Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery.(General 2).Vascular > Arterial.4.chronic ischemia ( Definition, Etiology, Clinical picture, GRADING and D.D) > Flashcards

Arterial.4.chronic ischemia ( Definition, Etiology, Clinical picture, GRADING and D.D) Flashcards

(88 cards)

Start Studying
1
Q

Definition of chronic lower limb ischaemia

A

It is a slowly progressive gradual decrease in arterial limb perfusion that may affect its function & vitality.
Thus giving enough time for collaterals to develop and, therefore, gangrene does not occur rapidly.

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

Etiology of chronic L.L ischaemia

A
  1. Above the age of 45 years

2. Below the age of 45 years :

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

Etiology of chronic L.L ischaemia Above 45 years

A

atherosclerosis is the commonest cause.

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

Etiology of chronic L.L ischaemia Below the age of 45 years

A
  • Diabetic presenile atherosclerosis.
  • Buerger’s disease.
  • Vasospastic conditions
  • Incomplete recovery after treatment of acute ischemia
  • Aneurysm.
  • Vascular compression : Thoracic outlet syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

By far the most frequent cause of chronic L.L ischaemia is

A

Atherosclerosis

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

Predisposing factors ofAtherosclerosis

A

Major risk factors :

  • Hypertension.
  • Hypercholesterolaemia.
  • Smoking.

Other risk factors :

  • D.M.
  • Obesity.
  • Positive family history.
  • Sedentary or stressful life style.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical picture of chronic L.L ischaemia

A
  • Symptoms

* Examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Symptoms in Clinical picture of chronic L.L ischaemia

A

1- pain

2- Ischemic foot ulcers and gangrene

3- Symptoms of atherosclerosis elsewhere

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

pain in Symptoms in Clinical picture of chronic L.L ischaemia

A

A. Intermittent claudications

B. Rest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A
  • Definition
  • Muscles affected
  • Level of obstruction for each affected muscle
  • Boyd’s classification
  • Claudication Distance
  • Claudication Time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Definition of Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

This is a cramp-like pain that is induced by exercise and is relieved by rest.

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

Muscles affected in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

Gluteal claudication

Thigh claudication.

Calf claudication

sole claudication

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

The level of obstruction of Gluteal claudication in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

Aorto-iliac obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The level of obstruction of Thigh claudication in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

Ilio-femoral obstruction

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

The level of obstruction of Calf claudication in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

Femoro-popliteal obstruction

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

The level of obstruction of sole claudication in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

Tibio-peroneal obstruction

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

Boyd’s classification in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

مش مهمة

A
  • Grade I
  • Grade II
  • Grade III
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Grade I in Boyd’s classification in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

The claudication passes off on continuing walking (as the metabolites cause vasodilatation & increases the muscle blood flow).

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

Grade II in Boyd’s classification in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

The pain persists but does not force the patient to stop

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

Grade III in Boyd’s classification in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

The pain increases & forces the patient to stop

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

Claudication Distance in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A
  • Definition

* Meaning of Crippled claudication

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

Definition of Claudication Distance in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

It’s the distance that after which the patient complains of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Meaning of Crippled claudication in Claudication Distance in Symptoms in Intermittent claudicationsin Clinical picture of chronic L.L ischaemia

A

If claudication distance < 150m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Claudication Time in Intermittent claudications in Symptomsin Clinical picture of chronic L.L ischaemia

A

Is the time that the patient can walk on a treadmill until he complains of pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Rest pain in Symptoms in Clinical picture of chronic L.L ischaemia
* Definition * Pathogenesis * The reason why It's more severe at night * Handling
26
Definition of Rest pain in Symptoms in Clinical picture of chronic L.L ischaemia
It is severe burning pain in the toes & dorsum of the foot. | Partially relieved by putting the leg below the level of the heart.
27
Pathogenesis of Rest pain in Symptoms in Clinical picture of chronic L.L ischaemia
It is due to cutaneous nerve ischaemia.
28
The reason why It's more severe at night in Rest pain in Symptoms in Clinical picture of chronic L.L ischaemia
because the warmth of the limb during sleep increases the metabolic demands while the blood supply cannot cope with these increased requirements
29
Handling Rest pain in Symptoms in Clinical picture of chronic L.L ischaemia
Many of these miserable patients spend the night sitting on a chair or hanging the leg over the side of the bed & rubbing the dorsum of the foot in an attempt to relieve the pain.
30
Ischaemic foot ulcers and gangrene in Symptoms in Clinical picture of chronic L.L ischaemia
* Definition * Pathogenesis * Morphology * End stage
31
Definition of Ischaemic foot ulcers and gangrene in Symptoms in Clinical picture of chronic L.L ischaemia
* Very painful Ulcers "except if associated with severe neuropathy" * Occur at or between the toes & on the dorsum of foot * In severe ischaemia
32
Pathogenesis of Ischaemic foot ulcers and gangrene in Symptoms in Clinical picture of chronic L.L ischaemia
May be related to minor trauma to pressure areas.
33
Morphology of Ischaemic foot ulcers and gangrene in Symptoms in Clinical picture of chronic L.L ischaemia
* Starts as a small superficial ulcer & slowly gets deeper & larger.
34
End stage of Ischaemic foot ulcers and gangrene in Symptoms in Clinical picture of chronic L.L ischaemia
The end stage of ischaemia is dry gangrene with black mummified skin and tissues.
35
Ischaemic foot ulcers and gangrene is very painful except if
associated with severe neuropathy
36
Symptoms of atherosclerosis elsewhere in Symptoms in Clinical picture of chronic L.L ischaemia
May be present as * Angina pectoris. * History of cerebral stroke. * Transient ischaemic attacks
37
Leriche syndrome
A triad of impotence Buttock and thigh claudication Absent bilateral femoral pulse
38
the reason why impotence occurs with leriche syndrome
due to diminished blood supply in the internal iliac arteries
39
Examination in Clinical picture of chronic L.L ischaemia
* General | * Local
40
General Examination in Clinical picture of chronic L.L ischaemia
Pulse all over the body except L.L
41
Local Examination in Clinical picture of chronic L.L ischaemia
I- INSPECTION II- PALPATION III- AUSCULTATION IV. SPECIAL TESTS
42
INSPECTION in Local Examination in Clinical picture of chronic L.L ischaemia
* Trophic changes | * Colour changes
43
Trophic changes in INSPECTION in Local Examination in Clinical picture of chronic L.L ischaemia
A. Cutaneous changes : B. Loss of subcutaneous fat C. The muscles become wasted.
44
Cutaneous changes in Trophic changes in INSPECTION in Local Examination in Clinical picture of chronic L.L ischaemia
* Loss of skin appendages as hairs, sebaceous & sweat glands. * The skin becomes dry. * The nails become brittle, deformed & Iose their luster. * Ischaemic ulcers with punched out edge.
45
Loss of subcutaneous fat in Trophic changes in INSPECTION in Local Examination in Clinical picture of chronic L.L ischaemia
The skin becomes thin and the toes become tapered.
46
Colour changes in INSPECTION in Local Examination in Clinical picture of chronic L.L ischaemia
* Pallor * Cyanosis and rubor * a Fixed black colour of dry gangrene is present in some cases.
47
Pathogenesis of Pallor in Colour changes in INSPECTION in Local Examination in Clinical picture of chronic L.L ischaemia
due to decreased blood flow into the skin.
48
Cyanosis and rubor in Colour changes in INSPECTION in Local Examination in Clinical picture of chronic L.L ischaemia
* Pathogenesis | * Morphology
49
Pathogenesis of Cyanosis and rubor in Colour changes in INSPECTION in Local Examination in Clinical picture of chronic L.L ischaemia
due to stagnation of blood in the markedly dilated capillaries under the effect of accumulated vasodilator metabolites
50
Morphology of Cyanosis and rubor in Colour changes in INSPECTION in Local Examination in Clinical picture of chronic L.L ischaemia
The colour of blood is at first red but it later becomes blue due extraction of oxygen by the tissues Rubor "rubber colour" is reversible as it increases with dependency & disappears (foot becomes pale) with elevation.
51
rubor indicates
severe ischaemia
52
Rubor vs redness
Redness : normal healthy limb irreversible color Rubor : Reversible with elevation
53
Palpation in Local Examination in Clinical picture of chronic L.L ischaemia
* Temperature changes | * Absent or weak pulsations
54
Temperature changes in Palpation in Local Examination in Clinical picture of chronic L.L ischaemia
Expected finding unexpected finding
55
Expected finding in Temperature changes in Palpation in Local Examination in Clinical picture of chronic L.L ischaemia
Some degree of coldness will be detected in the ischaemic limb up to a level below but near that of obstruction
56
unexpected finding in Temperature changes in Palpation in Local Examination in Clinical picture of chronic L.L ischaemia
limb may be falsely warm in  * it was kept under clothes * there's infection * previous sympathectomy
57
Absent or weak pulsations in Palpation in Local Examination in Clinical picture of chronic L.L ischaemia
* Expected finding * Normal Variation * Disappearing pulse
58
Expected finding in Absent or weak pulsations in Palpation in Local Examination in Clinical picture of chronic L.L ischaemia
The pulses distal to the site of occlusion will be absent or weak.
59
Normal Variation in Absent or weak pulsations in Palpation in Local Examination in Clinical picture of chronic L.L ischaemia
The dorsalis pedis artery is absent in 10% of individuals. The posterior tibial pulse is absent in 2% of individuals.
60
Disappearing pulse in Absent or weak pulsations in Palpation in Local Examination in Clinical picture of chronic L.L ischaemia
ln patients with early ischaemia, pulsation may be felt distal to the obstruction due to collaterals Ask the patient to exercise his limb to the point of pain the pulse will disappear due to pooling of blood in the muscles.
61
Auscultation in Local Examination in Clinical picture of chronic L.L ischaemia
A systolic bruit may be heard over the Common femoral artery
62
clinical picture of advanced "critical" lower limb ischaemia (pre-gangrene)
1. rest pain 2. ischaemic foot ulcers 3. color changes
63
Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
* Test for the capillary circulation * Buerger's angle * Harvey's venous refilling time * Guttering of veins
64
Test for the capillary circulation in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
Procedures: Normal finding Abnormal finding
65
Procedures of Test for the capillary circulation in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
If one presses over the tip of the toe, it becomes pale. Once the pressure is released, the colour returns.
66
Normal finding of Test for the capillary circulation in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
Normal capillary refill is < 2 seconds.
67
Abnormal finding of Test for the capillary circulation in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
* Sluggish capillary circulation. * Advanced ischemia. * Established gangrene.
68
Sluggish capillary circulation in Abnormal finding of Test for the capillary circulation in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
In an ischaemic limb the return of colour is slow
69
Advanced ischemia in Abnormal finding of Test for the capillary circulation in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
If the return of colour is delayed to above 30 seconds
70
Established gangrene in Abnormal finding of Test for the capillary circulation in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
if there's failure of blanching
71
pathogenesis of failure of blanching in Established gangrene in Abnormal finding of Test for the capillary circulation in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
thrombosis of vessels and within few hours it will be black
72
Buerger's angle in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
* Procedures: | * Abnormal Findings
73
Procedures of Buerger's angle in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
The patient lies supine and the limb is gradually elevated. The angle at which blanching of the toes occurs is called Buerger's angle.
74
Abnormal Findings of Buerger's angle in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
* The smaller the angle at which blanching occurs, the more severe the ischaemia is. * Advanced ischaemia.
75
Advanced ischaemia in Abnormal Findings of Buerger's angle in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
If < 20 degree
76
Harvey venous refilling time in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
Procedures: Normal findings Abnormal findings
77
Procedures of Harvey venous refilling time in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
* With the patient supine, the limb is elevated to right angle until all veins empty. * It is then brought down to the horizontal position "some prefer to Lower the limb below the level of the bed
78
Normal findings of Harvey venous refilling time in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
Normally the veins fill in 10-15 seconds
79
Abnormal findings of Harvey venous refilling time in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
* Chronic ischaemia | * Advanced ischaemia.
80
Chronic ischaemia in Abnormal findings of Harvey venous refilling time in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
Venous refilling is delayed to above 30 seconds
81
Advanced ischaemia in Abnormal findings of Harvey venous refilling time in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
Venous refilling is delayed to above 2 minutes:
82
Guttering of veins in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
* Normal finding | * Abnormal finding
83
Normal finding of Guttering of veins in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
Veins of a normal foot are full when the patient is lying horizontal & collapse when the foot is raised above the level of the heart.
84
Abnormal finding of Guttering of veins in Special tests in Local Examination in Clinical picture of chronic L.L ischaemia
With severe chronic ischaemia, guttering of veins occurs with 10-15 degree Iimb elevation.
85
GRADING Of CHRONIC L.L ISCHEMIA : Fontain's staging:
Grade I : Asymptomatic. Grade II : IIa : Mild claudication. IIb : Crippled claudication . Grade III : Rest pain. Grade IV: Ischemic foot ulcers or gangrene.
86
D.D OF CHRONIC L.L ISCHEMIA
I- D.D of claudication pain: II. D.D of rest pain
87
D.D of claudication pain in D.D OF CHRONIC L.L ISCHEMIA
1. Venous claudication of chronic ilio-femoral DVT :Associated with varicosities with intact arterial pulses 2. Neurogenic pain: Prolapsed disc: Pain starts by the 1st of walking 3. Osteoarthrosis :Pain is located at the joints with intact arterial pulses
88
D.D of rest pain in D.D OF CHRONIC L.L ISCHEMIA
Burning pain of peripheral neuropathy.

Surgery.(General 2).Vascular (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions