Berger's disease is a rare disease of the arteries and veins in the arms and legs. In Berger's disease also called thromboangiitis obliterans

1. Berger's disease

2. INTRODUCTION
Berger's disease is a rare disease of the arteries and
veins in the arms and legs. In Berger's disease also
called thromboangiitis obliterans ( TAO) your blood
vessels become inflamed, swell and can become
blocked with blood clots (thrombi).
This eventually damages or destroys skin tissues and
may lead to infection and gangrene. Berger's disease
usually first shows in your hands and feet and may
eventually affect larger areas of your arms and legs

4. Symptoms
Berger's disease symptoms include:
 Tingling or numbness in the hands or feet.
 Pale, reddish or blue-tinted hands or feet.
 Pain that may come and go in your legs and feet or in your arms and hands.
This pain may occur when you use your hands or feet and eases when you stop
that activity (claudication), or when you're at rest.
 Inflammation along a vein just below the skin's surface (due to a blood clot in
the vein).
 Fingers and toes that turn pale when exposed to cold (Raynaud's
phenomenon).
 Painful open sores on your fingers and toes

5. Causes
 The exact cause of Berger's disease is unknown. While tobacco
use clearly plays a role in the development of Berger's disease,
it's not clear how it does so. It's thought that chemicals in
tobacco may irritate the lining of your blood vessels, causing
them to swell.
 Experts suspect that some people may have a genetic
predisposition to the disease. It's also possible that the disease
is caused by an autoimmune response in which the body's
immune system mistakenly attacks healthy tissue.

6. Risk factors
Tobacco use
• Cigarette smoking greatly increases your risk of Berger's disease.
But Berger's disease can occur in people who use any form of
tobacco, including cigars and chewing tobacco.
• People who smoke hand-rolled cigarettes using raw tobacco and
those who smoke more than a pack and half of cigarettes a day
may have the greatest risk of Berger's disease. The rates of
Berger's disease are highest in areas of the Mediterranean, Middle
East and Asia where heavy smoking is most common.

7.  Chronic gum disease
Long-term infection of the gums has been linked to the
development of Berger's disease, though the reason for this
connection isn't yet clear.
 Sex
Berger's disease is far more common in males than in females.
However, this difference may be linked to higher rates of smoking
in men.
 Age
The disease often first appears in people less than 45 years old.

8. Complications
• If Berger's disease worsens, blood flow to your arms and legs
decreases. This is due to blockages that make it hard for blood to
reach the tips of your fingers and toes. Tissues that don't receive
blood don't get the oxygen and nutrients they need to survive.
• This can cause the skin and tissue on the ends of your fingers and
toes to die (gangrene). Signs and symptoms of gangrene include
black or blue skin, a loss of feeling in the affected finger or toe, and
a foul smell from the affected area. Gangrene is a serious condition
that usually requires amputation of the affected finger or toe.

9. Diagnosis
Blood tests
• Blood tests to look for certain substances can rule out other conditions that may cause
similar signs and symptoms. For instance, blood tests can help rule out autoimmune
diseases such as scleroderma or lupus, blood-clotting disorders, and diabetes.
The Allen's test
• Your doctor may perform a simple test called the Allen's test to check blood flow through
the arteries carrying blood to your hands. In the Allen's test, you make a tight fist, which
forces the blood out of your hand. Your doctor presses on the arteries at each side of
your wrist to slow the flow of blood back into your hand, making your hand lose its
normal color.
• Next, you open your hand and your doctor releases the pressure on one artery, then the
other. How quickly the color returns to your hand may give a general indication about the
health of your arteries. Slow blood flow into your hand may indicate a problem, such as
Berger's disease.

10.  Angiogram
An angiogram helps to see the condition of your arteries. An angiogram
can be done non-invasively with the use of CT or MRI scans.
Or it may be done by threading a catheter into an artery. During this
procedure, a special dye is injected into the artery, after which you
undergo a series of rapid X-rays. The dye helps make any artery
blockages easier to see on the images.
Your doctor may order angiograms of both your arms and your legs —
even if you don't have signs and symptoms of Berger's disease in all of
your limbs. Berger's disease almost always affects more than one limb,
so even though you may not have signs and symptoms in your other
limbs, this test may detect early signs of vessel damage

11. Treatment
Smoking cessation
• Although no treatment can cure Berger's disease, the most effective way to stop the disease
from getting worse is to quit using all tobacco products. Even a few cigarettes a day can
worsen the disease.
• Your doctor can counsel you and recommend medications to help you stop smoking and stop
the swelling in your blood vessels. You'll need to avoid nicotine replacement products
because they supply nicotine, which activates Berger's disease. There are non-nicotine
products that you can use.
• Another option is a residential smoking cessation program. In these programs, you stay at a
treatment facility, sometimes a hospital, for a set number of days or weeks. During that time
you participate in daily counseling sessions and other activities to help you deal with the
cravings for cigarettes and to help you learn to live tobacco-free.

12. Other treatments
Other treatment approaches exist for Berger's disease,
but are less effective than quitting smoking. Options
include:
 Medications to dilate blood vessels, improve
blood flow or dissolve blood clots
 Intermittent compression of the arms and legs to
increase blood flow to your extremities
 Spinal cord stimulation
 Amputation, if infection or gangrene occurs

13. Prevention
 Quit using tobacco in any form here's no vaccine or behavior
modification that can prevent a person from developing Berger's
disease. However, quitting smoking can prevent progression of
the disease.
 Virtually everyone who has Berger's disease has used tobacco in
some form, most prominently cigarettes. To prevent Berger's
disease, it's important to not use tobacco

14. Nursing Management
 Provide for ulcer debridement and healing
 Remove dead or damaged material from the wound, using wet-to-dry dressing
with saline solution and coarse-mesh gauze filled with cotton
 Consider using an enzymatic debrided to aid removal of debris.
 Provide additional intervention to promote venous return and healing, maximize
comfort and provide client education for measures to prevent venous stasis
ulcer.
 Administer medications which may include antibiotics.
 The patient is encouraged to make the lifestyle changes necessitated by the
onset of a chronic disease, including pain management and modifications in diet,
activity, and hygiene (skin care).
 The nurse assists the patient in developing and implementing a plan to stop
using tobacco.

15. the end
By – Nitin sharma