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17225308
A 63 Year old smoker with leg pain
Description
Mind Map on A 63 Year old smoker with leg pain, created by Alya Almualla on 11/03/2019.
Mind Map by
Alya Almualla
, updated more than 1 year ago
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Created by
Alya Almualla
almost 6 years ago
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Resource summary
A 63 Year old smoker with leg pain
Due to
Peripheral Vascular Disease
Circulation disorder due to narrowing or blockage of blood vessels
Earliest sign
Pain in the calf muscles
Increases with exercise and subsides with rest
Fontaine Stages
Stage 1
Asymptomatic
Stage 2
Intermittent claudication
Differential diagnosis of claudication
Musculoskeletal claudication
Arthritis
Chronic compartment syndrome
Muscle strain
Symptomatic Baker cyst
Neurologic claudication
Nerve entrapment
Nerve root compression
Herniated disc
Radiculopathy
Peripheral neuropathy
Diabetes mellitus
Alcohol abuse
Spinal stenosis
Pseudoclaudication
Vascular claudication
PVD
DVT
Popliteal artery entrapment
Vasculitis
Venous insufficiency
Muscle pain on mild exertion
Relieved by a short period of rest
Early-stage peripheral artery disease
Stage 3
Rest Pain
Stage 4
Ischemic Ulcers or Gangrene
Causes
Atherosclerosis
Pathogenesis
Physical or chemical insults to the endothelial cell layer of arteries
The fatty streak
Stable and Unstable Plaques
Injury to the arms or legs
Irregular anatomy of muscles or ligaments
Infections
CAD
Venous problem
Deep Vein Thrombosis
Virchow’s triad
Stasis
Hypercoagulability
Endothelial damage
Signs and symptoms
Asymmetrical edema
Erythema
Warmth
Asymmetrical calf swelling
Asymmetrical localized pain
Complications
Pulmonary embolism
Post thrombotic syndrome
Acute GI bleeding
Investigations
Full blood count
D-dimer lab test
Liver function test
Urea and creatinine
INR
APTT
Venous duplex ultrasound
Venography
CT and MRI
Chest imaging
Causes and Risk factors
Immobility
Birth control use
Pregnancy
Smoking
Obesity
Genetics
Varicose Veins
Risk factors
Women
Aging
Prolonged standing
Crossing knees for long time
Obesity
Pregnancy
Family history
Signs and symptoms
Dark blue or purple veins
Spider veins
Bulging and twisted veins
Heavy feeling in legs
Burning and throbbing muscle cramping in lower legs
Itchiness and redness around veins
Pain worsened after standing for long time
Diagnosis
Physical examination and ultrasound
Chronic Venous Insufficiency
Causes
DVT
Phlebitis
Congenital defects
Signs and symptoms
Ulcers
Hyperpigmentation
Pruritis
Varicose veins
Pain
Edema
Diagnosis
Duplex ultrasound & venography
Vasculitis
Inflammation of the blood vessels
Mechanisms
Immune mediated vasculitis
Immune complex deposition
ANCA
Perinuclear
Cytoplasmic
Direct invasion by microorganism
Radiation, mechanical trauma or toxins
Clinical features
Fever / Arthralgia / Myalgia / Malaise
Classification
Based on
Size of Vessel
Anatomical Site
Histological Features
Large Vessel Vasculitis
Giant cell arteritis "Temporal arteritis"
Above the age of 50
Affects ophthalmic artery
Sudden blindness
Takayasu disease "Pulseless disease"
Females less than 40
Medium Vessel Vasculitis
Polyarteritis Nodosa
Necrotising arteritis “immune complex mediated”
Kawasaki disease "Mucocutaneous lymph node syndrome"
Children below 4 years / Common in boys
Delayed hypersensitivity reaction
Buerger’s disease "Thromboangiitis obliterans"
Males / Heavy smokers / Below 35
Wegener’s granulomatosis
Necrotizing granulomas
Adult males
Churg-Strauss Syndrome
History of airway allergic hypersensitivity (atopy)
Small Vessel Vasculitis
Henoch-Schonlein Purpura (HSP)
Children
IgA and C3 deposit
After acute URTI
Risk factors
Modifiable
Diabetes
High cholesterol
High blood pressure
Overweight
Physical inactivity
Smoking or use of tobacco products
Non-modifiable
Age "Above 50"
History of heart disease
Male gender
Postmenopausal women
Family history
High cholesterol
High blood pressure
Peripheral vascular disease
Complications
Due to decreased or absent blood flow
Amputation
Poor wound healing
Restricted mobility
Severe pain
Stroke
Investigations
Imaging
ABI
Duplex ultrasonography
Anatomic information
Hemodynamic information
MRA
Angiography
CT
DSA
Physical exam
Ankle-Brachial Index
Blood tests
CBC
Blood urea / Nitrogen / Creatinine / Electrolyte
Lipid profile
Coagulation tests
Management
Drugs
Cilostazol
MOA
Phosphodiestrase 3 inhibitors
AE
Headache / Diarrhea / heat intolerance / Abnormal stool / Increased heart rate / Palpitations
Dipyridamole
MOA
Inhibit the cellular re-uptake of adenosine into platelets phosphpdiesterase enzymes
AE
Bleeding
Pentoxifylline
MOA
Competitive nonselective phosphodiesterase inhibitor
AE
Belching / Bloating / Stomach discomfort or upset / N&V
Aspirin
MOA
Cox 2 inhibitor
AE
GIT bleeding
Clopidogrel / Ticlopidine
MOA
Inhibit ADP
AE
Bleeding
Statin
MOA
Competitively inhibiting HMC-CoA reductase
AE
Hepatotoxicity / Myopathy / Gi upset / Cataracts
Interventional procedures
Angioplasty
Stenting
Atherectomy
Surgical procedures
Peripheral artery bypass surgery
Atherosclerosis endarterectomy
Media attachments
2 (binary/octet-stream)
1 (binary/octet-stream)
3 (binary/octet-stream)
Index (binary/octet-stream)
Angiography (binary/octet-stream)
D (binary/octet-stream)
Hs (binary/octet-stream)
Taka (binary/octet-stream)
Kwa (binary/octet-stream)
Nod (binary/octet-stream)
T Em (binary/octet-stream)
Ch (binary/octet-stream)
We (binary/octet-stream)
Bur (binary/octet-stream)
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