Peripheral vascular diseases

Blood vessels of the lower limbs
1. Arteries
  1. Veins
Vasculitis
1. Large vessels
  1. Giant cell (temporal arteritis)
    1. Elderly female, headache, jaw claudication
    2. Could lead to blindness (ophthalmic artery)
  2. Takayasu arteritis
    1. Asian young female
    2. Pulseless disease, fever, night sweats
2. Medium vessels
  1. Polyarteritis nodosa
    1. Kawasaki disease
      1. Buerger disease
        Heavy smoker, young male
        Gengrene, autoamputation of digits
      2. Asian children less than 4 years old, affecting skin, lips, tongue
    2. Middle-aged men, Hep B in 30%, immune mediated
    3. Nerves, skin, kidneys
3. Small vessels
  1. Wegener
    1. Microscopic polyangiitis
      1. Churg-Strauss
        Henoch-Schonlein purpura
        Most common childhood systemic vasculitis
        Classic triad: palpable purpura, arthralgia, GI problems
        Asthma in adults, pouch-immune
        p-ANCA positive, high IgE levels
        Eosinophilia
      2. Similar to Wegener but no granuloma or nasopharungeal involvement
      3. p-ANCA positive
    2. affecting both upper and lower respiratory tracts
    3. c-ANCA positive
Atherosclerosis
1. Risk factors
  1. Tobacco smoke
    1. Hereditary
      1. Endocrine
        Obesity
        Males
        Age
        Stress
  2. Pathogenesis
    1. endothelial cell dysfunction
      1. macrophage and LDL accumulation
        Foam cell formation
        fatty streaks
        smooth cell migration
        proliferation and extracellular matrix deposition
        fibrous plaque
        complex atheroma
Intermittent claudication
1. A symptom of PAD characterized by pain, aching, or fatigue in exercising leg muscles
Aortic dissection
1. Intimal tear with dissection of blood through media of the aortic wall
Aneurysms
1. Thoracic
  1. compression of mediastinal structures
    1. Abdominal
      1. Primarily due to atherosclerosis
Investigations
1. ABI index
  1. Duplex US
    1. photoplethysmogram
Management
1. Smoking cessation
  1. Excersice
    1. Statins (anti-heperlipidemics)

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Peripheral vascular diseases

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	Creado por Fatima Alkhateeb hace más de 5 años