein of Giacomini

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18
Q

What is C?

A

Saphenopopliteal junction

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19
Q

What is D?

A

Lesser saphenous vein

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20
Q

What is E?

A

Dorsal venous arch

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21
Q

What is F?

A

Posterolateral tributary vein

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22
Q

What is G?

A

Anterolateral superficial thigh vein

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23
Q

What is the course of the long saphenous vein?

A

Dorsal venous arch drains into the long saphenous vein which passes anterior to the medial malleolus, up the medial aspect of the leg

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24
Q

What does LSV stand for?

A

Long saphenous vein

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25
Q

Where is the saphenofemoral junction?

A

2.5cm below and lateral to the pubic tubercle

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26
Q

What happens at the saphenofemoral junction?

A

Long saphenous vein perforates the cribiform fascia and empties into the femoral vein (deep system)

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27
Q

What does the dorsal venous arch drain into?

A

Long saphenous vein

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28
Q

What does the long saphenous vein drain into?

A

Femoral vein

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29
Q

Where does the long saphenous vein drain into the femoral vein?

A

Saphenofemoral junction

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30
Q

Where is the short saphenous vein?

A

Planter venous arch drains into the short saphenous vein which travels posterior to the lateral malleolus, up the posterior aspect of the leg and drains into the poplital vein (deep system)

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31
Q

What does SSV stand for?

A

Short saphenous vein

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32
Q

What does the planter venous arch drain into?

A

Short saphenous vein

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33
Q

What does the short saphenous vein drain into?

A

Poplital vein

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34
Q

What things assist blood flow back to the heart against gravity?

A

Valves

Calf muscle pump

Perforating veins to drain blood into deep system (deep veins are within muscular compartments and can withstand higher pressures)

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35
Q

Why can deep veins withstand higher pressures than superficial veins?

A

They are within muscular compartments

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36
Q

What are some causes of valvular failure?

A

Surgical or traumatic disruption of the valve

Deep vein thrombosis (DVT)

Hormonal changes in pregnancy

Large pelvic tumour

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37
Q

What does DVT stand for?

A

Deep vein thrombosis

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38
Q

How can hormonal changes in pregnancy cause valvular failure?

A

Weakness of the veins and valves, leading to venous incompetence

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

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39
Q

How can a large pelvic tumour cause valve failure?

A

Increase pressure within the distal venous system and disrupt it

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40
Q

What happens to venous pressures once one valve fail?

A

It increases

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41
Q

What is venous incompetence?

A

Veins do not work correctly

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42
Q

What is it called when veins do not work correctly?

A

Venous incompetence

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43
Q

What are risk factors for venous incompetence?

A

Age

Females more than males

Pregnancies

Deep vein thrombosis

Standing for long periods of time (occupation)

Family history

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44
Q

What is seen in the history for venous incompetence?

A

Burning

Itching

Heaviness

Tightness

Swelling

Decolourisation

Phlebitis

Bleeding

Disfigurement

Eczema

Ulceration

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45
Q

What is phlebitis?

A

Inflammation of a vein

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46
Q

What is inflammation of a vein called?

A

Phlebitis

47
Q

What does the examination for venous incompetence involve?

A

Looking

Feeling

48
Q

What are some special tests for venous incompetence?

A

Tap test

Trendelenburg test

Doppler

49
Q

What is the tap test?

A

1) Place one hand over the saphenofemoral junction and one over the long saphenous vein above the knee
2) Tap the saphenofemoral junction
3) A transmitted impulse at the knee indicates an incompetence of the valves between the two hands

50
Q

What is the trendelenburg test?

A

1) Lie the patient flat and drain the superficial vein by raising the leg and stroking the vein towards the trunk
2) Apply pressure over the saphenofemoral junction, keep this pressure on as the patient stands
3) If the varicose veins don’t dilate on standing (you are preventing this by your hands acting like a valve) release your hands and you will see the veins refill as the patients saphenofemoral junction valve is incompetent

51
Q

What is the process of using a doppler for venous incompetence?

A

1) Hold the doppler probe over the saphenofemoral junction
2) Squeeze the calf muscle, in competent superficial veins you will hear a ‘whoosh’ as the blood flows upwards into the deep vein system
3) In a patient with an incompetent saphenofemoral hunction you will hear two waves as the blood flows upwards and then refluxes downwards again

52
Q

What investigation is done for venous incompetence?

A

Ultrasound

53
Q

How can ultrasound help diagnose venous incompetence?

A

Can demonstrate the valves, anatomy of the varicose veins and can be used to show dynamic blood flow such as reflux

54
Q

What are the different classifications of chronic venous disease?

A

C0

C1

C2

C3

C4a

C4b

C5

C6

55
Q

What is C0?

A

No visible or palpible signs of venous disease

56
Q

What is C1?

A

Teleangiectasies or reticular veins

57
Q

What is C2?

A

Varicose veins

58
Q

What is C3?

A

Oedema

59
Q

What is C4a?

A

Pigmentation or eczema

60
Q

What is C4b?

A

Lipodermatosclerosis or athrophie blanche

61
Q

What is C5?

A

Healed venous ulcer

62
Q

What is C6?

A

Active venous ulcer

63
Q

When should treatment for varicose veins?

A

When the patient is compaining of:

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)

64
Q

What are the management options for varicose veins?

A

1) Endovenous treatment (laser treatment used to treat varicose veins)
2) Ultrasound guided foam sclerotherapy (injecting a chemical into the affected vein that inflames the lining and causes them to block)
3) Open surgery

65
Q

What is endovenous treatment for varicose veins?

A

Laser treatment

66
Q

What is laser treatment for varicose veins known as?

A

Endovenous treatment

67
Q

What is ultrasound guided foam sclerotherapy?

A

Injecting a chemical into the affected vein that inflames the lining and causes them to block

68
Q

What is a process involving injecting a chemical into the affected vein that inflames the lining and causes the vessel to block?

A

Ultrasound guided foam sclerotherapy

69
Q

What should be offered if interventional treatment is unsuitable?

A

Compression hosiery

70
Q

What is a compression hosiery?

A

Stocking that helps to preven the occurence of venous disorders such as oedema or thrombosis

71
Q

When should intervention for varicose veins not be offered?

A

Deep vein system is occluded, hosiery should be used instead

72
Q

What is the process of endovenous treatment for varicose veins?

A

1) The LSV or SSV is cannulated under ultrasound guidance
2) Catheter is passed up the length of the vein to just distal of the saphenofemoral or saphenopoplital junction
3) Local anaesthetic is used for the small skin puncture, and is then infiltrated in the superficial tissues around the length of the vein
4) Catheter causes injury to the vein wall (either by heat or laser) which causes fibrosis and occlusion of the vein, the subsequent ablation/disappearance of the vein

73
Q

What are some complications of endovenous treatment?

A

Skin burns

Paraethesiae

Phlebitis

Deep vein thrombosis

74
Q

What is paraethesiae?

A

Abnormal sensation, typically tingling or prickling (pins and needles)

75
Q

What is an abnormal sensation, typically tingling and prickling (pins and needles) called?

A

Paraethesiae

76
Q

What is the process of foam sclerotherapy?

A

1) Under ultrasound guidance a chemical foam is injected into the affected vessel
2) Foam damaged the venous wall, causing fibrosis and occlusion

77
Q

What are some complications of foam sclerotherapy?

A

Vein should be occluded with pressure proximally to prevent foam migrating and causing stroke, TI or MI

Thrombophlebitis

Skin pigmentation

78
Q

What is thrombophlebitis?

A

Inflammatory process that causes a blood clot to form and block a vein, usually in your leg

79
Q

What is an inflammatory process that causes a blood clot to form and block a vein, typically in your leg?

A

Thrombophlebitis

80
Q

What is the process of open surgery?

A

1) Under general anaesthetic a groin incision is made and the saphenofemoral junction is exposed
2) The saphenous vein is ligated from the femoral vein, an instrument is passed along the length of the saphenous vein and then used to strip the vein out
3) Small superficial varicose veins are avulsed as using small, stab incisions and a small hook instrument

81
Q

What are some complications of open surgery?

A

Anaesthetic risk

Wound infection

Damage to nearby nerves (saphenous and sural nerves)

Bleeding

82
Q

What nerves are near the saphenofemoral junction that can become damaged in open surgery?

A

Saphenous and sural nerves

83
Q

What is venous insufficiency?

A

Condition that occurs when the venous walls and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart

84
Q

What is a condition that occurs when the venous walls and/or valves in the leg veins are not working effectively, making it difficult for blood to return to the heart?

A

Venous insufficiency

85
Q

What can venous insufficiency be caused by?

A

Failure of calf muscle pump

Superficial venous reflux

Deep venous reflux (due to surgery, DVT or congenital)

Venous obstruction (due to heart failure, portal hypertension or obesity)

86
Q

What is the pathophysiology of venous insufficiency?

A

1) Venous insufficiency
2) Venous hypertension
3) Endothelial leak
4) Oedema
5) Increase perfusion distance
6) Impaired healing
7) Inflammation
8) Fibrinogen tissue damage
9) Impaired tissue perfusion

87
Q

What are some symptoms of chronic venous insufficiency?

A

Oedema

Telangiectasia

Eczema

Hemosiderin pigmentation

Hypopigmentation

Lipodermatosclerosis

Ulceration

88
Q

What is telangiectasia?

A

Widened venules cause threadlike red lines on the skin

89
Q

What is it called when widened vessels cause threadlike red lines on the skin?

A

Telangiectasia

90
Q

What is eczema?

A

Condition that causes the skin to become itchy, red, dry and cracked

91
Q

What is a conditiont that causes the skin to become itchy, red, dry and cracked?

A

Eczema

92
Q

What is hemosiderin pigmentation?

A

Hemosiderin accumulates under your skin and causes yellow, brown or black staining or bruise like appearance

93
Q

What is it called when hemosiderin accumulates under your skin and causes yellow, brown or black staining or bruise like appearance?

A

Hemosiderin pigmentation

94
Q

What is hypopigmentation?

A

Skin lacks colour

95
Q

What is it called when the skin lacks colour?

A

Hypopigmentation

96
Q

What is lipodermatosclerosis?

A

Form of inflammation of the layer of fat under the skin

97
Q

What is a form of inflammation of the layer of fat under the skin?

A

Lipodermatosclerosis

98
Q

What is ulceration?

A

Break in a bodily membrane that impedes the organ of which the membrane is a part from, continuing normal function

99
Q

What is a break in a bodily membrane that impedes the organ of which the membrane is a part of, continuing normal function called?

A

Ulceration

100
Q

What is hemosiderin?

A

Protein compound that stores iron in your tissues

101
Q

What are venous ulcers?

A

Breach in the skin between the knee and ankle joint present for more than 4 weeks

102
Q

What is the presentation of venous ulcers?

A

Granulomatous (red) base

Shallow

Irregular margins

Exudative

Painless

Pulses present

103
Q

What investigations are done for venous ulcers?

A

ABPI (ankle-brachial pressure index)

104
Q

What does ABPI stand for?

A

Ankle-brachial pressure index

105
Q

What is the treatment of venous ulcers?

A

Exclude arterial disease

Wound care

Elevation

Compression bandaging

Shockwave therapy

106
Q

When looking at venous ulcers, what excludes arterial disease?

A

Ankle-brachial pressure index (ABPI)

107
Q

What is lymphoedema?

A

Long term chronic condition that causes swelling in the body’s tissues

108
Q

What is a long term chronic condition that causes swelling in the body’s tissues?

A

Lymphoedema

109
Q

What are the different categories of lymphoedema?

A

Primary

Secondary

110
Q

What are different kinds of primary lymphoedema?

A

Congenital

Praecox (around puberty)

Tarda (age > 35)

111
Q

What can lymphoedema be secondary to?

A

Malignancy

Surgery

Radiotherapy

Infection

112
Q

How is lymphoedema treated?

A

Elevation

Drainage

113
Q

What is praecox?

A

Around puberty

Medicine 1 Cardiovascular (36 decks)

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