RAYNAUD’S -1.pptx.......................

Medical content

1. RAYNAUD’S PHENOMENON

2. RAYNAUD’S DISEASE 1. Definition & Demographics · An idiopathic condition characterized by abnormal vasospasm in digital arteries. · Primarily affects young women. · More common in the hands than the feet. 2. Pathophysiology: Key Abnormality · Central feature is an exaggerated arteriolar vasoconstrictive response to cold or stress. · This leads to reduced blood flow to the digits.

3. 3. Classic Tri-Phasic Color Changes The condition is recognized by its characteristic sequence: · White (Blanching): Due to arteriolar constriction and ischemia. · Blue (Dusky Cyanosis): Capillaries dilate and fill with deoxygenated blood. · Red (Hyperemic): Arterioles relax, oxygenated blood returns, causing reactive hyperemia. 4. Associated Symptoms · Pain often accompanies the color changes. · Loss of fine motor function in the fingers during an attack. · Sensation of numbness and cold.

4. 5. Prognosis & Complications · Superficial necrosis (tissue death) is very uncommon. · Generally a functional disturbance rather than a destructive process. 6. Critical Differential Diagnosis · Must distinguish from Raynaud's Syndrome (Secondary Raynaud's): · Syndrome has an underlying cause (e.g., connective tissue disorders like scleroderma, SLE, vascular disease). · Syndrome is often more severe and carries a higher risk of ulcers and tissue damage.

5. 7. First-Line Management · Patient Education: Protection from cold is paramount (layered clothing, hand warmers). · Avoidance of trauma and pulp/nail bed infections. 8. Medical & Interventional Therapy · Pharmacologic: Calcium channel blockers (e.g., Nifedipine) are first-line to reduce vasospasm. · Adjuvant Therapy: Electrically heated gloves can be beneficial. · Sympathectomy: Not recommended due to being largely ineffective or providing only short-lived relief.

6. RAYNAUD’s SYNDROME ( SECONDARY RAYNAUD’S ) 1. Definition · Secondary Raynaud's phenomenon: Peripheral vasospasm that is a manifestation of an underlying disease or condition, not idiopathic. 2. Key Etiologies & Causes · Connective Tissue Diseases: Most common association (e.g., Scleroderma, Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis). · Occupational: Vibration White Finger (a recognized industrial disease from using vibrating tools). · Other Causes: Atherosclerosis, thoracic outlet syndrome, carpal tunnel syndrome.

7. 3. Prognosis & Complications · High risk of tissue damage: Frequently leads to digital ulcers, necrosis (gangrene), and multiple amputations. · This increased severity is a major distinguishing factor from the primary disease. 4. Treatment Principle: Treat the Cause · Primary goal is management of the underlying condition (e.g., immunosuppressants for autoimmune disease). · Conservative measures (e.g., cold avoidance) from Raynaud's disease management are still helpful.

8. GANGRENE

9. 1. Definition Gangrene is the death of body tissue due to a critical lack of blood supply or a serious bacterial infection. It is a type of coagulative necrosis often accompanied by putrefaction. 2. Core Pathophysiology The final common pathway is ischemia. This can be caused by: · Arterial obstruction: (e.g., atherosclerosis, embolism, trauma, thrombosis). · Venous obstruction: (rarely, can lead to congestion and subsequent ischemia). · Infection: by toxin-producing bacteria (e.g., Clostridium perfringens). · Prolonged vasoconstriction: (e.g., in severe shock, Raynaud's phenomenon).

10. 3. Classification: The Two Main Types Gangrene is primarily classified into: · Dry Gangrene · Wet Gangrene Dry Gangrene Wet Gangrene

11. Types of Separation Separation by aseptic ulceration is seen in dry gangrene. Separation by septic ulceration is seen in infected condition and wet gangrene.

12. Clinical Features & Diagnosis · Symptoms: Pain (may be severe in wet gangrene), numbness, coldness. · Signs: Discoloration (black/green), loss of pulse, skin breakdown, crepitus (in gas gangrene), systemic signs of sepsis (fever, tachycardia). · Investigations: X-Ray (for gas in tissues), Blood tests (Leucocytosis, elevated CRP), Culture & Sensitivity, Arterial Doppler, Angiography.

13. Principles of Management · Resuscitation: IV fluids, broad-spectrum IV antibiotics (for wet gangrene), analgesia. · Surgical Debridement: Urgent and radical removal of all necrotic tissue (amputation in extremities) is the cornerstone of treatment for wet gangrene. · Revascularization: If viable tissue remains, may be attempted via angioplasty or bypass grafting (more relevant for dry gangrene/ischemia). · Adjunctive Therapy: Hyperbaric Oxygen Therapy (HBOT) may be used as an adjunct for gas gangrene.

14. Case scenario A 50-year-old male has come with progressive blackening of right toes and foot extending proximally. What is the diagnosis? What are the causes? What proximal lesions are often called as? How this patient can be managed?

15. Answer It is gangrene right foot. Causes could be atherosclerosis, embolism if it is of short duration, vasculitis. Condition is more common in diabetic. Proximal lesions are called as ‘skip lesions’. It suggests limb is critical even up to the skip lesion. Initial investigations are—blood sugar, lipid profile, haematocrit, C-reactive protein, arterial Doppler, CT angiogram, abdominal ultrasound, evaluation of other vessels. Treatment is—as this is gangrene it needs amputation— below knee, treatment of the cause, reperfusion of the remaining vessel depending on the site and extent of the block; associated cardiac treatment if needed; sepsis management; evaluation of renal status and management.

16. MCQS

17. Corkscrew collaterals are radiologically seen in: A) Aortoliac obstruction B) Buerger disease C) Raynaud disease D) Varicose veins

18. B. BUeRGER’S disease

19. A patient was diagnosed with thromboangiitis obliterans. Regarding the same, choose the true statements: 1. Also called Buerger disease 2. Can cause superficial thrombophlebitis 3. Affects large arteries like brachial, popliteal 4. Seen in young smokers 5. Raynaud phenomenon seen A) 1 2 3 B) 1 4 5 C) 1 2 4 5 D) 1 3 4 5

20. 1,2,4,5

21. Find the incorrect match regarding Ankle Brachial Pressure Index (ABPI): A) Normal - 0.9-1.2 B) Diabetes mellitus - 1.5 C) Limb threatening ischemia- 0.5 D) Drop in resting ABI after exercise in patient of PAD - 25%

22. Ankle-Brachial Pressure Index (ABI) is the ratio of the systolic pressure at the ankle to that in the ipsilateral arm. The highest pressure in the dorsalis pedis, posterior tibial or peroneal artery serves as the numerator, with the highest brachial systolic pressure being the denominator. · The normal resting ABI is 0.9–1.4. · Values below 0.9 indicate a haemodynamically significant arterial lesion. · A value ≤ 0.4 suggests CLTI (chronic limb threatening ischemia). · A drop in the resting ABI of >20% after exercise is indicative of flow-limiting arterial disease. · Artificially high ABI readings (>1.4) can be caused by media sclerosis and calcification of the arterial wall, causing vessel incompressibility and a falsely elevated ABI; this pattern of disease typically occurs in patients with diabetes mellitus. Ans. C) Limb threatening ischemia- 0.5

23. DHANYAWADAGALU