Chronic limb ischemia by Muhamad Fathy (MD)
•
25 likes•4,941 views
This document discusses the examination of chronic limb ischemia. It covers four parts: history taking including complaints like pain, color changes, and tissue loss; inspection of the limb looking at gangrene, ulcers, color, and pulses; palpation of pulses, sensation, gangrenous tissue, and wasting; and special tests including Buerger's test, venous refilling test, and tests for thoracic outlet syndrome like Adson's test and Wright's hyperabduction test. The document provides detailed descriptions of examination findings and procedures for each part of the examination.
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Chronic limb ischemia by Muhamad Fathy (MD)
Similar to Chronic limb ischemia by Muhamad Fathy (MD) (20)
Recently uploaded
Recently uploaded (20)
Chronic limb ischemia by Muhamad Fathy (MD)
- 1. Examination of chronic limb ischemia By / Mohamed Fathy Zaidan (MD) Lecturer of General surgery
- 2. I. Complains and history taking II. Inspection III. Palpation IV. Special test
- 3. l. Complains
- 4. Complains • Pain 1- Claudication ( site- time- distance ) 2-Rest pain • Color changes • Loss of sensation and limb power (paraesthesia – paralysis) • Tissue loss • Other ischemic manifestation ( TIAs- IHD- Ischemic bowel)
- 6. Items of inspection • Gangrene • Ulcer • Color changes • Skin and nail affection (trophic changes) • Veins • Scar for sympathectomy
- 7. Gangrene • Press and see how color fade (5 cardinal manifestations) 1) Loss of color 2) Loss of pulsations 3) Loss of sensations 4) Loss warmth 5) Loss of function
- 8. Types of gangrene Dry gangrene • Shrinked , wrinkled , mummified • No odor ,, no discharge • Line of demarcation • Line of separation • Tissue above normal and healthy Wet gangrene • Swallow , edematous • Bad odor , purulent discharge, • No line of…… • Tissue above shows , edema , redness, hemorrhagic bullae ,,skip areas • Crepitus may be present.
- 9. Types of gangrene Dry gangrene Wet gangrene
- 10. Tissue loss (ulcer) • Unhealed ulcer for 2 weeks + rest pain=?? • Located distally • Describe it (site- shape- size- edge- margin- floor)
- 11. Color changes
- 12. Scar
- 13. III. Palpation
- 14. Items of palpation • Pulsations • Capillary circulation • Sensation, motor power • Palpation of gang. Part • Palpation of an ulcer • Wasting
- 15. Pulsations
- 16. Radial pulse • One of the brachial bilocation.. • Felt against…. • Lateral to the …. • Started….Ended.. • Comment on the pulse??
- 17. Dorsalis pedis pulse • Continuation of .. • Felt against…. • Lateral to the …. • Started at …
- 18. Posterior tibial pulse • One of the triple forcation • Artery of the posterior compartment • Passes between superficial and deep Ms. Layer • Started … ended….by dividing into .. • Where to feel it??
- 19. Popliteal pulse • PA. started at .. As a continuation of …ended at …by becoming… • Felt against…
- 21. Popliteal pulse
- 22. Fuchsig’s test
- 23. Common Femoral pulse • Started. .. As a continuation of…. Ended…. By becoming… • Artery of the extensor compartment of the thigh • Felt at… against….
- 25. Wasting
- 27. 1-Buerger’s test 2-Venous refilling test 3-Cold water test 4-Tests for thoracic outlet syndrome • Elevated arm stress test • Adson’s test • Wright's hyperabduction test 5-Allen’s test 6-BRANHAM’S test
- 28. Buerger’s test • Patient on his back • A-Rising the affected limb cause blanching within 2-3 M. • B-Lowering the leg below the below the horizontal plane leads to cyanotic congestion • Bureger’s angle : is the angle of elevation ay which the pallor occurs • Normally no change of color occur whatever the position of the limb.
- 29. Venous refilling test • In the horizontal plane the veins of the foot and the leg are normally filled • Collapsed veins= poor circulation • Elevate the leg to empty the V. then hang it down and estimate the V refilling time • Normally V. refilled in 5-10 sec. • May prolonged to several Min. in sever ischemia.
- 30. Cold and warm water test for Reynold’s phenomena • Dip the fingers in cold water : pallor will occur • Take out of water : swallon and cyanosed • After some time : red and engorged
- 32. Elevated arm stress test (for TOS) • In this position, the patient opens and closes his hands repeatedly • Positive test reproduces pain, heaviness or arm weakness within the first minute after beginning
- 33. ADSON or scalene maneuver Radial pulse diminishes and disappears on turning chin to same side. Decreases space between scaleneus anterior and medius .
- 34. Wright's hyperabduction test Arm hyperabducted to 180°leads to diminishing radial pulse. Neurovascular structures compressed in subcoracoid region by pectoralis minor tendon, head of humerus or coracoid process.
- 35. Allen’s test
- 37. BRANHAM’S test • This is performed when arteriovenous fistula is suspected. • A pressure on the artery proximal to the fistula will cause reduction in the size of swelling, disappearance of bruit, fall in PR.
- 38. Thank you