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GI > Vascular > Flashcards

Vascular Flashcards

1
Q

What is Raynaud’s disease?

A 
Idiopathic condition of young females
Affects hands > feet
Digits - white -> blue -> red
Calcium antagonist
Cold exposure or emotions
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2
Q

Risks for venous ulcers?

A 
Varicose veins
Previous DVT
Plebitis
Fracture, trauma or surgery
Family history
Venous insufficiency
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3
Q

Risks for arterial ulcers?

A 
Coronary heart disease
History of stroke/TIA
Diabetes 
Peripheral arterial disease
Obesity
Immobility
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4
Q

What is an ulcer?

A

Loss of skin that takes more than 2 weeks to heal, may be venous, arterial or both

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5
Q

Prevalence of ulcer type?

A

75% venous

22% arterial

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6
Q

Rheumatoid ulcer?

A 
Vasculitis
Deep
Demarcated 
Punched out
Dorsum of foot or calf
Pyoderma gangrenous
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7
Q

Systemic vasculitis ulcers?

A

Multiple, deep, necrotic
Atypical distribution
Other vasculitic lesions
SLE, scleroderma, polyarteritis nodosa

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8
Q

Diabetic ulcer?

A

Bony prominence on foot

Neuropathic, arterial and venous components

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9
Q

Hypertensive ulcer?

A

Arteriolar constriction
Painful
Necrotic edge
Lateral aspect of lower leg

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10
Q

Malignancy ulcer?

A

Rolled or everted edge
Non-responsive ulcers
Marjolin’s ulcer

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11
Q

Features of venous ulceration?

A 
Circumference of lower leg
Large but shallow 
Moist granulating base
Blood when handled
Irregular border
Hyperpigmentation due to haemosiderin deposition
Atrophie blanche
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12
Q

Features of arterial ulcers?

A 
Distal, dorsum of foot or toes
Irregular edges become defined
Grey granulation tissue
No/little blood
Nocturnal pain
Features of ischaemia
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13
Q

Features of chronic ischaemia?

A 
Hairlessness
Pale skin
Absent pulses
Nail dystrophy
Muscle wasting
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14
Q

Features of neuropathic ulcers?

A 
Punched out appearance
Deep sinus
Under callus or over pressure points
Surrounding by inflammatory tissue
Brisk bleeding
Painless
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15
Q

Causes of venous ulcers?

A

Incompetent valves in lower leg, causing blood to be pushed into superficial veins leading to varicose veins, venous eczema and ulceration

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16
Q

Cause of diabetic ulcers?

A

Changes in bony architecture of foot
Peripheral neuropathy
Atherosclerotic PAD

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17
Q

Metabolic abnormalities in diabetes?

A

Hyperlipidemia
Raised vW factor + fibrinogen
Increased platelet adhesiveness

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18
Q

Assessment of an ulcer?

A 
Edges
Base
Condition of surrounding skin
Size
Infection
Pulses
Sensation
Blood pressure
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19
Q

Investigations for new ulcer?

A

ABPI - arterial disease
Swabs
Urinalysis/HBa1c

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20
Q

Management of venous ulcers?

A 
Graduated compression
Debridement
Occlusive hydrocolloidal dressing
Antibiotics
Pentoxifylline
Steroids
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21
Q

What is pentoxifylline?

A

Erythrocyte phosphodiesterase inhibitor
Improves blood flow
Increasing erythrocyte and leukocyte flexibility

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22
Q

Management of arterial ulcers?

A 
Improve blood supply to the area
Blood thinners
Stenting
Reduce cardiovascular risk
Prone to infection
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23
Q

What is superficial thrombophlebitis?

A

Local superficial inflammation of the vein wall with secondary thrombosis

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24
Q

How does superficial thrombophlebitis present?

A

Painful, tender cord-like structure
Redness
Swelling
Associated with varices

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25
Q

What is DVT?

A

A primary thrombus with secondary inflammation

After a period of immobilisation or due to malignancy

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26
Q

How does DVT present?

A

Red, tender swelling
Engorged veins
Hornan’s sign

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27
Q

What is hornan’s sign?

A

Pain in calf on dorsiflexion of foot

28
Q

What is phlegmasia cerulean dolens?

A

Total obstruction of venous drainage from a limb

Results in venous gangrene

29
Q

Treatment of DVT?

A

Below knee - anticoagulate for 6 weeks
Above knee - anticoagulate for 3 months
Encourage movement

30
Q

Risks for acute thrombosis

A 
Sepsis
Hypotension
Low cardiac output
Aneurysm
Aortic dissection
Bypass graft
Atherosclerotic lesion
31
Q

Common sites for emboli deposition?

A

Femoral artery bifurcation
Iliac arteries
Aorta
Popliteal arteries

32
Q

Rare causes of acute limbs ischemia?

A 
Vasculitis
Popliteal entrapment syndrome
Compartment syndrome
Iatrogenic
Aortic dissection
Graft occlusion
33
Q

Symptoms/signs of acute limb ischemia?

A 
Pain
Pulseless
Paralysis
Parasthesia
Pallor
34
Q

What is claudication?

A

Pain in calves on walking due to lack of oxygen to muscles
Patients can walk a predictable distance before symptoms start
Relieved by rest

35
Q

Assessment of claudication pain?

A

Pulses
Duplex ultrasound
ABPI
MRA

36
Q

ABI interpretation?

A

1 - normal
0.6-0.9 - claudication
0.3-0.6 - rest pain
<0.3 impending

37
Q

Classification of acute limb ischemia?

A

I - viable
IIa - marginally threatened
IIb - immediately threatened
III - irreversible

38
Q

Blood tests in acute limb ischemia?

A 
FBC - haematological disorders?
U+Es - dehydrated? raised K?
Glucose - raised?
CK - Raised if muscle ischemia?
Clotting factors
39
Q

Signs of non viable limb?

A

Tissue loss
Nerve damage
Sensory loss
AMPUTATE

40
Q

Why not revascularise non-viable limb?

A

Massive electrolyte release from ischaemic tissue will cause renal failure, myocardial toxicity and organ failure

41
Q

What is necrotising fasciitis?

A

Life threatening infection of subcutaneous soft tissue

42
Q

What pathogens cause necrotising fasciitis

A

Type 1 - Staph
Enterobacteriae
Anaerobes
Type 2 - Streptococcus A

43
Q

Symptoms of necrotising fasciitis?

A

Red/purple skin
Severe pain
Fever
Vomiting

44
Q

What is Fournier’s gangrene?

A

Necrotising fasciitis of perianal and genital region

45
Q

Ulcer at incision site?

A

Pyoderma gangrenous

46
Q

What is gas gangrene?

A

Clostridium perfringens

Excessive gas production in tissues causing necrotic damage

47
Q

Ischemic gangrene?

A

Result of atherosclerosis
Critical limb schema leaves tissues at risk of necrosis
Dry gangrene

48
Q

Risk factors for peripheral vascular disease?

A 
Smoking
Diabetes mellitus
Hypertension
Hyperlipidemia
Physical inactivity
Obesity
49
Q

Treatment of claudication pain?

A

Cilostazol - antiplatlet + vasodilator
Pentoxifylline - reduce blood viscosity
Naftidrofuryl - vasodilator

50
Q

Indications for amputation?

A

Trauma
Peripheral vascular disease
Gangrene
Tumours

51
Q

Early complications of amputation?

A 
Pain
Bleeding
Infection 
Scarring
Clots
Stroke, MI
Death
52
Q

Late complications of amputation?

A

Phantom limb

Reintervention

53
Q

Process of raynaud’s syndrome?

A 
Pallor of distal portion of one or more digits
Clear demarcation line
Feeling of numbness or pain
Cyanosis of digits
Digit becomes red and warm
54
Q

What is compartment syndrome?

A 
Pressure increase within a fascial compartment
Compromised blood flow
Tissue necrosis
Anterior compartment most at risk
Fasciotomy
55
Q

Role of doppler ultrasound?

A

Estimates blood flow through blood vessels

56
Q

Arterial aneurysm?

A

Abnormal dilation of an artery due to a weakness in the arterial wall

57
Q

True aneurysm?

A

All three layers of the wall

58
Q

False aneurysm?

A

Collection of blood held around the vessel by connective tissue

59
Q

Causes of aneurysms?

A 
Atherosclerosis
Vasculitis
Syphilis
Infection
Cocaine use
Congenital 
Trauma
60
Q

Normal width of abdominal aorta?

A

2cm - abnormal defined as 3cm

61
Q

Management of 3.0 - 4.4 cm abdominal aortic aneurysm

A

Annual ultrasound

62
Q

Management of 4.5 - 5.4 cm abdominal aortic aneurysm?

A

3 monthly ultrasound

63
Q

Management of 5.5 cm abdominal aortic aneurysm or rapidly growing aneurysm?

A

Surgical intervention

64
Q

Other management for aortic aneurysms?

A

Smoking cessation
Blood pressure control
Statin
Antiplatelet

65
Q

Screening in general population for AAA?

A

One off ultrasound when 65

GI (9 decks)

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