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Vascular Flashcards

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1
Q

What is Raynaud’s disease?

A 
Idiopathic condition of young females
Affects hands > feet
Digits - white -> blue -> red
Calcium antagonist
Cold exposure or emotions
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2
Q

Risks for venous ulcers?

A 
Varicose veins
Previous DVT
Plebitis
Fracture, trauma or surgery
Family history
Venous insufficiency
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3
Q

Risks for arterial ulcers?

A 
Coronary heart disease
History of stroke/TIA
Diabetes 
Peripheral arterial disease
Obesity
Immobility
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4
Q

What is an ulcer?

A

Loss of skin that takes more than 2 weeks to heal, may be venous, arterial or both

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5
Q

Prevalence of ulcer type?

A

75% venous

22% arterial

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6
Q

Rheumatoid ulcer?

A 
Vasculitis
Deep
Demarcated 
Punched out
Dorsum of foot or calf
Pyoderma gangrenous
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7
Q

Systemic vasculitis ulcers?

A

Multiple, deep, necrotic
Atypical distribution
Other vasculitic lesions
SLE, scleroderma, polyarteritis nodosa

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8
Q

Diabetic ulcer?

A

Bony prominence on foot

Neuropathic, arterial and venous components

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9
Q

Hypertensive ulcer?

A

Arteriolar constriction
Painful
Necrotic edge
Lateral aspect of lower leg

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10
Q

Malignancy ulcer?

A

Rolled or everted edge
Non-responsive ulcers
Marjolin’s ulcer

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11
Q

Features of venous ulceration?

A 
Circumference of lower leg
Large but shallow 
Moist granulating base
Blood when handled
Irregular border
Hyperpigmentation due to haemosiderin deposition
Atrophie blanche
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12
Q

Features of arterial ulcers?

A 
Distal, dorsum of foot or toes
Irregular edges become defined
Grey granulation tissue
No/little blood
Nocturnal pain
Features of ischaemia
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13
Q

Features of chronic ischaemia?

A 
Hairlessness
Pale skin
Absent pulses
Nail dystrophy
Muscle wasting
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14
Q

Features of neuropathic ulcers?

A 
Punched out appearance
Deep sinus
Under callus or over pressure points
Surrounding by inflammatory tissue
Brisk bleeding
Painless
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15
Q

Causes of venous ulcers?

A

Incompetent valves in lower leg, causing blood to be pushed into superficial veins leading to varicose veins, venous eczema and ulceration

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16
Q

Cause of diabetic ulcers?

A

Changes in bony architecture of foot
Peripheral neuropathy
Atherosclerotic PAD

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17
Q

Metabolic abnormalities in diabetes?

A

Hyperlipidemia
Raised vW factor + fibrinogen
Increased platelet adhesiveness

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18
Q

Assessment of an ulcer?

A 
Edges
Base
Condition of surrounding skin
Size
Infection
Pulses
Sensation
Blood pressure
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19
Q

Investigations for new ulcer?

A

ABPI - arterial disease
Swabs
Urinalysis/HBa1c

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20
Q

Management of venous ulcers?

A 
Graduated compression
Debridement
Occlusive hydrocolloidal dressing
Antibiotics
Pentoxifylline
Steroids
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21
Q

What is pentoxifylline?

A

Erythrocyte phosphodiesterase inhibitor
Improves blood flow
Increasing erythrocyte and leukocyte flexibility

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22
Q

Management of arterial ulcers?

A 
Improve blood supply to the area
Blood thinners
Stenting
Reduce cardiovascular risk
Prone to infection
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23
Q

What is superficial thrombophlebitis?

A

Local superficial inflammation of the vein wall with secondary thrombosis

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24
Q

How does superficial thrombophlebitis present?

A

Painful, tender cord-like structure
Redness
Swelling
Associated with varices

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25
What is DVT?
A primary thrombus with secondary inflammation | After a period of immobilisation or due to malignancy
26
How does DVT present?
Red, tender swelling Engorged veins Hornan's sign
27
What is hornan's sign?
Pain in calf on dorsiflexion of foot
28
What is phlegmasia cerulean dolens?
Total obstruction of venous drainage from a limb | Results in venous gangrene
29
Treatment of DVT?
Below knee - anticoagulate for 6 weeks Above knee - anticoagulate for 3 months Encourage movement
30
Risks for acute thrombosis
``` Sepsis Hypotension Low cardiac output Aneurysm Aortic dissection Bypass graft Atherosclerotic lesion ```
31
Common sites for emboli deposition?
Femoral artery bifurcation Iliac arteries Aorta Popliteal arteries
32
Rare causes of acute limbs ischemia?
``` Vasculitis Popliteal entrapment syndrome Compartment syndrome Iatrogenic Aortic dissection Graft occlusion ```
33
Symptoms/signs of acute limb ischemia?
``` Pain Pulseless Paralysis Parasthesia Pallor ```
34
What is claudication?
Pain in calves on walking due to lack of oxygen to muscles Patients can walk a predictable distance before symptoms start Relieved by rest
35
Assessment of claudication pain?
Pulses Duplex ultrasound ABPI MRA
36
ABI interpretation?
1 - normal 0.6-0.9 - claudication 0.3-0.6 - rest pain <0.3 impending
37
Classification of acute limb ischemia?
I - viable IIa - marginally threatened IIb - immediately threatened III - irreversible
38
Blood tests in acute limb ischemia?
``` FBC - haematological disorders? U+Es - dehydrated? raised K? Glucose - raised? CK - Raised if muscle ischemia? Clotting factors ```
39
Signs of non viable limb?
Tissue loss Nerve damage Sensory loss AMPUTATE
40
Why not revascularise non-viable limb?
Massive electrolyte release from ischaemic tissue will cause renal failure, myocardial toxicity and organ failure
41
What is necrotising fasciitis?
Life threatening infection of subcutaneous soft tissue
42
What pathogens cause necrotising fasciitis
Type 1 - Staph Enterobacteriae Anaerobes Type 2 - Streptococcus A
43
Symptoms of necrotising fasciitis?
Red/purple skin Severe pain Fever Vomiting
44
What is Fournier's gangrene?
Necrotising fasciitis of perianal and genital region
45
Ulcer at incision site?
Pyoderma gangrenous
46
What is gas gangrene?
Clostridium perfringens | Excessive gas production in tissues causing necrotic damage
47
Ischemic gangrene?
Result of atherosclerosis Critical limb schema leaves tissues at risk of necrosis Dry gangrene
48
Risk factors for peripheral vascular disease?
``` Smoking Diabetes mellitus Hypertension Hyperlipidemia Physical inactivity Obesity ```
49
Treatment of claudication pain?
Cilostazol - antiplatlet + vasodilator Pentoxifylline - reduce blood viscosity Naftidrofuryl - vasodilator
50
Indications for amputation?
Trauma Peripheral vascular disease Gangrene Tumours
51
Early complications of amputation?
``` Pain Bleeding Infection Scarring Clots Stroke, MI Death ```
52
Late complications of amputation?
Phantom limb | Reintervention
53
Process of raynaud's syndrome?
``` Pallor of distal portion of one or more digits Clear demarcation line Feeling of numbness or pain Cyanosis of digits Digit becomes red and warm ```
54
What is compartment syndrome?
``` Pressure increase within a fascial compartment Compromised blood flow Tissue necrosis Anterior compartment most at risk Fasciotomy ```
55
Role of doppler ultrasound?
Estimates blood flow through blood vessels
56
Arterial aneurysm?
Abnormal dilation of an artery due to a weakness in the arterial wall
57
True aneurysm?
All three layers of the wall
58
False aneurysm?
Collection of blood held around the vessel by connective tissue
59
Causes of aneurysms?
``` Atherosclerosis Vasculitis Syphilis Infection Cocaine use Congenital Trauma ```
60
Normal width of abdominal aorta?
2cm - abnormal defined as 3cm
61
Management of 3.0 - 4.4 cm abdominal aortic aneurysm
Annual ultrasound
62
Management of 4.5 - 5.4 cm abdominal aortic aneurysm?
3 monthly ultrasound
63
Management of 5.5 cm abdominal aortic aneurysm or rapidly growing aneurysm?
Surgical intervention
64
Other management for aortic aneurysms?
Smoking cessation Blood pressure control Statin Antiplatelet
65
Screening in general population for AAA?
One off ultrasound when 65

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