Peripheral Vascular/Arterial Disease - Hunt Flashcards Preview

Adult/Ped Medicine 4 > Peripheral Vascular/Arterial Disease - Hunt > Flashcards

Flashcards in Peripheral Vascular/Arterial Disease - Hunt Deck (26):
1

identify the signs, symptoms, and approach to the diagnosis of:

Abdominal Aortic Aneurysm

Signs & Symptoms

  • most are Asymptomatic and discovered on routine exam or chest x-ray or ultrasound
  • expanding AAA: sudden, severe and constant low back, flank, abdominal or groin pain
  • syncope may be chief complaint

Diagnosis

  • pulsatile abdominal mass
  • plain x-ray
  • CT
  • MRI
  • Ultrasound is gold standard

Treatment

  • surgery
    • any symtomatic aneurysm
    • asymptomatic aneurysm > 5 cm
    • any aneurysm that has shown an increase in size over last 6 months
  • stents

2

identify the signs, symptoms, and approach to the diagnosis of the following: 

Acute arterial occlusion

SIGNS - recognition is vital

  • Pain hearlds onset of ischemia
  • Paralysis and Parasthesia are most important 
  • Pallor - indicates decreased circulation
  • Absence of Pulses confirms the diagnosis and localizes the point of occlusion

Causes

  • embolism
  • trauma
  • thrombosis

TX

  • emergent referral
  • immediate anticoagulation
  • embolectomy

2

Identify this condition and describe the management:

pt presents with pain in his leg and that it feels like it is "asleep"

exam reveals absence of dorsal pedis pulse

Acute Arterial Occlusion

treatment:

  • emergent referral
  • immediate anticoagulation
  • embolectomy

3

ANKLE BRACHIAL INDEX

  • measure pt's brachial BP
  • measure ankle BP
  • divide ankle by brachial
  • 0.9-1.0 = normal
  • 0.7-0.9 = mild
  • 0.5-0.7 = moderate
  • < 0.5 = severe

3

identify the signs, symptoms, and approach to the diagnosis of:

Aortic Dissection

event of sudden onset in which blood leaves the normal aortic channel through a usually discrete point of exit (intimal tear) - dissects into layers of the aorta

causes

  • medial degneration
  • Marfan Syndrome
  • bicuspid aortic valve
  • dilated ascending aorta
  • aortic coarctation
  • systemic arterial hypertension

clinical features

  • sudden death
  • hypovolemic shock
  • sudden severe arterial hypertensive event
  • radiating pain through to back, neck or arms, occlusion of a major vessel

diagnosis and treatment

  • CXR
  • Echo
  • CT or MRI
  • Aortography

4

Identify this condition and describe the management:

pt is a 60 year old female reporting radiating pain to her back, neck and arms

pt has decreased blood pressure, weak thready pulse, pale skin, and is sweating

Aortic Dissection

diagnosis: CXR, echo, CT or MRI, aortography

tx: immediate surgical referral

5

Aortoiliac PVD

  • claudication involving calf, thigh and buttock
  • impotence
  • rest pain, ulceration and gangrene not common
  • forth, fifth to sixth decade of life

6

identify the signs, symptoms, and approach to the diagnosis of:

Carotid Artery Stenosis

Signs & Symptoms

  • transient ischemic attacks
    • transient focal neurological deficits
    • all symptoms resolve within 24 hours
  • ataxia
  • vertigo
  • drop attacks
  • diplopia
  • visual blurring
  • amaurosis fugox
  • bruits over carotids

Diagnosis and Treatment

  • doppler ultrasound
  • angiography
  • medical vs. surgical

6

Identify this condition and describe the management:

pt presents with complaints of vertigo and visual blurring

exam reveals pt burits on ascultation of carotid arteries

Carotid Artery Stenosis

  • medical and surgical treatment

6

Chronic Venous Insufficiency

  • dysfunction of valves in the superficial and/or communicating veins
  • dysfunction of valves
  • deep venous outflow obstruction
  • muscle dysfunction

7

identify the signs, symptoms, and approach to the diagnosis of:

Deep Vein Thrombosis

Signs and Symptoms

  • painful swollen leg
  • temperature
  • positive Homan's sign
  • positive risk factor

Diagnosis

  • duplex scanning
  • venography

Treatment

  • elevation and rest
  • thrombolytic agents
    • heparin
    • lovenox
    • coumadin

8

Diagnostic Testing of Venous Ulcers

  • LAB - CBC, blood sugar, ESR, albumin
  • culture
  • biopsy
  • plain film radiographs
  • test for peripheral arterial disease
  • duplex ultrasonography

10

Femoropopliteal PVD

  • common in smokers
  • tissue necrosis more common
  • rest pain more common
  • more common in older individuals

12

History - Peripheral Artery Disease

  • pain
    • rest-pain poor prognosis sign
  • intermittent claudication
    • most common complaint
    • due to limb ischemia
    • highly specific symptom, virtually diagnostic
  • smoking history
  • diabetes
  • cardiac disorders
  • trauma
  • familial disease
  • occupational history
  • impotence
  • drugs

13

Indications for Surgical Revascularization - Peripheral Artery Disease

  • pain at rest
  • ischemic ulcers or gangrene
  • atheroembolic (trash foot)
  • low ABI
  • claudications at short distance, worsening symptoms

14

Ischemic Leg Ulcers

  • little or no bleeding
  • irregular edge, poor granulation tissue
  • distal location on dorsum of foot & toes
  • severe pain
  • trophic changes of chronic ischemia
  • distal pulses are weak or gone

A image thumb
16

Laboratory/Diagnostic Tests Peripheral Artery Disease

  • blood sugar
  • lipid profile
  • ankle/brachial index
  • duplex ultrasound
  • arteriography

17

Neurotrophic Ulcers

  • brisk bleeding with manipulation
  • punched out, with deep sinus
  • demonstrable neuropathy
  • located under calluses or pressure points
  • no pain
  • common in diabetic patients

18

Pathogenesis of Deep Vein Thrombosis

  • Venous Stasis
  • Endothelial Damage
  • Hypercoagulability

19

Physical Exam Peripheral Artery Disease

  • color 
  • temperature
  • loss of hair
  • atrophy and rubor in skin
  • atrophy of the muscles
  • ulcers and gangrene
  • capillary refill
  • PALPATION OF PERIPHERAL PULSES

20

Risk Factors for Peripheral Artery Disease

  • smoking
  • increasing age
  • sex M > F
  • diabetes
  • hyperlipidemia
  • hypertriglyceridemia
  • hyperhomocystinemia
  • hypertension

21

Risk Factors of Deep Vein Thrombosis

  • CHF
  • MI
  • Stroke
  • Malignancy
  • Major Surgery
  • Trauma
  • Immobilization
  • Obesity
  • Age
  • Pregnancy
  • Oral Contraceptives
  • Smoking

23

Stasis Ulcers

  • venous ooze with manipulation
  • shallow, irregular shape, granulating base, rounded edges
  • stasis dermatitis
  • located lower third of leg
  • mild pain, relieved by elevation

A image thumb
24

Tibioperoneal PVD

  • common in diabetics
  • tissue necrosis
  • older individuals
  • most difficult to treat
  • amputation common

25

Treatment of Peripheral Artery Disease

  • abstinence from tobacco in any form
  • exercise
    • walk 35-30 min, 3-5 x/week
    • achieve moderate claudication pain the first 5 min
  • antiplatelet therapy
    • aspirin
    • plavix
    • pletal
    • trental
  • antihypertensives: ACE inhibitors
  • diabetes control
  • lipid-lowering agents

26

Treatment of Venous Ulceration

  • elevation of leg
  • compression therapy (stasis)
  • treat infection
  • dressings and topical agents - wet to dry
  • treatment of arterial insufficiency