Diseases Of The Arteries Veins And Lymphatic Question and Answers

Diseases Of The Arteries Veins And Lymphatic System Long Essays

Question 1. Describe the clinical features, diagnosis, and treatment of thromboangitis obliterans.

Answer:

Thromboangitis Obliterans/Buerger’s Disease:

• It is the inflammatory reaction in the arterial wall with the involvement of the neighboring vein and nerve, terminating in thrombosis of the artery.

Thromboangitis Obliterans Clinical Features:

• Age/sex – 20 – 40 years males.
• Pain while walking at the arch of the foot
• Pain increases when muscle is exercised
• Postural colour changes appear followed by trophic changes.
• Gradually ulceration and gangrene occurs.
• Gangrene starts from one digits and then involves the entire foot.
• BP – normal in normal limb, reduced in diseased limb.

Thromboangitis Obliterans Diagnosis:

• Arteriography.
  • Large arteries shows abrupt areas of occlusion surrounded by extensive collateral circulation.
  • It gives ‘tree roof or ‘spider legs’ in appearance.
  • Peripheral arteries gives a ‘cork screw’ appearance.

Thromboangitis Obliterans Treatment:

1. Conservative treatment.
   • Quit smoking.
   • Prostaglandin therapy to prevent platelet aggregation.
2. Surgical treatment
   • Microvascular transplantation of free grafts
   • Amputation – to remove gangrenous area.

Question 2. Define gangrene. Describe the types, clinical features, and management of wet gangrene.

Answer:

Gangrene: Gangrene is death of a portion of the body with putrefaction.

Gangrene Types:

1. Dry gangrene due to slow occlusion of arteries.
2. Wet gangrene – due to sudden occlusion of arteries.

Wet Gangrene: It is characterized by moist and oedematous limb.

Wet Gangrene Clinical Features:

• The part is cold, pulseless, swollen and oedematous
• Color changes varies-dark red, green, purple and black depending on hydrogen produced by bacteria.
• Skin becomes raised into blebs containing foul-smelling fluid.
• There is no line of demarcation present
• Crepitus may be present.

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Wet Gangrene Management:

1. General treatment
   • Nutritious diet
   • Control of diabetes
   • Relief of pain.
2. Local treatment.
   • Conservative treatment
     • Part should be kept dry
     • Part may be kept elevated
     • Part should be protected.
   • Surgical treatment.
     • Amputation – major amputation is necessary.

Question 3. Discuss the clinical features and management of diabetic gangrene.

Answer:

Diabetic Gangrene: Diabetes makes limbs more liable to gangrene formation.

Diabetic Gangrene Clinical features:

• Pain and ulceration of foot
• Loss of sensation.
• Absence of peripheral pulse.
• Change of colour and temperature.
• There may be abscess formation.
• Dry gangrene occurs frequently in old diabetic patients while moist gangrene in young diabetics.

Diabetic Gangrene Management:

1. Conservative treatment
   • Diabetic control.
   • Drugs used – vasodilators, dipyridamole, low-dose aspirin.
   • Care of foot – keep it dean and dry.
   • Antibiotics – in case of infections.
   • Use of micro-cellular rubber footwear.
2. Surgical treatment.
   • Amputation of the part.

Question 4. Describe the signs, symptoms, and treatment of varicose veins of leg.

Answer:

Varicose vein: When a vein becomes dilated, elongated, and tortuous, the vein is said to be varicose

Varicose vein Clinical features:

1. Symptoms:
   • Visible distension of superficial veins.
   • Tired and acting sensation in affected limb.
   • Sharp pain.
   • Ankle swelling towards evening.
   • Skin over the varicosities may itch and pigmented
   • Eczema of affected skin.
2. Signs:
   • Varicose eczema.
   • Hemosiderin pigmentation.
   • Atrophie blanche.
   • Lipodermatosclerosis.
   • Oedema.
   • Ulceration.

Varicose vein Treatment:

1. Palliative treatment:
   • Avoid prolonged standing.
   • Apply elastic stocking from toes to the thigh.
   • Elevation of lower extremities.
   • Exercise like bicycle riding.
2. Operative treatment:
   • Saphenous stripping.
     • It involves removal of all or part the saphenous vein’s main trunk.
   • Ambulatory phlebectomy.
     • Vein ligation
     • Cryosurgery.

Question 5. Describe the clinical features, diagnosis, and etiology, treatment of tuberculosis cervical lymphadenitis.

Answer:

Tuberculosis cervical lymphadenitis:

• Tuberculous cervical lymphadenitis refers to lymphadenitis of tire cervical lymph nodes associated with tuberculosis.

Tuberculosis cervical lymphadenitis Clinical features:

• Commonly found in children and young adults.
• Presence of chronic, painless, enlarging, or persistent mass.
• Nodes are firm and rubbery which later becomes matted.
• Skin become adhered to the mass and may rupture
• Systemic symptoms includes.
  • Fever with chills.
  • Weight loss
  • Malaise

Tuberculosis cervical lymphadenitis Diagnosis:

• Positive tuberculin test.
• Chest radiograph
• CT scan
• FNAC
• Acid-fast bacilli staining
• Mycobacterial culture.

Tuberculosis cervical lymphadenitis Treatment:

1. Anti-tubercular drugs:
   • Injection streptomycin – 0.5 – lg 1M daily.
   • INH – 300 mg/ day.
   • PAS – 5 – 15 g/day.
   • It is continued for at least 1 and half years.
2. Supportive treatment.
   • Vitamin supplements.
   • High protein diet
3. Surgery.
   • Removal of lymph nodes
   • Incision and drainage of abscess.

Etiology:

• It is caused by Mycobacterium tuberculosis.
• It has 4 pathological stages.
  • Stage 1 – lymphoid hyperplasia.
    • There is formation of tubercles and granulomas without caseation necrosis.
  • Stage 2 and 3 – caseation necrosis.
    • Caseation necrosis in the affected lymph nodes occurs.
    • There is the destruction of capsule of lymph nodes and adherence of multiple nodes with periadenitis.
  • Stage 4 – There is rupture of caseous material into surrounding soft tissue.
    • There is abscess cavity formation.

Question 6. Discuss the differential diagnosis of cervical lymphadenopathy.

Answer:

The differential diagnosis of cervical lymphadenopathy

Question 7. What are the methods of spread of carcinoma? Describe the block dissection of neck.

Answer:

Methods of spread of carcinoma:

1. Through lymphatic system.
   • It is called embolization
2. Through bloodstream.
   • Malignant cells can break off from the tumour and travel through the bloodstream until they find a suitable place to start forming a new tumor.
   • Sarcomas spread through the bloodstream.
3. Through local invasion.
   • Tumours invade the surrounding normal tissue.
4. Through implantation or inoculation.
   • It occurs rarely.
   • Can happens accidentally when a biopsy is done or when cancer surgery is performed.
   • Malignant cells actually drip from a needle or an instrument.

Block Dissection of Neck:

• The main goal of the procedure is to remove the entire ipsilateral lymphatic structures.

block dissection of neck Procedure:

• Incisions are made.
• Crile’s T incision
• Martin’s double Y incision
• Ward’s Y incision

Two horizontal incisions.
↓
Skin flaps are reflected
↓
Fibro-areolar tissue of posterior triangle are dissected away from trapezius.
↓
The lower end of the sternomastoid muscle is divided
↓
Internal jugular vein is separated and divided
↓
Above again sternomastoid muscle is transected.
↓
The submandibular salivary gland is dissected
↓
Spinal accessory nerve is divided in 2 places.
↓
Transection of jugular vein.
↓
Skin is closed with suction drainage.

block dissection of neck Structures removed:

• Lymph nodes – submental, submandibular, upper and lower deep cervical groups, posterior cervical group and supraclavicular group.
• Sternomastoid muscle.
• Internal jugular vein.
• Submental and submandibular salivary glands.
• Spinal accessory nerve.
• Branches of external carotied artery.

 

Diseases Of The Arteries Veins And Lymphatic System Important Notes

1. Buerger’s disease and Raynaud’s disease
2. Varicose veins
   • Develop in the calf when the veins above are normal
   • More frequent in people who stand during their work
   • Often develop during pregnancy under the influence of Estrogen and progesterone which cause the smooth muscle in the vein wall to relax
   • Complications
     • Superficial thrombophlebitis
     • Deep vein thrombosis
     • Venous ulceration
3. Lymph nodes in different diseases
   • Soft, elastic and rubbery – Hodgkin’s disease
   • Firm, discrete – syphilis
   • Stony hard – secondary carcinoma
   • Matted – tuberculosis
4. Draining lymph nodes in different disease
5. Intermittent claudication
   • It is most common complication of the limb due to chronic arterial occlusion
   • Features
   • Cramp like pain felt in the muscles during exertion and gradually disappears within minutes upon cessation of activity
   • Pain is due to accumulation of excessive P substance in the muscles
   • Boyd’s classification
     • Grade 1 – pain disappears if the patient continues to walk
     • Grade 2 – pain continues but the patient can still walk with effort
     • Grade 3 – pain compels the patient to take rest
6. Indications of sympathectomy
   • Rest pain and minor ulceration
   • Buerger’s disease
   • Raynaud’s disease
   • Senile gangrene
7. Types of gangrene
8. Complications of varicose veins
   • Thrombophlebitis
   • Pigmentation
   • Eczema
   • Ankle flare
   • Venous ulcer
   • Flaemorrhage
   • Periostitis
   • Calcification
   • Equinus deformity
9. Virchow’s triad – considered in etiology of venous thrombosis which includes
   • Stasis
   • Injury to the vessel wall
   • Hypercoagulability of blood

Read And Learn More: General Surgery Question and Answers

Diseases Of The Arteries Veins And Lymphatic System Short Essays

Question 1. Cervical rib.

Answer:

Cervical rib

Cervical rib is an extra rib present in the neck.

Cervical Rib Types:

• Type 1 – Free end of the cervical rib is expanded into a hard, bony mass.
• Type 2 – complete cervical rib extending from C7 vertebra to manubrium.
• Type 3 – Incomplete cervical rib – partly bony and partly fibrous.
• Type 4 – Complete fibrous band.

Cervical Rib Clinical Features:

• Common in females.
• Dull aching pain.
• Hand of the affected side is colder and paler
• Numbness of the fingers.
• Bruit is heard.
• Hard mass may be visible and palpable.
• Seonsory and motor disturbances in the area

Cervical Rib Treatment:

1. Conservative.
   • Shoulder girdle exercise.
   • Correction of faulty posture.
2. Surgery.
   • Excision of cervical rib.
   • Removal of thrombus if present

Question 2. Aneurysm.

Answer:

Definition: Dilatation of a localized segment of the arterial system is known as aneurysm.

Aneurysm Types:

1. True aneurysm – contains all three layers of arterial wall.
   • It is further classified into
     • Fusiform aneurysm
     • Saccular aneurysm
     • Dissecting aneurysm
2. False aneurysm – It has a single layer of fibrous tissue as the wall of the sac.
3. Arteriovenous aneurysm.

Aneurysm Clinical Features:

• Elderly patients are commonly affected.
• Pain
• Expansile pulsatile mass
• Severe ischaemia
• Bruit is heard.

Aneurysm Causes:

1. Congenital
2. Acquired.
   • Trauma
   • Infections
   • Atherosclerosis

Aneurysm Treatment:

• Repair of the aneurysm with graft.

Question 3. Arteriovenous aneurysm or Arteriovenous fistula.

Answer:

Arteriovenous aneurysm

Communication between an artery and adjacent vein leads to an arteriovenous aneurysm.

Arteriovenous Fistula Causes:

1. Congenital
2. Acquired – trauma
3. Iatrogenic.

Arteriovenous Fistula Clinical Features:

1. Systemic effects.
   • Increased cardiac output.
   • Increased heart rate
   • Increased systolic pressure
   • Cardiac hypertrophy.
   • Decreased peripheral resistance.
2. Local effects.
   • Aneurysmal dilatation.
   • Extensive collateral circulation.
   • Bruit can be heard
   • Veins are enlarged.

Arteriovenous Fistula Treatment:

1. Congenital lesions-excision.
2. Acquired lesions.
   • Reconstructive
   • Ligation of involved artery
   • Selective intra-arterial embolization.

Question 4. Venous Ulcer.

Answer:

Venous Ulcer Causes:

• Varicose veins
• Increased venous hydrostatic pressure.

Venous Ulcer Clinical Features:

• Located on the medial side of lower 1/3rd of leg
• It is shallow and superficial
• Painless
• Pain occurs if it is infected.
• Skin around the ulcer is pigmented
• Shows evidence of healing.

Venous Ulcer Treatment:

1. Conservative treatment:
   • Elevation of affected limb.
   • Movement of limb
   • Apply of firm elastic bandage.
   • Cleaning of ulcer.
   • Antibiotic administration.
2. Surgical
   • Sclerotherapy.
   • Split skin graft.
   • Ligation.

Question 5. Thrombophlebitis.

Answer:

Thrombophlebitis

• It is superificial vein thrombosis.
• It occurs more often in varicose veins or after intravenous infusion.

Thrombophlebitis Clinical Features:

• Painful cord-like inflamed area.
• Redness
• Tenderness
• Local induration.

Thrombophlebitis Treatment:

1. Conservative treatment:
   • Hot bath or compression
   • Application of crepe bandage
   • Use of anti-coagulant
   • Use of aspirin.
   • Intravenous infusion of antibiotics
2. Surgical treatment.
   • Ligation of the involved vein.

Question 6. Cystic hygroma.

Answer:

Cystic hygroma

It is the most common form of lymphangioma.

Cystic Hygroma Clinical Features:

• Common in neck region.
• Mostly seen in children.
• Painless swelling.
• Pain occurs when it is infected.
• Fluctuation and fluid thrill are present.
• Swellings are translucent.
• Regional lymph node enlarges in presence of infection.

Cystic Hygroma Treatment:

• Complete excision.

Question 7. Hodgkin’s lymphoma.

Answer:

Definition: It is a malignant neoplasm of the lymphoreticular system.

Hodgkin’s Lymphoma Clinical Features:

• Age – 30 – 50 years
• Sex- More common in males,
• Generalised Iymphodenopathy.
• Site involved- lymph nodes in the neck, axilla, mediastinal, para-aortic, and inguinal.
• Nodes are firm without matting.
• Fever with rigors.
• Malaise, weight loss, and pallor.
• Itching of skin.
• Abdominal pain.
• Bony pain.
• Ascites.
• Superior vena caval obstruction.

Hodgkin’s Lymphoma  Investigation:

Hodgkin’s Lymphoma  Treatment:

• Radiotherapy – for stage 1 and 2
• Chemotherapy – for stage 3 and 4

Question 8. Staging of Hodgkin’s disease.

Answer:

Stage 1:

• Lymph node involvement in one anatomical region.
• Example: palpable left supraclavicular nodes.

Stage 2:

• Involvement of two or more lymph nodes on the same side of the diaphragm.
• Example: Left supraclavicular and left axillary node.

Stage 3:

• Involvement of lymph node on both sides of the diaphragm.
• Example: Left supraclavicular and left inguinal lymph nodes.

Stage 4:

• Diffuse involvement of one or more extra lymphoid organs with or without lymph node involvement.

Question 9. Varicose ulcer

Answer:

Varicose ulcer

• It is type of venous ulcer
• Cause
  • Abnormal venous hypertension in lower third of leg, ankle, and dorsum of foot
• Features
  • Shallow and superficial
  • Doesn’t penetrate deep fascia
  • Usually painless
  • Associated with varicose veins
  • Skin around the ulcer is pigmented

Diseases Of The Arteries Veins And Lymphatic System Viva Voce

1. The commonest type of lymphoma is Hodgkin’s lymphoma
2. Application of warmth will increase the symptoms of arterial occlusion
3. Venous ulcers are commonest ulcers of the legs
4. Continuous machinery murmur indicates presence of an arteriovenous fistula
5. Synthetic grafts are used in aortoiliac occlusion
6. Vein grafts are used in femero-popliteal occlusion
7. Majority of the pulmonary emboli originates in the lower extremity