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CVS Pathology > Venous and Lymphatic Disease > Flashcards

Venous and Lymphatic Disease Flashcards

1
Q

What are varicose veins a sign of?

A

Superficial venous disease

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2
Q

What does chronic limb insufficiency affect?

A

Deep venous system

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3
Q

Pathology of varicose veins

A

Damaged valves so backflow of blood

Tortous dilated superfifical veins

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4
Q

Sites of varicose veins

A

Long saphenous 80-87%
Short saphenous 21-30%
Alone 13%
Combined 21%

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5
Q

Which gender gets varicose veins more?

A

F > M

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6
Q

Common things found in a history of varicose veins

A 
Occupation 
Pregnancies (twins, big babies)
Previous DVT / major trauma 
FH
IVDU
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7
Q

Presentation of varicose veins

A 
Cosmesis
Localised or general discomfort in leg
Nocturnal cramps
Swelling
Acute haemorrhage
Superficial thrombophlebitis
Pruritus 
Skin changes e.g. bruising, eczema, spider veins
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8
Q

Definition of pruritus

A

Itching

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9
Q

Presentation of chronic venous insufficiency

A 
Ankle oedema 
Telangectasia 
Venous eczema 
Haemoseridin pigmentation 
Hypopigmentation "atrophie blanche"
Lipdermatosclerosis 
Venous ulceration
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10
Q

Pathology of chronic venous insufficiency

A

Venous HTN
Venous enlargement and stasis
Imbalance of stirling forces and fluid exudate
High AVP

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11
Q

Pathological causes of chronic venous insufficiency

A

Failure of the calf muscle pump

  • superficial venous reflux
  • deep venous reflux
  • venous obstruction
  • neuromuscular
  • obesity
  • inactivity
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12
Q

Definition of leg ulcer

A

A breach of the skin between the knee and the ankle joint, present for over 4 weeks

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13
Q

Differential diagnosis of leg ulcers

A 
Venous (80%)
Arterial (20%)
DM
RA
Vasculitis
CT disease
Severe arterial disease
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14
Q

Investigations of leg ulcer

A

ABPI

Duplex

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15
Q

Investigations for varicose veins

A

Examination

Duplex

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16
Q

Indications for intervention in varicose veins

A 
Symptoms
Superficial thrombophlebitis
Signs of chronic venous insufficiency 
Bleeding
Cosmetic 
Anxiety that disease may progress
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17
Q

Treatment of varicose veins

A 
Surgery 
Injection (sclerotherapy)
Laser 
Heat
Compression 
Conservative
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18
Q

Contraindications for superficial venous surgery

A

Previous CVT
Arterial insufficiency
Co morbidity
Morbid obesity

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19
Q

Complications of venous surgery for VV

A 
Minor haemorrhage
Thrombophlebtitis
Haematoma
Wound problems
Severe pain
Sural/saphenous nerves can be damaged 
Damage to deep veins
A + V + DVT
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20
Q

How does laser treatment help varicose veins?

A

Vein scars and fibroses until it is occluded

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21
Q

How does compression help varicose veins?

A

Creating artificial mechanical pressure to drain the vein.

22
Q

Minimally invasive Txs of main trunk varicosities

A 
Foam sclerotherapy (chemical reaction with endothelium)
Endovenous laser ablation (EVLA)
Radiofrequency ablation
23
Q

Treatment of chronic venous insuffiency

A

Multi layer, granulated, elastic, high grade compression therapy (exclude arterial disease)
Non adherent dressings
Exercise (calf muscle pump)

24
Q

Causes of lymphodema

A 
Primary 
- congenital 
- praecox (age 9-25)
- tarda (over 35)
Secondary 
- malignancy 
- surgery 
- radiotherapy 
- infection
25
Q

What is Klippel-Trenaunay syndrome?

A

Mixture of venous and lymphatic disease

26
Q

Management of lymphedema

A

Elevation and manual drainage

Compression

27
Q

What kind of valves are found in the veins?

A

Bicuspid

28
Q

Function of perforator veins

A

Join superficial and deep veins

29
Q

What keeps the blood flowing around the veins in the leg?

A

Calf muscle pump

30
Q

What is the calf muscle pump made out of?

A

3 different muscle groups

31
Q

What may affect the calf muscle pump to work properly?

A

Fixed flexion of ankle

Immobilisation

32
Q

What is post thrombotic syndrome?

A

Valves in the veins being damaged after a clot

33
Q

What generally tends to be a trend with failing valves?

A

Genetic

34
Q

Pathology of venous ulcers

A

Unhealthy blood becomes stuck and components effect the microcirculation and cause ischaemia (fibrin cuff hypothesis)

35
Q

Why do women get varicose veins more than men?

A

Hormonal influences

  • pregnancy
  • puberty
  • menopause
36
Q

What is haemoseridin staining?

A

Brown staining of skin caused by bilirubin, due to venous disease

37
Q

Is haemoseridin staining permanent?

A

Yes

38
Q

What is lipodermatosclerosis?

A

Tissue becomes hard and solid

39
Q

What is the scaling system for varicose veins?

A

CEAP

40
Q

What are the CEAP stages for varicose veins?

A 
C0 - no visible or palpable signs of venous disease
C1 - Telangectasias or reticular veins
C2 - Varicose veins
C3 - Oedema
C4a - pigmentation or eczema 
C4b - Lipadermatosclerosis or atrophie blanche 
C5 - Healed venous ulcer
C6 - Active venous ulcer
41
Q

When should treatment be offered for varicose veins?

A

> C4, i.e. if skin changes

42
Q

Which circulation does ABPI look at?

A

Arterial

43
Q

What does ABPI look at?

A

Systolic pressure brachial vs ankle
(dorsalis pedis + posterior tibial)
Highest systolic / highest brachial

44
Q

What should the ABPI be?

A

0.8 - 1.3

Triphasic

45
Q

What ABPI indicates ischaemia?

A

< 0.3

46
Q

What is a duplex?

A

USS + colour

47
Q

What does a duplex show?

A

Direction of blood

48
Q

What does a doppler show?

A

Speed of blood

49
Q

What is looked at when assessing venous ulcers?

A 
Wound size (area, volume, method)
Wound edge (punched out (arterial), sloping, undermining, surrounding tissue)
Wound bed (granulation, hypergranulation, presence of slough)
Pain assessment (neuropathic vs nociceptive)
50
Q

What is slough?

A

Fibrous material that adheres to wounds

51
Q

Gold standard treatment of venous ulcers

A

Compression

52
Q

What % of venous ulcers will heal with compression at 6 months?

A

70%

CVS Pathology (19 decks)

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