Arterial.7.Vasospastic Disorders and Arteritis Flashcards
List Vasospastic Disorders
- Raynaud’s disease
- Raynaud’s phenomenon
- Acrocyanosis
- Erythromelalgia
- Erythrocyanosis Frigida (Bazin’s disease).
- Causalgia: Look Neurosurgery
- Sudeck’s atrophy : Look orthopedics.
ETIOLOGY of Raynaud’s disease
Not exactly known, Certain factors are suggested :
- Sensitivity of the small arteries and arterioles of the hands, and less commonly the feet, to cold.
- Increased sympathetic tone.
- Psychological instability.
- The presence of cold agglutinins in the blood which cause agglutination of RBCs on exposure to a low temperature.
DIAGNOSIS of Raynaud’s disease
History:
Examination
History in DIAGNOSIS of Raynaud’s disease
- The disease is bilateral and symmetrical and is much more common in young females, in both hands.
- The attacks are precipitated by coldness or emotional excitement and are relieved by warmth.
- The attack is usually accompanied by pain.
- The attack consists of 3 consecutive phases
3 consecutive phases in History in DIAGNOSIS of Raynaud’s disease
- Pallor
- Cyanosis
- Redness
Pathogenesis of Pallor in 3 consecutive phases in History in DIAGNOSIS of Raynaud’s disease
Due to spasm of the digital arterioles.
Pathogenesis of Cyanosis in 3 consecutive phases in History in DIAGNOSIS of Raynaud’s disease
Due to sluggish circulation & extraction of 02 by the tissues.
Pathogenesis of Redness in 3 consecutive phases in History in DIAGNOSIS of Raynaud’s disease
As the attack passes off, the arterioles dilate “under the effect of metabolites” and oxygenated blood passes into the dilated
capillaries
Examination in DIAGNOSIS of Raynaud’s disease
- The radial and ulnar pulses are preserved.
2. No major gangrene, only minute patches of ulceration or gangrene may occur.
Grades of Raynaud’s disease
- First grade :
- Second grade :
- Third grade :
First grade in Grades of Raynaud’s disease
Presents only with Raynaud’s phenomena
Second grade in Grades of Raynaud’s disease
Mild trophic changes in the tips of fingers & nails
Third grade in Grades of Raynaud’s disease
Presents with gangrene of the tips of fingers.
TREATMENT of Raynaud’s disease
- conservative measures
2. Cervico-dorsal sympathectomy
conservative TREATMENT of Raynaud’s disease
- Indications
* Modalities
Indications of conservative TREATMENT of Raynaud’s disease
In the early stages of Raynaud’s disease
Modalities of conservative TREATMENT of Raynaud’s disease
- The patient is advised to avoid cold weather and to wear woolen gloves in winter time.
- Vasodilator drugs.
- Calcium channel antagonists
Cervico-dorsal sympathectomy in TREATMENT of Raynaud’s disease
- Indication
* Outcomes
Indication of Cervico-dorsal sympathectomy in TREATMENT of Raynaud’s disease
In severe cases of Raynaud’s disease
Outcomes of Cervico-dorsal sympathectomy in TREATMENT of Raynaud’s disease
- Its immediate results are good
* but usually the symptoms recur after sometime, but are at least, not severe
Definition of Raynaud’s phenomenon
Colour changes similar to those of Raynaud’s disease may accompany a large group of organic diseases.
Causes of Raynaud’s phenomenon
- Thoracic outlet syndrome.
- Buerger’s disease.
- Collagen diseases as rheumatoid arthritis, scleroderma, SLE.
- Cryogloubulinaemia.
- Drugs as chronic administration of ergot-containing drugs for migraine.
- Certain occupations as typists, pianists & laborers using vibrating tools.
- Atrophic disorders of limbs, e.g. after poliomyelitis
Treatment of Raynaud’s phenomenon
- Treatment of the cause
* Vasodilators and B-blockers are prescribed
Difference between acrocyanosis and Raynaud’s disease
- Not paroxysmal.
- It affects hands, nose, ears & L.L.
- Initial stage of pallor is absent.
4- The attack is painless & pain occurs after the attack.
- Accompanied by paraesthesia.
- In between the attacks the hands are colder than normal & there is excessive sweating of the palms.
Treatment of acrocyanosis
Sympathectomy is less effective than in Raynaud’s disease.
Erythromelalgia
Precipitated by warmth rather than cold.
It affects mainly the feet.
Main complain of Erythromelalgia
- Burning pain.
- Redness.
- The patient often immerses his feet in cold water during the attack
a vasospastic condition in which The patient often immerses his feet in cold water during the attack
Erythromelalgia
Alternative name for Erythrocyanosis Frigida
Bazin’s disease
Erythrocyanosis Frigida
- Body parts affected
- Pathogenesis
- Morphology
- Prognosis
Body parts affected in Erythrocyanosis Frigida
L.L of obese females in winter.
Pathogenesis of Erythrocyanosis Frigida
It is due to ischemic fat necrosis.
Morphology of Erythrocyanosis Frigida
There are dusky red indurated areas in the calves & ankles.
Prognosis of Erythrocyanosis Frigida
After repeated attacks, indolent ulcers will result.
vasospastic condition affecting L.L of obese females in winter.
Erythrocyanosis Frigida
vasospastic condition in which There are dusky red indurated areas in the calves & ankles.
Erythrocyanosis Frigida
vasospastic condition Precipitated by warmth rather than cold.
Erythromelalgia
vasospastic condition affects hands, nose, ears & L.L
acrocyanosis
vasospastic condition in which The attack is painless & pain occurs after the attack
acrocyanosis
vasospastic condition Accompanied by paraesthesia
acrocyanosis
vasospastic condition in which In between the attacks the hands are colder than normal & there is excessive sweating of the palms.
acrocyanosis
Vasospastic condition in which The attacks are precipitated by coldness or emotional excitement and are relived by warmth.
Raynaud’s disease
Vasospastic condition in which The attack is usually accompanied by pain
Raynaud’s disease
Types of Arteritis
- Buerger’s diseases.
- Takayasu’s diseases
- Arteritis of collagen origin
- Cranial arteritis (temporal & occipital).
- Erythema nodosum
Takayasu’s diseases in Types of Arteritis
- Autoimmune disease
- Affecting thoracic & abdominal aorta & their branches.
- Treated by cortisone.
Arteritis of collagen origin in Types of Arteritis
- Polyarteritis nodosa.
- Scleroderrna
- Rheumatoid
- SLE
Erythema nodosum in Types of Arteritis
Allergic vasculitis due to bacterial toxins
Autoimmune disease Affecting thoracic & abdominal aorta & their branches.
Takayasu’s diseases
Allergic vasculitis due to bacterial toxins
Erythema nodosum