arterial disease examination
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Arterial diseases
andExamination of Arterial system
By
Dr. Mohammad NaumanFRCS
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Common terminology used in arterialdisease
Claudication intermittent
Ischaemia Acute chronic
Critical ischemiagangrene
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Common disease processes of arterialdisease
ThrombosisEmbolismAtherosclerosisArteritis (angiitis)Endartritis obliterans (buergers disease)Arterial spasm
AneurysmArterio-venous fistulaTraumatic arterial injury
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G angreneIt is the death of the tissues with superadded
putrefactionPoints to note in established G angreneExtent & colour G as gangrene G as, crepitus, odour of
hydrogen sulphideMuscle colour Brick red green black
T ype of gangreneD ry Parts become mummifiedWet Putrifaction as In diabetic gangrene
Line of demarcationL ine between living & dead
L imb above the gangrenous areacongested, oedematous, paleBlack patches indicate skip lesion
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Arterial walls
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Aneurysms
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Mesenteric ischemia
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Arteriovenous fistula Athroma removal
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G angreneG angrene of fingers
R aynaud, cervical rib, scalene anticussyndrome,Morvans disease painless syringomyelia
U inlateral / Bilateral
AtherosclerosisU
nilateral first BilateralBuergers & R aynauds disease Bilateral
Embolic G angrene U nilateral-- mostly
D iabetic U nilateral / bilateral
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H istory
Age & Sex> men than womenOld age AtherosclerosisYoung men 20-40 years Buergers diseaseYoung women R aynauds diseaseMiddle age D iabetic arteriopathy
L imb affectedLower limb Buergers diseaseU pper limb R aynaud disease
Mode of Onset
G radual & spontaneousBuerger, R aynaudSudden EmbolicTrauma or infection D iabetic G angrene
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symptoms
PainTwo types
Claudication
Intermittent pain Claudio L impPain in calf on walking accumulation of P Substance
Rest painContinuous aching pain Cry of dying nervesPain worse at night, on elevationPain relieved hanging down below heart level
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Site of painD epends on level of obstruction
FootTibial / planter aretries Buergersdisease
Calf Occlusion Femoral-Popliteal Junction
T highSuperficial femoral artery
ButtockOcclusion at bifurcation Iliacartery/Aorta
Claudication distanceD istance walked when pain starts
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symptomsEffects of cold and warmth
warmth increases symptomsRaynaudL ocal syncope digits become cold & white +
Tingling & numbness spasm of arteriesL ocal asphyxia digits become blue with burning
sensation slow circulation + accumulation of reduced HbL ocal recovery release of spasm normal
colour
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P araesthesia
Tingling, numbness, pins and needles in foot--blood is shunted from skin to musclesSuperficial phlebitis
Swelling, redness, pain Buergers diseaseInvolvement of other arteries
T ake H/OFainting, transient blackouts (cranial),chest pain, (angina, heart),weakness, paraesthesia in upper limb,blurred vision, (ophthalmic),abdominal pain (mesenteric),
Impotenceabdominal aortaBilateral Iliac artery occlusion
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Physical ExaminationInspection
Colour changeMarked pallor sudden occlusion Embolism,
R aynaud diseaseP urple blue cyanosed Severe ischaemia, pregangrene stage
Elevation of limb leads to Pallor.
Signs of IschaemiaThinning of skin,D iminished hair growth
Loss of subcutaneous fat,ShininessBrittle nails with transverse ridgesMinor ulcers in pressure areas
``heel, malleoli, ball of foot, tips of toes
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Buergers T estBroad day lightPatient lying on his back
NormalR aise straight legs to 90 0 colour of skin
remains pinkIschaemic limb
Marked pallor on elevation
Veins collapsed and guttered Angle between limb and horizontal planeBuergers
AnglePallor at Angle < 30 0 Severe ischaemiaLegs elevated (doctor hold limbs)
Ankle Exercised till fatigue Pallor at H eelindicates Occlusive diseaseFeet now lowered to sitting posture in 2-3
min. Cyanosed
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Ischaemia (cond)Capillary filling time
Elevated pallor leg when becomes pinkon bringing down the time taken iscalled Capillary filling time
Severe ischaemia Takes 2030 sec.
Again limb changes colour to purplereddue to skin filling with deoxygenatedblood
V enous filling
Normal Elevated limb when put down Veins fill within
5 sec.
Ischaemic limb take more time
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PalpationSkin temperature
With back of fingersCompare with other limb
Capillary fillingPress the nail see blanching
V enous refillingTwo finger testvenous filling poor in ischaemic limb
H arveys signCross leg test
shows oscillatory movements of kneedue to popliteal artery pulsationsMovements absent in blocked artery
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Examination of vesselsDorsalis pedis aretry
Just lateral to tendon Extensor hallucis longus
P osterior tibialMid way between med. Malleolus & Tendo -
Achillis
Ant.tibail arteryMidway between malleioli anteriorly lateral to
tendon Exten. hallucis longus
P opletial arteryK nee 40 0 flexion to relax the fossa Palpate inupper part of popletial fossa
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Auscultation
L isten along the course of major arterysystolic bruit due to turbulence of blood flowrenal artery stenosis
Continuous machinery murmur arteriovenous fistula
Check BP in both arms
Reactive hyperaemiaInflate sphygmomanometer above
250mmH
g & then releaseH
yperaemiain 1-2 sec in normal limbD elayed in arterial occlusive disease
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Neurological examinationSensation
lost in gangrenous areaBorder line of gangrene skin is hyperaesthetic
U lcers exclude/ find underlying causeH emiplegia, transvesre myelitis,
syringomyelia, tabes dorsalis
Adsons testPositive in cervical rib, scalene syndromepatient sits on stoolTurn face to other sideR adial pulse obliterated due to compression
Examination of LN
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T he End