Clinical features of vasculitis on the basis of size of the affected blood vessel Size of blood vessel Blood vessel involved Clinical features Small vessel vasculitis (vessels smaller than arteries such as capillaries and venules) Cutaneous post‐capillary venules Palpable purpura Glomerular capillaries Haematuria, red cell casts in urine, proteinuria, and…

Four categories causing a sensation of dizziness Categories Pathophysiology Aetiology Vertigo= spinning sensation Vestibular pathology Vestibular neuritisLabyrinthitisMeniere’s disease Presyncope= fainting sensation Reduced cerebral perfusion Volume depletionNeurocardiogenic syncope Dysequilibrium= imbalance sensation Gait disorder MyelopathyPeripheral neuropathyParkinson’s disease Light-headedness= sensation of disconnection from the environment Psychological disorder AnxietyDepression Etiology of presyncope/syncope Neurally mediated…

Incidence Risk Groups Pathogenesis – May be: Clinical Features Vascular territories involved in neurological ischaemia with some of the commonly observed clinical symptoms and signs Vascular territory Commonly involved vessels Common clinical symptoms and signs Anterior circulation Internal carotid artery Anterior cerebral artery Middle cerebral artery Retinal artery Contralateral hemiparesis…

Management

differentials

May approach 33 Million cases worldwide, Gender: Slight male predominance, OnsetAge: 30-40 years old

can occur alone or in association with chronic venous insufficiency.  ANATOMY The venous system in the lower extremities consists of the  draining of blood is done by Varicose veins: visible, palpable, dilated (>4 mm), tortuous, elongated, subcutaneous veins Telangiectasias and reticular veins: are smaller and non-palpable, frequently looks like a…

Deep veins are more important in the development of chronic venous insufficiency  ↓ flow is directed abnormally from the deep to the superficial system ↓ deep and superficial veins distended with excess volume ￫ anatomic distortion of the vessel wall ↓ further valvular incompetence ↓ excess superficial venous pressures (60-…

Treatment for stasis ulcers General measures factors delaying healing venous ulcers Differential diagnosis of arterial, venous, and neuropathic foot ulcers  Characteristic Arterial ulcer* Arteriolar infarct Venous ulcer Neuropathic ulcer* SCC/BCC   10%   10%     Location Toes or pressure points  over bony prominence Lateral aspect Lower medial side Malleolar…

1: Expose patient and do General inspection: 2: Inspection of Leg: 3: Palpation DPA: dorsalis pedis artery DPN: deep peroneal nerve EDL: extensor digitorum longusEHL extensor hallucis longus AT :anterior tibial tendon 4: Auscultation: 5: Buerger’s Test (see Intermittent Claudication) 6: Neuromuscular exam:

Specific early Specific late:

IS A MEDICAL EMERGENCY Initial Stabilization Focussed History/Examination Baseline investigations Urgent surgical r/v Anticoagulation – IV heparin Arrange angiography if considered necessary Surgery within 12 hours of onset of symptoms   Definition Sudden onset of severe ischaemia  induced by distal embolization of proximal atheromatous material to the toes, resulting in…

occurs when arterial blood flow is insufficient to meet the metabolic demands of resting muscle or tissue The natural history of limb-threatening ischemia usually involves inexorable progression to amputation unless there is an intervention that results in the improvement of arterial perfusion. This is in contrast to the often benign…

  Acute Limb Ischaemia   Chronic Critical Limb Ischaemia Intermittent Claudication   Underlying Pathology     Gen. due to thromboembolism Also due to: thrombosis; trauma; other  Thrombosis superimposed on pre-existing atherosclerosis Atherosclerotic stenosis Definition           Sudden onset of severe ischaemia with assoc. sensory/motor loss and intense…

Clinical features suggestive of underlying thrombophilia Acquired causes of hypercoagulability Hereditary causes of hypercoagulability: Antithrombin III deficiency Protein C deficiency Protein S deficiency Activated protein C (APC) resistance/factor V Leiden Prothrombin gene variant Hyperhomocysteinemia Sickle cell anemia Lipoprotein A Thrombophilia SCREENING Blood tests for Hereditary Thrombophilia (*= medicare rebatable) Blood…

Traditional risk factors for thromboembolic disease RISK FACTORS FOR PE INVESTIGATIONS VQ or CTPA? VQ CTPA Less radiation dose detects clots in smaller vessels widespread availability contrast-induced nephropathy In Pregnancy – PE is a leading cause of maternal mortality. D-dimer assays are of limited usefulness Perfusion-only lung scanning using a…

OVERVIEW CLASSIFICATION A car mechanic said argumentatively to his client, a cardiac surgeon: “So Doc, look at this work. I also take valves out, grind ’em, put in new parts, and when I finish this baby will purr like a kitten. So how come you get the big bucks, when…

OVERVIEW Emergency presentations of AAA include: Prevalence and natural history 12 month AAA rupture risk by diameter AAA diameter (cm) Rupture risk (%/year) 3.0–3.9 0% 4.0–4.9 1% 5.0–5.9 1–10% 6.0–6.9 10–22% >7.0 30–50% Screening and surveillance Suggested surveillance intervals: Suggested AAA surveillance intervals AAA diameter (cm) Surveillance interval (months) 3.0–3.9…