Buergers Disease

Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi)

1. BUERGERS DISEASE PRESENTED BY , MR.JAGDISH SAMBAD M.Sc.NURSING -MSN ASSI.PROFESSOR BALAJI COLLEGE OF NURSING

2. THROMBOANGITIS OBLITERENS Buerger's disease ( thromboangiitis obliterans ) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi) This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger's disease usually first shows in your hands and feet and may eventually affect larger areas of your arms and legs.

3. It is differentiated from other vessel diseases by its microscopic appearance. In contrast to atherosclerosis, Buerger’s disease is believed to be an autoimmune disease that results in occlusion of distal vessels.

4. ALSO CALLED AS “ PRESENILE GANGRENE ”

5. INCIDENCE It occurs most often in men between the ages of 20 and 35 years, and it has been reported in all races and in many areas of the world

6. ETIOLOGY The cause of Buerger’s disease is unknown, but it is believed to be an autoimmune vasculitis . Genetic predisposition There is considerable evidence that heavy smoking or chewing of tobacco is a causative or an aggravating factor. Generally, the lower extremities are affected, but arteries in the upper extremities or viscera can also be involved. Buerger’s disease is generally bilateral and symmetric with focal lesions.

7. RISK FACTORS Tobacco use Chronic gum disease

8. PATHOPHYSIOLOGY Due to etiological factors Acute inflammation and thrombosis of the viens of hands and feet Vasculitis Decreased blood supply to skin Gangrene formation

9. CLINICAL MANIFESTATIONS Pain The patient complains of foot cramps, especially of the arch ( instep claudication ), after exercise. A burning pain is aggravated by emotional disturbances, nicotine and chilling. Cold sensitivity of the Raynaud type is found in one half the patients. Digital rest pain is constant, and the characteristics of the pain do not change between activity and rest.

10. Physical signs Includes; Intense rubor of the foot Absence of the pedal pulse but with normal femoral and popliteal pulses. Radial and ulnar artery pulses are absent or diminished. Various types of paresthesia may develop. As the disease progresses, definite redness or cyanosis of the part appears when the extremity is in a dependent position.

11. Involvement is generally bilateral, but color changes may affect only one extremity or only certain digits. Color changes may progress to ulceration, and ulceration with gangrene eventually occurs

12. ASSESSMENT AND DIAGNOSTIC FINDINGS History taking (current or rescent history of tobacco taking) Physical examination (presence of extremity ischemia.claudication,pain at rest) Segmental limb blood pressures ( to demonstrate the distal location of the lesions or occlusions) Duplex ultrasonography (to document patency of the proximal vessels and to visualize the extent of distal disease) Contrast angiography (to demonstrate the diseased portion of the anatomy) Distal Plesthysmography

13. MAIN OBJECTIVES OF MANAGEMENT To improve circulation to the extremities To prevent the progression of the disease To protect the extremities from trauma and infection.

14. MANAGEMENT Treatment of ulceration and gangrene is directed toward minimizing infection and conservative debridement of necrotic tissue. Tobacco use is highly detrimental, and patients are strongly advised to stop using tobacco completely. Vasodilators are rarely prescribed because these medications blood away from the partially occluded vessels, making the situation worse. Prostaglandins like limaprost are vasodialators which gives relief in pain.

15. A regional sympathetic block or ganglioectomy may be useful in some instances to produce vasodilatation and increase blood flow of limb Debridement is done for necrotic ulcers. In chronic cases lumbar sympathectomy is done to reduce vasoconstriction and increases blood flow to limb. Above knee and below knee amputation is done in rare cases Anti inflammatory drugs like corticosteroids are used for inflammation and pain Bypass can sometimes be helpful

16. NURSING MANAGEMENT If amputation is performed elevating the stump for the first 24 hours to promote venous return and minimize edema and the incision is monitored for the signs of hematoma. The patient may experience grief, fear, or anxiety related to loss of the limb. The patient is encouraged to discuss his or her feelings. Spiritual advisors and other health care team members are consulted as appropriate. Recovery and rehabilitation require consultation among health care providers.

17. The patient is assisted in developing a plan to stop using tobacco and to manage pain. The patient may need to be encouraged to make the lifestyle changes necessary with a chronic disease, including modifications in diet, activity, and hygiene (skin care). The nurse determines whether the patient has a network of family and friends to assist with activities of daily living. The nurse ensures that the patient has the knowledge and ability to assess for any postoperative complications such as infection and decreased blood flow .

18. summary Definition Etiological factors Risk factors Patho -physiology Clinical manifestation Diagnostic evluation Medical management Nursing management of

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