vascular - podiatry Flashcards
risk factors of PAD
smoking, hypertension, dyslipidaemia, DM, Male gender, CVD, elevated plasma hmyocysteine levels, sedentary lifestyle, age, family Hx of PAD, other known forms of atherosclerosis
clinical signs and symptoms of PAD
anhydrotic skin, minimal hair growth, IC, general thickening of the nail (onychauxis) pulslessness, temperature
reasons for Anhidrotic skin
not meeting metabolic demands of the dermal structures(arterial insufficiency) , fungal infections like tinea pedis, non- enzymatic glycosilation, surgery affecting the sweat response.
diabetes and PAD together
higher incidence of lower leg arterial involvement, greater severity of disease process, likelihood of distal ishemic ulcers and gangrene and higher chance of amputation
anhydrtoc skin appearance
dry, flaky skin affecting the dorm or plantar surfaces and extending up the leg
causes of onychauxis
damage to mnail matrix - trauma form single blow of micro trauma from footwear, Fingal nail infection, systemic disturbance like PAD(impaired arterial insufficiency), also due to ageing and
what is intermittent claudication
transient ischemic muscle pain occurring due to exercise. when increased exercise demands metabolites, by products accumulate activating pain receptors therefore inducing pain symptoms. reduction of exercise, reduces metabolic demand therefore reducing pain.
clinical features of Intermittent claudication
cramp like pain and tiredness. (at muscle compartment that is affected) can be at buttock-thigh-calf (aortoilliac), calf + plantar (femoropopliteal) plantar (infrapopliteal)
characteristic of pain between compartment syndrome and IC, venous congestion
ic: cramp like, tiredness, tightness
compartment+ venous congestion: tightness, bursting pain
location of discomfort (IC vs spinal stenosis)
IC - buttock, hip, thick, calf, plantar foot
Spinal - buttock, hip and thigh
further diagnosis of extent of PAD process
duplex scan - provides info on location and extent of arterial disease and type of lesion present
what is critical limb ischemia
the End stage of PAD where peripheral flow is reduced to the point at which a Pt has chronic ishemia rest pain.
what is rest pain
persistent pain at night due to nerve ishemia leading to ishemic neuropathy. occurs when legs are elevated. gravity assists decrease of pain.
what does Rest pain indicate
two haemodynamically significant arterial blocks in series
clinical features of rest pain
tearing, pulling agonising discomfort often with burning throbbing and tingling
further diagnosis for rest pain nada IC
vascular screening from GP - duplex ultrasound
ishaemic ulcers
wounds caused by lack of arterial flow to the capillary bed. causing tissue damage that is unable to repair as a result
signs and symptoms of ischemic ulcers
usaully brown, yellow or black. slight depression and borders look like they have been punched out. incase of infection - surrounding tissue (erythemous) commonly found at apex. extremely painful
rest pain Vs. night cramps
rest pain - tingling, throbbing, burning discomfort. (at plantar foot)
night cramps - at calf muscles, due to neurological hyper excitability.
what is gangrene
necrotic tissue repressenting end stage arterial insufficiency. affects distal extremities first.
possible causes for gangrene
atherosclerosis, Myocardial infarction, embolism or valvular heart disease
dry vs wet gangrene
dry - possible due to ishemia
wet/moist - bacterial infection
what may venous hypertension cause
pain, swelling oedema, skin changes and ulcerations
risk factors with chronic venous insufficiency
age, gender, family history, varicose vein, obesity, varicosities, pregnancy, phlebitis, previous leg injury
risk factors for CVD
smoking, overweight, diabetes, genes, depression, age, diet, sedentary lifestyle, cholesterol, ethnicity
risk factors of atherosclerosis
hyperlydidemia, lifestyle, hypertension, smoking, genetics
what is the difference between thrombosis and embolism
thrombosis - blot in the blood vessel
embolis.- clot that moves
aneurism - when it bulges out