Arteries , Veins , Lymphatics Flashcards
Causes of DVT
Virchows triad-inflammation, hypercoagualble , endothelial injury
Prothrombotic state
Genetic: factorV leiden and prothrombin gene mutation
Acquired : APAS
Cancer Laong travel Pregnancy Hormone replacement Surgery Trauma
Most common acquired cause of thrombophilia
APAS
Pathophysiology of hypoxia in PE
Increased pulmonary vascular resistance due to vascular obstruction or platelet secretion of vasoconstricting neurohumoral agents such as serotonin. Release of vasoactive mediators can produce ventilation-perfusion mismatching at sites remote from the embolus, thereby accounting for discordance between a small PE and a large alveolar-arterial O2 gradient.
Effect of PE on heart
Pulmonary artery obstruction causes a rise in pulmonary artery pressure and in pulmonary vascular resistance. When RV wall tension rises, RV dilation and dysfunction ensue, with release of the cardiac biomarker, brain natriuretic peptide. The interventricular septum bulges into and compresses an intrinsically normal left ventricle (LV). Diastolic LV dysfunction reduces LV distensibility and impairs LV filling. Increased RV wall tension also compresses the right coronary artery, limits myocardial oxygen supply, and precipitates right coronary artery ischemia and RV microinfarction, with release of cardiac biomarkers such as troponin. Underfilling of the LV may lead to a fall in LV cardiac output and systemic arterial pressure, with consequent circulatory collapse and death.
C/f Of DVT
Calf pain Tenderness Erythema Pitting edema Collateral nonvaricose veins
Lungs Dysnoea Hemopytsis Syncope Hypotension Cyanosis
Chest x ray findings of PE
A normal or nearly normal chest x-ray often occurs in PE. Well-established abnormalities include focal oligemia (Westermark’s sign), a peripheral wedged-shaped density above the diaphragm (Hampton’s hump), and an enlarged right descending pulmonary artery (Palla’s sign).
Dx imaging in DVT/PE
Same for both
Low probability-D-dimer (n:no DVT/PE , high:imaging
Moderate/high: imaging
IMAGING
DVT:doppler(if not dxtic: MR ,CT, phlebography)
PE CT(if not dxtic:vantilation perfusion scan- doppler leg -TE ECHO,MR, angiography)
Leriche s syndrome
Claudication (buttocks, thighs and calves) + impotence in males
Artherosclerotic ds of aorta exending to iliac arteries
C/F in pwripheral artery ds
SYMPTOM
Intermittent claudication
Rest pain
SIGNS Dec/absent pulse Bruits Muscle atrophy Hair loss Thickened nail Smooth shiny skin Reduced skin temp Pallor /cyanosis Ulcer/gangrene Edema(if they keep their leg in dependant position on case of rest pain) Ischemic neuropathy leading to numbness and hyporeflex
What is intermittent claudication
which is defined as a pain, ache, cramp, numbness, or a sense of fatigue in the muscles; it occurs during exercise and is relieved by rest. The site of claudication is distal to the location of the occlusive lesion.
Why is ankle pressure higher than arm
Due to pulse wave amplification
Fibromuscular dysplasia
Hyperplastic ds of small /medium sized vs
Renal and carotid a. mostly involved
on angiography STRING OF BEADS
Thromboangitis obliterans
is an inflammatory occlusive vascular disorder involving small and medium-size arteries and veins in the distal upper and lower extremities.
Men
Cigerette smoking
triad of claudication of the affected extremity, Raynaud’s phenomenon, and migratory superficial vein thrombophlebitis
Buergers ds
Thrombosngitis obliterans
Vs effected thromboangitis obliterans
Distal vessel like radial,ulnar ,tibial
