Clinical features & Diagnosis of Pulmonary Vascular Diseases
History-Taking & Physical Examination in Vascular Diseases.
-
Upload
isabel-mason -
Category
Documents
-
view
309 -
download
2
Transcript of History-Taking & Physical Examination in Vascular Diseases.
![Page 1: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/1.jpg)
History-Taking & Physical Examination in Vascular
Diseases
![Page 2: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/2.jpg)
Aim – To reach for a Presumptive Diagnosis
![Page 3: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/3.jpg)
How to take the History
• Establish a rapport with patient introduce yourself.
• Initiate by asking – what made him to seek medical advice.
• Listen without interruption.
• Wait for answers before asking another question.
![Page 4: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/4.jpg)
Don’ts of history taking
• Do not interrupt the patient.
• Do not use medical terminology.
• Do not ask irrelevent questions
• Do not ask leading questions.
• Do not be abrupt or impatient.
![Page 5: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/5.jpg)
The Present Complains
• Ask the patient to tell you what made him to seek medical advice.
• Record the answer in patients words.
![Page 6: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/6.jpg)
History of Presenting Complains
• Details of the history of the main complaints.
- when did it start
- what was the first thing noticed
- progress since then
- ever had it before.
![Page 7: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/7.jpg)
History of Presenting Complains
• S – Site
• O – Onset
• C – Character
• R – Radiation
• A – Association
• T – Timing/Duration
• E – Exacerbating & alleviating factors
• S - Severity
![Page 8: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/8.jpg)
Direct Questioning
• Specific questions about the diagnosis you have in mind.
- Risk factors.
- Review of relevant system.
![Page 9: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/9.jpg)
• Past Medical History
• Drug History
• Family History
• Social History
• Habits
![Page 10: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/10.jpg)
• Vascular Diseases
- Arterial
- Venous
- Lymphatic
![Page 11: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/11.jpg)
Arterial Diseases
• Electively – Chronic Symptoms• Acutely – Limb threatening disorders• Pain
Intermittent Claudication
Rest pain• Tissue loss
Ulcer
Gangrene
![Page 12: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/12.jpg)
• Acute arterial occlusion
Sudden onset
Severe, Shocking pain
Diffuse
Associated Symptoms
![Page 13: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/13.jpg)
• Chronic Arterial Insuffciency: Intermittent Claudication Site – depends on the level & extent of
arterial disease - Cramp like pain - Consistantly reproduced by same level of
exercise - Completely & quickly relieved by rest - Claudication distance
![Page 14: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/14.jpg)
• Rest Pain
- continuous severe pain, aching in nature
- occurs in distal part of foot
- often relieved by putting the leg below the
level of heart
- movement or pressure causes exacerbn.
![Page 15: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/15.jpg)
• Ulcer – area of discontinuity of surface epithelium• Gangrene – Dead tissue - Duration, Site. - what drew the patient’s attention to the ulcer - other symptoms - progression - persistance - multiplicity
![Page 16: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/16.jpg)
Examination
• Inspection
- Expose
- Compare
![Page 17: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/17.jpg)
• Look For
![Page 18: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/18.jpg)
• Ulcer
site, shape, size, no.
edge, floor, deapth, discharge, surrounding area.
Base
![Page 19: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/19.jpg)
![Page 20: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/20.jpg)
• Vascular Angle
Or Buerger’s angle
Normal-straight leg can be raised by 90* & foot rmains pink.
Ischemia – elevation to 15-30*cause pallor
• Dependant rubor
![Page 21: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/21.jpg)
• Venous Filling
Normal – veins of foot are full of blood
Ischemia – veins are collapsed & looks like pale blue gutters
- Guttering of veins
![Page 22: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/22.jpg)
Palpation
• Temperature
which foot – warm/cold.
level at which change occurs
• Tenderness
• Capillary filling
![Page 23: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/23.jpg)
Feel for P. pulses & grade
![Page 24: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/24.jpg)
• Peripheral Nerves Examination
- Sensory
- Motor
• Auscultation
- Bruit
![Page 25: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/25.jpg)
Venous diseases
• Common Presentation
- Varicose veins
Asyptomatic, Cosmetic, Dull aching pains, Feeling of heaviness, Itching/Eczema, superficial thrombophlebitis, bleeding, Ulceration, Saphenavarix.
![Page 26: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/26.jpg)
• Primary – Venous valve failure
• Secondary – Post thrombotic
- Congenital Malformations
![Page 27: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/27.jpg)
![Page 28: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/28.jpg)
Examine both supine & standing
![Page 29: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/29.jpg)
Touniquet Test–Identify clinically site of reflux from deep to superficial veins-Identify incompetant perforators – tie tourniquet above suspected perforator
![Page 30: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/30.jpg)
Lymphatic diseases
• Lymphangitis – inflamation of lymphatics.
• Lymphedema – faiure of lymph drainage.
Protein rich fluid accumulates in tissue
![Page 31: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/31.jpg)
Lymphedema
• Primary
- congenital – at birth
- Precox - adolescence
- Tarda - middle age
Lymphatic abnormalities – aplasia, hypoplasia, hyperplasia.
![Page 32: History-Taking & Physical Examination in Vascular Diseases.](https://reader038.fdocuments.net/reader038/viewer/2022102707/56649cd75503460f9499fa5c/html5/thumbnails/32.jpg)
• Secondary :
- Infection
- Surgery
- Radiation
- Trauma