Peripheral arterial occlusion disorder.pptx

peripheral vascular disease

1. Peripheral Artery Occlusive Disease- Buerger’s Disease

2. Chief Complaints A 30 yr old gentleman, resident of Delhi presented with chief complaint of Pain left leg while walking for last 1.5 years. Blackish discoloration of left great toe for last 1 month

3. History of Present illness My patient having the history of pain in his left leg while he starts walking for a distance .Initially the pain was started after half a kilometer still he could able to manage walking but fo last 6 months he is unable to walk more than 300 meters. He has to stand for few minutes than only he can start walking again. Now a days, during rest at night he also experiences ain in his left leg, get relieved on hanging the leg from the bed. Since, last one month along with pain he also noticed blackish discoloration of his great toe following a minor trivial trauma. The black discoloration of left great toe is gradually progressive along with pain.

4. But there is no history of chest pain, breathlesnessand syncope. No history suggestive of su perficial thrombophlebitis . No history of pain, pallor of toes and or finger on exposure to cold. No history of impotence, claudication of hip, gluteal region. No joints pain, difficulty in movement, etc.

5. Past History No history of diabetes, hypertension, hyperlipidemia , no past history of vascular disease. No history of previous surgery.

6. Personal History He is a chronic smoker. Smokes 20-30 bidis per day. Occasional alcoholic.

7. Family History No family history of peripheral vessels disease, atherosclerosis, etc.

8. Summary of History A 45yr old gentleman has come with a painless, progressive swelling in front and below the left ear lobule for 6 months without any history of increase in size of the swelling while mastication, features of facial nerve involvement.

9. Physical Examination & General Survey I have examined the patient with informed consent in a well lit room in sitting position and adequate exposure in the presence of a chaperone. Patient was conscious, oriented , co-operative Moderately built with BMI – 23 kg/m 2 (wt= 67kg, ht =1.7m) Hydration status- well maintained Karnofsky Performance Status - 90/100 No pallor, icterus , cyanosis, generalised lymphadenopathy , Pedal Edema Vital signs: Pulse rate -82/min in right artery, normal volume, regular rhythm, no radio radial delay and radio-femoral delay. BP: 120/80 mmHg in right arm supine position. Afebrile Respiratory rate 14 cycles/min

10. Local Examination Right lower limb appears normal. Left lower limb: INSPECTION Attitude – standing comfortably Muscle wasting seen at calf level . Buerger’s angle: leg appears pale at 30 degrees. Guttering of vein Loss of hair on dorsum of toes and foot upto the level of ankle. The skin is thin and shiny, nails are brittle. Affected area here left great toe, blackish great toe left, dry no edema and signs of progression noticed.

11. PALPATION Temperature : left lower limb is colder than right. Affected part: blackish discoloration of left great toe, no gangrene as such.

12. Peripheral pulses: RIGHT LOWER LIMB LEFT LOWER LIMB FEMORAL ++ ++ POPLITEAL ++ + ANTERIOR TIBIAL ARTERY ++ - POSTERIOR TIBIAL ARTERY ++ - ARTERY DORSALIS PEDIS ++ -

13. Capillary filling > 3 seconds Venous filling >20 seconds Cross leg test positive Buerger’s test < 30 degrees Test for DVT- Homan’s sign negative

14. Adjacent joint movement – 1 st metatarsophalangeal joint restricted movement on left side. Other joint movements normal No neurological deficit in lower limb. ON AUSCULTATION: No bruit heard over femoral, aortic, carotid arteries.

15. Systemic Examination: Cardiovascular system : S1, S2 Normal . No murmurs heard. Other systemic examination is essentially normal.

16. Summary of case My patient is a 30 year old male, chronic smoker, presented with complain of intermittent claudication which is gradually progressive for last 1.5 years and blackish discoloration of his left great toe for last 1 month without any history of cardiovascular events. On examination, general survey is essentially normal. Left lower limb is colder, Buerger’s angle is less than 30 degrees, Peripheral pulses are absent in left anterior tibial artery, posterior tibial artery and artery dorsalis pedis . There is blackish discoloration in left great toe which is not on progression and no gangrenous changes noticed.

17. Clinical Diagnosis (Provisional) So this is a case of peripheral artery occlusive disease affecting the left lower limb with ischemic changes at left great toe most probably due to Buerger’s disease.