history-taking & physical examination in vascular diseases
Post on 16-Dec-2015
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History-Taking & Physical Examination in Vascular
Diseases
Aim – To reach for a Presumptive Diagnosis
How to take the History
• Establish a rapport with patient introduce yourself.
• Initiate by asking – what made him to seek medical advice.
• Listen without interruption.
• Wait for answers before asking another question.
Don’ts of history taking
• Do not interrupt the patient.
• Do not use medical terminology.
• Do not ask irrelevent questions
• Do not ask leading questions.
• Do not be abrupt or impatient.
The Present Complains
• Ask the patient to tell you what made him to seek medical advice.
• Record the answer in patients words.
History of Presenting Complains
• Details of the history of the main complaints.
- when did it start
- what was the first thing noticed
- progress since then
- ever had it before.
History of Presenting Complains
• S – Site
• O – Onset
• C – Character
• R – Radiation
• A – Association
• T – Timing/Duration
• E – Exacerbating & alleviating factors
• S - Severity
Direct Questioning
• Specific questions about the diagnosis you have in mind.
- Risk factors.
- Review of relevant system.
• Past Medical History
• Drug History
• Family History
• Social History
• Habits
• Vascular Diseases
- Arterial
- Venous
- Lymphatic
Arterial Diseases
• Electively – Chronic Symptoms• Acutely – Limb threatening disorders• Pain
Intermittent Claudication
Rest pain• Tissue loss
Ulcer
Gangrene
• Acute arterial occlusion
Sudden onset
Severe, Shocking pain
Diffuse
Associated Symptoms
• Chronic Arterial Insuffciency: Intermittent Claudication Site – depends on the level & extent of
arterial disease - Cramp like pain - Consistantly reproduced by same level of
exercise - Completely & quickly relieved by rest - Claudication distance
• Rest Pain
- continuous severe pain, aching in nature
- occurs in distal part of foot
- often relieved by putting the leg below the
level of heart
- movement or pressure causes exacerbn.
• Ulcer – area of discontinuity of surface epithelium• Gangrene – Dead tissue - Duration, Site. - what drew the patient’s attention to the ulcer - other symptoms - progression - persistance - multiplicity
Examination
• Inspection
- Expose
- Compare
• Look For
• Ulcer
site, shape, size, no.
edge, floor, deapth, discharge, surrounding area.
Base
• Vascular Angle
Or Buerger’s angle
Normal-straight leg can be raised by 90* & foot rmains pink.
Ischemia – elevation to 15-30*cause pallor
• Dependant rubor
• Venous Filling
Normal – veins of foot are full of blood
Ischemia – veins are collapsed & looks like pale blue gutters
- Guttering of veins
Palpation
• Temperature
which foot – warm/cold.
level at which change occurs
• Tenderness
• Capillary filling
Feel for P. pulses & grade
• Peripheral Nerves Examination
- Sensory
- Motor
• Auscultation
- Bruit
Venous diseases
• Common Presentation
- Varicose veins
Asyptomatic, Cosmetic, Dull aching pains, Feeling of heaviness, Itching/Eczema, superficial thrombophlebitis, bleeding, Ulceration, Saphenavarix.
• Primary – Venous valve failure
• Secondary – Post thrombotic
- Congenital Malformations
Examine both supine & standing
Touniquet Test–Identify clinically site of reflux from deep to superficial veins-Identify incompetant perforators – tie tourniquet above suspected perforator
Lymphatic diseases
• Lymphangitis – inflamation of lymphatics.
• Lymphedema – faiure of lymph drainage.
Protein rich fluid accumulates in tissue
Lymphedema
• Primary
- congenital – at birth
- Precox - adolescence
- Tarda - middle age
Lymphatic abnormalities – aplasia, hypoplasia, hyperplasia.
• Secondary :
- Infection
- Surgery
- Radiation
- Trauma
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