Arterial Ds Flashcards
(23 cards)
Ankle brachial index
Right ABI= ratio of
higher of the rt ankle S.P pressure among dorsalis pedia or post tibial/higher arm S.P (left or right)
LEFT ABI=ratio of
higher of the left ankle S.P pressure among dorsalis pedia or post tibial/higher arm S.P (left or right)
0.9-1.2 : normal
<0.9 : arterial ds(thrombus , localised plaqur)
_>1.3 : calcification /thickening of vessel (Diabetes , end stage renal ds, smoking)
Feature of rest pain
Due to severe underlying occlusion
Comstant and occurs in foot
Relieved by dependancy
Calf pain indicates ___ vs ds
Femoral
Buttock claudication indicates ___ vs ds
Iliac
Aorta divides at
Umblicus
Aorta divides at
Umblicus
D/D of carotid bruit
Carotid stenosis
Aortic stenosis
Where to palpate femoral
Popliteal
Post tibial
Dorsalis pedis
Midway bw pubic tubercle and ASIS
45°flexion of knee
Foot supported to relax calf muscles
Bimanual
Thumb on tibial tuberosity
Fingers in popliteal fossa below knee joint bw 2 heads of gastronemius
Compress the artery against posterior aspect of tibia
2cm posterior to medial malleolus with inversion
1cm lateral to tendon of hallucis longus extensor
Normal thigh pressure
Greater by 20mmhgor more from brachial pressure
Parts of aorta
Proximal:ascending,transverse
Distal: descending thoracic and abdominal
Parts of aorta
The brachiocephalic vessels arise from the transverse aortic arch and are used as anatomic landmarks to define the aortic regions. The ascending aorta is proximal to the innominate artery, whereas the descending aorta is distal to the left subclavian artery.
Elastin content is highest in which part of aorta
Ascending
Causes of thoracic aortic aneurysms
Nonspecific medial degeneration
Aortic dissection
Genetic disorders
Marfan syndrome
Loeys-Dietz syndrome
Ehlers-Danlos syndrome
Familial aortic aneurysms
Aneurysms-Osteoarthritis syndrome Congenital bicuspid aortic valve
Bovine aortic arch(common origin of innominate and left common carotid a)
Poststenotic dilatation (aortic stenosis, artherosclerosis)
Infection (syphillis)
Aortitis
Takayasu arteritis
Giant cell arteritis
Rheumatoid aortitis
Trauma
Defect in marfan
Mitation in fibrillin gene causes degeneration of the aortic wall matrix by increasing the activity of transforming growth factor beta (TGF-β)
The phenotype of patients with Marfan syndrome typically includes a tall stature, high palate, joint hypermobility, eye lens disorders, mitral valve prolapse, and aortic aneurysms.
Loeys dietz syndrome
autosomal dominant condition that is distinguished by the triad of arterial tortuosity and aneurysms, hypertelorism (widely spaced eyes), and bifid uvula or cleft palate. It is caused by heterozygous mutations in the genes encoding TGF-β receptors.
Mycotic aneurysm
Aneurysm due to bacterial infection not due to fungal
True or false aneurysm
True aneurysms can take two forms: fusiform and saccular. Fusiform aneurysms are more common and can be described as symmetri-cal dilatations of the aorta. Saccular aneurysms are localized outpouchings of the aorta. False aneurysms, also called pseu-doaneurysms, are leaks in the aortic wall that are contained by the outer layer of the aorta and/or the periaortic tissue; they are caused by disruption of the aortic wall and lead blood to collect in pouches of fibrotic tissue.
C/m of thoracic aortic aneurys.
Local compression and erosion SCV pul a Sternum Vertebra Spinal cord Esophagus Duodenum IVC Iliac
AORTIC VALVE REGIRGITATION
ascending
DISTAL EMBOLISATION
Thoracic
RUPTURE Ascending-ant chest Descending- upper back or left chest Thoracoabd- left flank , abdomen Pleura Tamponade
Elective operation in asymptomatic patients with thoracic aortic aneurysm is done when the size is____
when the diameter of an ascending aortic aneurysm is >5.5 cm, when the diameter of a descending thoracic aortic aneurysm is >6.0 cm, or when the rate of dilatation is >0.5 cm/y.
Main mesentric circulation
the celiac artery (CA), the superior mesenteric artery (SMA), and the IMA. In general, the CA provides arterial circulation to the foregut (distal esophagus to duodenum), hepatobiliary system, and spleen; the SMA supplies the midgut (jejunum to mid-colon); and the IMA supplies the hindgut (mid-colon to rectum).
Collateral network in mesentric vessels
Collateral networks between the CA and the SMA exist primarily through the superior and inferior pancreaticoduodenal arteries. The IMA may provide collateral arterial flow to the SMA through the marginal artery of Drummond, the arc of Riolan, and other unnamed retroperitoneal collateral vessels termed meandering mesenteric arteries
progressive diminution of flow in one or even two of the main mesenteric trunks is usually tolerated, provided that uninvolved mesenteric branches can enlarge over time to provide sufficient compensatory collateral flow. In contrast, acute occlusion of a main mesenteric trunk may result in profound ischemia due to lack of sufficient collateral flow
Lower ectremity occlusive ds classification
The Fontaine classification uses four stages: Fontaine I is the stage when patients are asymptomatic; Fontaine II is when they have mild (IIa) or severe (IIb) claudication; Fontaine III is when they have ischemic rest pain; and Fontaine IV is when patients suffer tissue loss, such as ulceration or gangrene
The Rutherford classification has four grades (0–III) and seven categories (0–6). Asymptomatic patients are classified into category 0; claudicants are stratified into grade I and divided into three categories based on the severity of the symptoms; patients with rest pain belong to grade II and category 4; and patients with tissue loss are classified into grade III and categories 5 and 6 based on the significance of the tissue loss
De bakey and stanford classification of aortic aneurysm
DeBakey I : asc+ desc II : asc IIIa :desc thoracic IIIB : desc thoracic+ abdominal
Stanford
A :asc / asc+ desc
B : desc
