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Examination of vascular disorder by Dr Min

Examination of vascular disorder by Dr Min






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    Examination of vascular disorder by Dr Min Examination of vascular disorder by Dr Min Presentation Transcript

    • Examination ofvascular disorder A.P DR. MIN OO (SURGERY)
    • Outline 2 Introduction Learning objectives Peripheral occlusive arterial disease Venous disorder Applied anotomy & pathophysiology for arterial supply & venous drainage of lower limb Video show for examination peripheral vascular disease Video show for examination of varicose vein 7/31/2012
    • Introduction 3Arterial Peripheral occlusive arterial disease (POAD) is predominantly affects the lower limbs. It may be acute or chronic Acute limb ischaemia is surgical emergency Chronic limb ischaemia may be complication of diabetes or Burger`s disease 7/31/2012
    • Introduction 4Venous Congenital anormalies( Klippel Trenaunay syndrome) Inflammation ( thrombophlenitis) Thrombosis & its sequalae Acute thrombosis DVT( deep vein thrombosis) Varicose vein (V.V) 7/31/2012
    • Learning objectives 5 To apply the basic science knowledge of anatomy & pathophysiology in clinical examination To know the clinical features of Peripheral Occlusive Arterial Disease(POAD) (acute & chronic ischaemic limbs) and deep vein thrombosis (DVT) & varicose veins(V.V) To able to examine and apprehend the physical signs of the patient with POAD & V.V 7/31/2012
    • Peripheral occlusive arterial disease (POAD) 6 Peripheral occlusive arterial disease (POAD) is caused bya) atherosclerosis, thrombosis , embolism,b) vascular trauma,c) complications of DMd) Burger`s disease 7/31/2012
    • Peripheral occlusive arterial disease (POAD) 7 Male> female Risk factors are ??? Cigarette smoking Hypertension Hyperlipidaemia Diabetes mellitus Critical ischaemia when reduction of blood flow leads to tissue viability can not sustained. 7/31/2012
    • Clinical features (POAD) 8Chronic ischaemia ??? Intermittent claudication in - calf( femoral), - thigh (iliac), buttock ( aortic ) Cold peripheries Prolonged capillary refill time Rest pain, especially at night Venous guttering Absent pulses Arterial ulcer Gangrene over pressure point 7/31/2012
    • Clinical features (POAD) 9Acute ischaemia ??? ( 6 P & 2 M) Pain pallor Pulselessness Paraesthesia Paralysis Perishing cold Pistol-shot onset Mottling ( late sign) Muscle rigidity ( late sign) 7/31/2012
    • Deep vein thrombosis(DVT) 10Epidemiology DVT is very common in surgical patients Affect 10-30 % of all general surgical patients over 40 years who undergo a major operation PE is a common cause of sudden death in hospital patients ( 0.5-3 % of patients die from P.E) 7/31/2012
    • Deep vein thrombosis(DVT) 11 Ilio femoral thrombous Migratrion of thrombus to the lungs ( P.E) pulmonary embolism  fatal Destruction of valves in deep venous system  chronic venous hypertension  post-phlebitis limb(PPL) 7/31/2012
    • Deep vein thrombosis(DVT) 12AetiologyRisk factors ??? Increasing age >40 years Immobilization Obesity Malignancy Inflammatory bowel disease Anti coagulant protein deficiency (e.g. antithrombin III, protein C, protein S) Trauma Sepsis Heart disease Pregnancy/ oestrogen 7/31/2012
    • Deep vein thrombosis(DVT) 13Virchow`s triad ??? Stasis Endothelial injury hypercoagulopathy 7/31/2012
    • Deep vein thrombosis(DVT) 14Pathology Aggregation of platelets in the valve pokets Activation of clotting cascade producing fibrin Fibrin production overwhelms the natural anti-coagulating (fibrinolytic ) system Natural H/O  resolve / PE/ CVH(PPL) 7/31/2012
    • Deep vein thrombosis(DVT) 15Clinical featuresDVT Asymptomatic Calf tenderness Ankle edema Mild pyrexiaP.E ??? Substernal chest pain Dyspnoea Circulatory arrest Pleuritic chest pain haemoptysis 7/31/2012
    • Deep vein thrombosis(DVT) 16Clinical featuresPPL H/O of DVT Aching limb Leg swelling Venous eczema Venous ulceration Inverted bottle-shape leg 7/31/2012
    • Arterial Anatomy 17 7/31/2012
    • Arterial Anatomy 18 7/31/2012
    • Arterial Anatomy 19 7/31/2012
    • Venous anatomy 20 Superficial Deep perforator 7/31/2012
    • 21 7/31/2012
    • Saphenofemoral junction 22 Great saphenous veindorsal venous arch 7/31/2012
    • 23 Popliteal veinSaphenopopliteal junctionShort saphenous vein dorsal venous arch ( lateral side of foot) 7/31/2012
    • Perforating vein 24 Blood from superficial veins enters the deep veins at the saphenopopliteal and saphenofemoral junctions In the calf and thigh there are a number of valved perforating veins It penetrates the deep fascia at an obligue angle  compressed when muscles contract during walking (Calf m/s pump ) 7/31/2012
    • Perforating vein 25 The most important are the direct perforating veins of the medial calf and the mid-thigh 1. mid thigh perforators ( Dodd )  Hunter’s canal ( adductor hiatus ) 2. Lower leg perforators ( Cockett )  I, II & III I  5cm II  10cm above medial malleous III  15cm 7/31/2012
    • 26 Dodd’s perforator Boyd’s perforator III (15 cm) II (10 cm) Cockett’s perforatorsI (5 cm) May or Kuster 7/31/2012
    • Deep veins 27 The deep veins of the lower limb arise from 3 pairs of venae commitantes  anterior and posterior tibial and peroneal veins ant tibial vein  from dorsal venous arch post and peroneal vein  from plantar arch These veins intercommunicate and join in the popliteal fossa  form the popliteal vein  passes up through the adductor canal becomes the femoral vein in the thigh 7/31/2012
    • 28 Deep (profunda) femoral veins drain from thigh muscles  terminate in femoral vein Femoral vein passes deep to the inguinal lig.  external iliac vein common iliac vein  IVC 7/31/2012
    • Deep femoral vein 29 Femoral veinPoplitealvein 7/31/2012
    • 30Video show for PVD & V.V 7/31/2012