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Cardiovascular System > Peripheral arterial and venous disease > Flashcards

Peripheral arterial and venous disease Flashcards

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1
Q

What are the lower limb veins divided into?

A

Superficial and deep

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2
Q

Where are superficial veins located?

A

Subcutaneous tissue

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3
Q

What do the superficial veins drain into?

A

Deep veins

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4
Q

Where are the deep veins located?

A

Within muscles

e.g. calf

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5
Q

What are the veins that go between superficial and deep veins called and why?

A

Perforating veins - because they perforate the deep fascia

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6
Q

What is the function of valves?

A

To prevent backflow of blood

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7
Q

What are the deep veins of the lower limb?

A

External iliac vein
Femoral vein
Popliteal vein

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8
Q

What are the superficial veins of the lower limb?

A

Long saphenous vein

Short saphenous vein

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9
Q

What does the long saphenous vein drain into?

A

Femoral vein

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10
Q

Describe the course of the long saphenous vein

A

Descends medially down though
posterior to knee
medially down leg
anterior to medial malleolus

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11
Q

What does the short saphenous vein drain into?

A

Popliteal vein

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12
Q

Describe the course of the short saphenous vein

A

Midline of posterior leg

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13
Q

What happens to blood flow when the muscles relax?

A

Deep veins expand
blood is sucked into the deep veins
from the superficial veins

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14
Q

What happens to blood flow when the muscles contract?

A

Muscles contract within their compartments
increases pressure within compartments
compresses deep veins
pushes blood along

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15
Q

What happens to velocity of blood after a stenosis? Why?

A

Increases
Because cross-sectional area of blood vessel decreases, same amount of blood moving through smaller area, has to move faster

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16
Q

What happens to blood flow after a stenosis?

A

Decreases

less blood passing through narrowed area of blood vessel

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17
Q

If flow increases, what happens to velocity?

A

Increases

more blood moving through same blood vessel means it has to move faster

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18
Q

If area of blood vessel decreases, what happens to velocity?

A

Increases

because same amount of blood moving through smaller vessel, so has to move faster

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19
Q

If area of blood vessel increases, what happens to velocity?

A

Decreases
because same amount of blood moving through larger vessel
can move slower

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20
Q

What is a varciose vein?

A

Tortuous, twisted or lengthened veins

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21
Q

Are varicose veins more common in men or women?

A

Men

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22
Q

What is the pathophysiology of varicose veins?

A

Wall of vein becomes weak
vein dilates
valves separate
become incompetent

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23
Q

What are the symptoms of varicose veins?

A

Heaviness
Tension
Aching
Itching

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24
Q

Where are the symptoms of varicose veins felt?

A

Only along the actual vein

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25
What are the causes of complications of varicose veins?
Problems with the vein itself Venous hypertension
26
Problems with the vein itself causes which complications?
Haemorrhage | Thrombophlebitis
27
Venous hypertension causes which complications?
``` Oedema Skin pigmentation Varicose eczema Lipodermatosclerosis Venous ulceration ```
28
How is haemorrhage from varicose veins treated?
Lie patient down | Lift leg up
29
What is thrombophlebitis?
Venous thrombosis | producing inflammatory response - pain
30
How does arterial thrombosis differ from venous thrombosis?
Arterial thrombosis doesn't itself cause pain the consequences e.g. ischaemia, infarction cause pain Whereas venous thrombosis itself causes pain
31
What does thrombophlebitis look like?
Dark brown staining over skin
32
Why is there dark brown staining over the skin with thrombophlebitis?
Red blood cells leak out of vein macrophages phagocytose red blood cells oxidise Fe2+ in Hb to ferric oxide
33
What is lipodermatosclerosis?
Hardening of fat in subcutaneous tissue over vein
34
What causes venous hypertension?
Calf muscle pump failure
35
What causes calf muscle pump failure?
Immobility Obesity Reduced hip, knee, ankle movement Deep vein incompetence Volume overload - superficial vein incompetence
36
How does deep vein incompetence cause calf muscle pump failure?
Valve in deep vein allows some backflow of blood | blood falls back into down deep vein
37
How does superficial vein incompetence cause calf muscle pump failure?
Valve between superficial and deep vein is incompetent allows some backflow of blood blood keeps falling back into superficial vein enters deep veins
38
What is the pathophysiology of thrombosis? - Virchow's triad
Change in lining of vessel wall Change in flow of blood Change in constituents of blood
39
What is the pathophysiology of arterial thrombosis?
Change in lining of wall of artery
40
What is the most common cause of changes in lining of arterial walls?
Atheroma
41
What is the pathophysiology of venous thrombosis?
Changes in flow of blood
42
What change in blood flow causes venous thrombosis?
Stasis of blood
43
Does stasis alone cause venous thrombosis?
Not usually | other factors involved
44
What are some of the other factors involved in venous thrombosis - alongside stasis of blood?
Trauma e.g. surgery Oral contraceptive pill Cancer
45
How does arterial thrombosis occur?
Platelets | Clotting factors - intrinsic and extrinsic pathway
46
How are arterial thrombi described in terms of their constituents?
Platelet-rich
47
How does venous thrombosis occur?
Firstly the intrinsic pathway | then the extrinsic pathway aswell
48
How are venous thrombi described in terms of their constituents?
Fibrin rich
49
What occurs in both arteries and veins when they bleed?
Constriction of blood vessel arteries - vasoconstriction veins - venoconstriction
50
Where is deep vein thrombosis most common?
Deep calf veins
51
What are the symptoms of deep vein thrombosis?
Pain Can't walk Swelling Blue-red skin discolouration
52
What are the signs of deep vein thrombosis?
Calf tenderness - pain Muscle induration - muscles harden Skin warmth Skin discolouration Distended, warm superficial veins Oedema Pyrexia - fever
53
Why is surgery associated with deep vein thrombosis?
Immobility prior to, during, and after surgery don't use calf muscle pump Surgery induces a prothrombotic state
54
What is the complication of deep vein thrombosis? Why is it important?
Pulmonary embolism Can lead to death
55
How is peripheral arterial disease categorised?
Acute Chronic
56
Where are collateral arteries common? Why?
Around joints e.g. elbow and knee Because flexing the joint occludes the main arteries but the collateral arteries ensure there is still sufficient blood supply
57
When do new collateral arteries form? Why?
Gradual narrowing of blood vessel Collateral arteries develop to bypass the stenosis maintain blood supply
58
What is acute limb ischaemia?
Limb suddenly has largely impaired blood supply | over a few minutes
59
What causes acute limb ischaemia?
Embolism from heart or from abdominal aortic aneurysm Trauma
60
Within what timeframe must acute limb ischaemia be reversed?
Within 6 hours
61
What are the consequences of acute limb ischaemia after 6 hours?
Muscle necrosis Dead cells release lots of K+, hyperkalaemia Causes cardiac asystole, cardiac arrest
62
What must be done to the limb after 6 hours?
It must be amputated
63
What are the signs and symptoms of acute ischaemia? 6 P's
Pain Paraesthesia Paralysis Pallor Perishing cold Pulseless
64
What is the apperance of an acute ischaemic limb with different times from onset?
Onset - white 1 hour - moveable mottling 6 hours - fixed mottling
65
What does moveable mottling look like?
Patchy cyanosis - blue/purple discolouration
66
What causes moveable mottling?
Deoxygenated Hb in blood | Deoxygenated blood in limb
67
What is a feature of moveable mottling?
It blanches | still some blood flow in capillaries
68
What does fixed mottling like?
Widespread constant cyanosis
69
What causes fixed mottling?
Deoxygenated Hb, blood | as with moveable mottling
70
What is a feature of fixed mottling?
Non-blanching | because absolutely no blood flow
71
How is chronic peripheral arterial disease categorised?
Intermittent claudication Critical ischaemia
72
What does claudication mean?
Limping
73
What are the features of chronic peripheral arterial disease?
Rest pain Ulceration, gangrene
74
What does intermittent claudication mean?
Pain in muscles of lower limb | brought on by walking, exercise
75
Which muscles are most frequently affected by intermittent claudcation?
Calf muscles
76
What relieves the pain of intermittent claudication?
Stopping exercising, standing up | sitting down
77
What are the arteries of the lower limb?
Common iliac artery Internal iliac artery - gives off gluteal arteries External iliac artery Femoral artery Profunda femoris artery Popliteal artery Anterior tibial artery - continues as dorsalis pedis into foot Posterior tibial artery - continues into foot Common fibular artery
78
Where is the common femoral artery palpated?
Mid-inguinal point
79
What is the mid-inguinal point?
Midway between ASIS and pubic symphysis
80
Is the popliteal artery easy or difficult to palpate?
Difficult
81
What does an easily palpable popliteal artery possibly mean?
Popliteal aneurysm
82
Where is the dorsalis pedis palpated?
Lateral to tendon of extensor hallucis longus
83
Where is posterior tibial artery palpated?
Posterior to medial malleolus
84
What are the features of chronic aorti-iliac occlusion?
Bilateral buttock, thigh, calf claudication Absent lower limb pulses
85
What are the features of chronic right common iliac occlusion?
Right-sided buttock, thigh, calf claudcation Absent right lower limb pulses
86
What are the features chronic right common femoral artery occlusion?
Right-sided thigh and calf claudcation Absent right lower limb pulses
87
What are the features of right superficial femoral artery occlusion?
Right-sided calf claudication Absent right-sided popliteal artery, posterior tibial artery and dorsalis pedis artery
88
Which artery is most commonly occluded?
Superficial femoral artery occlusion
89
What is rest pain?
Pain in the foot at rest
90
What causes rest pain?
Skin, muscles, bone are ischaemic at rest | Not enough oxygen for basal metabolic requirements of cells
91
What is the typical history of rest pain?
Comes on when going to bed Relieved by hanging foot out of bed
92
Explain the typical history of rest pain - why does it come on when going to bed?
Reduced effect of gravity drawing blood down arteries of foot Increased temperature of foot metabolic rate goes up increased demand for oxygen Cardiac output decreases at night increased parasympathetic activity
93
If rest pain is untreated, what are the consequences?
Ulceration | Gangrene
94
Where is ulceration due to ischaemia most common?
Anterior tibia (shin) because poor blood supply to this region more prone to worsening ischaemia, ulceration
95
What is intermittent claudication equivalent to when compared to heart disease?
Stable angina
96
What is rest pain equivalent to when compared to heart disease?
Unstable angina

Cardiovascular System (22 decks)

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