Brainscape's Knowledge GenomeTM

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


See full index

Vascular Surgery > 2: Vascular Disease In Other Sites > Flashcards

2: Vascular Disease In Other Sites Flashcards

1
Q

What is renal-artery stenosis

A

Narrowing of one or both renal arteries

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

What are the two possible causes of renal artery stenosis

A
  • Atherosclerosis

- Fibromuscular dysplasia

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

What % of RAS is due to atherosclerosis

A

90

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

What % of RAS is due to fibromuscular dysplasia

A

10

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

In which population is atherosclerotic RAS more common

A

Males over 50

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

In which population is fibromuscular dysplasia RAS more common

A

Females under 50

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

how may renal artery stenosis present clinically

A
  • Renal bruit
  • Treatment-resistant HTN
  • Features of renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain the pathophysiology of renal artery stenosis

A

Narrowing of the renal arteries causes ischaemic. This results in activation of RAAS system. Aldosterone increases sodium + hence fluid retention. Increases peripheral vascular resistance leading to secondary HTN. Ischaemia also causes ischaemic renal injury and progressive atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What three investigations are important in work-up of RAS

A
  1. U+E
  2. Duplex USS
  3. CT/MR angiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How will U+Es present in RAS

A

Raised creatinine

Hypokalaemia

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

What is treatment-resistant hypertension and hypokalaemia a good indicator of

A

Renal artery stenosis

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

Why is there hypokalaemia in renal artery stenosis

A

Renal ischaemia causes activation of RAAS and hyper-aldosteronism. This causes exchange of sodium for potassium causing hypokalaemia

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

What are the indications for duplex USS

A
  • HTN onset before 30
  • Resistant to three anti-HTN medications
  • Renal dysfunction with ACEi
  • Unexplained renal atrophy - difference of more than 1.5cm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

On CT angiography if there is stenosis of proximal renal artery segment what does it suggest

A

Atherosclerotic pathophysiology

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

On CT angiography if there is stenosis of distal renal artery segment what does it suggest

A

Fibromuscular dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What lifestyle factors are used in management of renal artery stenosis

A

Smoking cessation
Weight loss
Control diabetes and HTN

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

Why should ACEi not be given to manage blood pressure in renal insufficiency

A

Due to toxic if renal damage

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

What is ultimate management of renal artery stenosis

A

Percutaneous trans-luminal angioplasty

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

What percentage of the renal artery must be stenosed to require percutaneous trans-luminal angioplasty

A

60%

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

Explain why ACEi are contraindicated in patients with renal artery stenosis

A

Normal system:
PGE2 causes vasodilation of renal artery to control blood flow through glomerulus and Angiotensin II controls efferent arteriole

In RAS:
There is narrowing of the afferent impairing flow. Therefore more reliant on efferent to control flow through glomerulus. If ACEi are used this is lost.

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

Define acute mesenteric ischaemia

A

occlusion of blood supply to the small bowel resulting in necrosis and possible perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In which age-group is mesenteric ischaemia more common

A

> 60

23
Q

What are 4 causes of mesenteric ischaemia

A
  1. Thrombosis
  2. Embolism
  3. Mesenteric venous thrombosis
  4. Non-occlusive disease
24
Q

When is mesenteric vein thrombosis more common

A

Younger patients w/ hyper-coagulable states

25
Q

Explain non-occlusive disease as a cause of mesenteric thrombosis

A

Drop in cardiac output

26
Q

What are three risk factors for acute mesenteric ischaemia

A
  • Hypercoagulable states
  • AF
  • Vasculitis
27
Q

What is the triad of symptoms for acute mesenteric ischaemia

A
  1. Severe abdominal pain
  2. No abdominal signs
  3. Rapid shock
28
Q

what is the stereotypical presenting complaint of acute mesenteric ischaemia

A

Abdominal pain disproportionate to clinical findings

29
Q

where is the abdominal pain in acute mesenteric ischaemia

A

Central

30
Q

if due to embolism describe onset of pain in acute mesenteric ischaemia

A

Abrupt onset and extremely painful

31
Q

if due to thrombosis explain symptoms of acute mesenteric ischaemia

A

Less severe - as there is collateral supply

32
Q

what artery is occluded in 90% of acute mesenteric ischaemia

A

Superior mesenteric artery

33
Q

what does the superior mesenteric artery supply

A

Midgut

34
Q

What investigations may be ordered in mesenteric ischaemia

A

FBC (Raised WBC)
Abdominal X-Ray
CT/MRI
CT angiography

35
Q

What investigations may be ordered in mesenteric ischaemia

A

FBC (Raised WBC)
Abdominal X-Ray
CT/MRI
CT angiography (confirmatory)

36
Q

How should acute mesenteric ischaemia be managed

A

Emergency laparotomy - remove necrotic segments

37
Q

What are main complications of acute mesenteric ischaemia

A

Peritonitis

Sepsis

38
Q

How common is chronic mesenteric ischaemia

A

Rare!

39
Q

In which individuals does chronic mesenteric ischaemia occur

A

> 60

40
Q

What is the most common presentation of chronic mesenteric ischaemia and when does this occur

A

Asymptomatic - when there is occlusion of single artery. More than this causes symptoms

41
Q

If symptomatic, how does chronic mesenteric ischaemia present

A

Intestinal angina - dull epigastric pain following meals

42
Q

What is the problem with chronic mesenteric ischaemia

A

Pain may cause avoidance of eating which can lea to weight loss

43
Q

What will be auscultated in chronic mesenteric ischaemia

A

abdominal bruit

44
Q

Explain chronic mesenteric ischaemia

A

stenosis of two or more main gastric arteries causes a post-prandial mismatch between blood supply and metabolic demand

45
Q

Why is one artery occluded asymptomatic

A

due to collateral supply from other vessels

46
Q

What is first line investigation for chronic mesenteric ischaemia

A

CT abdomen

47
Q

How is chronic mesenteric ischaemia managed

A

Nutritional support- regular small meals

Long-term anticoagulant

Revascularisation

48
Q

What medication is used to control risk factors contributing to carotid stenosis

A

Clopidogrel
Atorvostatin
ACEi

49
Q

What is first-line management for carotid stenosis

A

Carotid endarterectomy

50
Q

What are the indications for carotid endarterectomy in carotid stenosis

A
  1. Symptomatic, Cartoid.a stenosis >70% and life-expectancy >5y
  2. Asymptomatic and stenosis >80%
51
Q

if individuals are unfit for carotid endarterectomy what is second-line

A

Endovascular carotid.a stenting

52
Q

what is the main risk of carotid artery stenosis

A

stroke

53
Q

What are the indications for carotid endarterectomy in carotid stenosis

A
  1. Symptomatic, Cartoid.a stenosis >70% and life-expectancy >5y
  2. Asymptomatic and stenosis >80%
  3. Symptomatic and stenosis 50-69%
54
Q

Explain clinical presentation of carotid artery stenosis

A

asymptomatic. May cause gradual decline condition. Presents suddenly with stroke/TIA

Vascular Surgery (6 decks)

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