The Arteries Nick Harvey
Limb Ischaemia: Definitions <ul><li>Acute </li></ul><ul><ul><li>Sudden interruption if blood supply </li></ul></ul><ul><ul...
Limb Ischaemia: Symptoms of Chronic Ischaemia <ul><li>Claudication </li></ul><ul><li>Rest Pain </li></ul><ul><li>Impotence...
Limb Ischaemia: Presentation of Acute Ischaemia <ul><li>Pain </li></ul><ul><li>Pallor </li></ul><ul><li>Perishingly cold <...
Limb Ischaemia: History <ul><li>Claudication Pain </li></ul><ul><ul><li>Cramping muscle pain that is caused by exercise an...
Limb Ischaemia: History <ul><li>Rest Pain </li></ul><ul><ul><li>Continuous pain present at rest </li></ul></ul><ul><ul><li...
Limb Ischaemia: Aorto-iliac Occlusive Disease <ul><li>Bilateral Claudication </li></ul><ul><li>Impotence </li></ul><ul><li...
Limb Ischaemia: Femoro-popliteal Occlusive Disease <ul><li>Unilateral Calf Claudication </li></ul><ul><li>Absent Pulses Be...
Limb Ischaemia: Tibio-peroneal Occlusive Disease <ul><li>Unilateral Foot Claudication </li></ul><ul><li>Absent Pulses Belo...
Limb Ischaemia: General Examination <ul><li>Pulse, BP both arms </li></ul><ul><li>Pallor </li></ul><ul><li>Heart </li></ul...
Limb Ischaemia: Local Examination Inspection <ul><li>Skin </li></ul><ul><li>Nails </li></ul><ul><li>Trophic changes </li><...
Limb Ischaemia: Local Examination Inspection <ul><li>Colour </li></ul><ul><ul><li>Horizontal </li></ul></ul><ul><ul><li>El...
Limb Ischaemia: Local Examination Palpation & Auscultation <ul><li>Palpate </li></ul><ul><li>Skin temperature </li></ul><u...
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010 Arteries - Introduction to Clinical Surgery Lectures

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Lecture on arteries from a series of lectures on an introduction to clinical surgery. It has been devised with medical students in mind.

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010 Arteries - Introduction to Clinical Surgery Lectures

  1. 1. The Arteries Nick Harvey
  2. 2. Limb Ischaemia: Definitions <ul><li>Acute </li></ul><ul><ul><li>Sudden interruption if blood supply </li></ul></ul><ul><ul><li>Caused by emboli, trauma </li></ul></ul><ul><ul><li>No collaterals </li></ul></ul><ul><li>Chronic </li></ul><ul><ul><li>Gradual obstruction of blood supply </li></ul></ul><ul><ul><li>Caused by atherosclerosis </li></ul></ul><ul><ul><li>Collaterals often well developed </li></ul></ul><ul><li>Acute on Chronic </li></ul><ul><ul><li>Acute thrombosis </li></ul></ul>
  3. 3. Limb Ischaemia: Symptoms of Chronic Ischaemia <ul><li>Claudication </li></ul><ul><li>Rest Pain </li></ul><ul><li>Impotence </li></ul><ul><li>Commonly associated with: </li></ul><ul><ul><li>CVS – hypertension, angina, MI </li></ul></ul><ul><ul><li>Cerebrovascular – strokes, TIAs </li></ul></ul><ul><li>Risk factors: </li></ul><ul><ul><li>smoking, hyperlipidaemia, DM, sedentary life </li></ul></ul>
  4. 4. Limb Ischaemia: Presentation of Acute Ischaemia <ul><li>Pain </li></ul><ul><li>Pallor </li></ul><ul><li>Perishingly cold </li></ul><ul><li>Pulseless </li></ul><ul><li>Paresthesia </li></ul><ul><li>Paralysis </li></ul>
  5. 5. Limb Ischaemia: History <ul><li>Claudication Pain </li></ul><ul><ul><li>Cramping muscle pain that is caused by exercise and relieved by rest </li></ul></ul><ul><ul><li>Due to muscle ischaemia </li></ul></ul><ul><ul><ul><li>Claudication distance: increasing, decreasing or static? </li></ul></ul></ul><ul><ul><ul><li>Does it affect patient’s lifestyle? </li></ul></ul></ul>
  6. 6. Limb Ischaemia: History <ul><li>Rest Pain </li></ul><ul><ul><li>Continuous pain present at rest </li></ul></ul><ul><ul><li>Toes or forefoot </li></ul></ul><ul><ul><li>Increased by exercise and warmth </li></ul></ul><ul><ul><li>Relieved by hanging legs over the side of the bed </li></ul></ul><ul><ul><li>Rest pain is due to nerve ischaemia </li></ul></ul><ul><ul><ul><li>Diabetic neuropathy sufferers? </li></ul></ul></ul>
  7. 7. Limb Ischaemia: Aorto-iliac Occlusive Disease <ul><li>Bilateral Claudication </li></ul><ul><li>Impotence </li></ul><ul><li>Bilateral decreased or absent pulsations </li></ul>
  8. 8. Limb Ischaemia: Femoro-popliteal Occlusive Disease <ul><li>Unilateral Calf Claudication </li></ul><ul><li>Absent Pulses Below Femoral Artery </li></ul>
  9. 9. Limb Ischaemia: Tibio-peroneal Occlusive Disease <ul><li>Unilateral Foot Claudication </li></ul><ul><li>Absent Pulses Below Popliteal </li></ul><ul><li>Rest pain, ulcers or gangrene </li></ul>
  10. 10. Limb Ischaemia: General Examination <ul><li>Pulse, BP both arms </li></ul><ul><li>Pallor </li></ul><ul><li>Heart </li></ul><ul><li>Scars of previous arterial surgery </li></ul>
  11. 11. Limb Ischaemia: Local Examination Inspection <ul><li>Skin </li></ul><ul><li>Nails </li></ul><ul><li>Trophic changes </li></ul><ul><ul><li>Hair loss, thin skin, muscle wasting </li></ul></ul><ul><li>Ulcers </li></ul><ul><ul><li>check pressure areas including between digits </li></ul></ul><ul><li>Gangrene </li></ul>
  12. 12. Limb Ischaemia: Local Examination Inspection <ul><li>Colour </li></ul><ul><ul><li>Horizontal </li></ul></ul><ul><ul><li>Elevated </li></ul></ul><ul><ul><ul><li>determine vascular (Buerger’s) angle </li></ul></ul></ul><ul><ul><li>Depended </li></ul></ul>
  13. 13. Limb Ischaemia: Local Examination Palpation & Auscultation <ul><li>Palpate </li></ul><ul><li>Skin temperature </li></ul><ul><li>CRT </li></ul><ul><li>Pulses </li></ul><ul><ul><li>DP, PT, popliteal, femoral, aorta, carotids, brachial, radial </li></ul></ul><ul><li>Auscultation </li></ul><ul><ul><li>All major arteries </li></ul></ul>

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