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7/31/2019 BUERGERS SYNDROME final report
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DEFINITION
It is a chronic diseasecharacterized by a combination ofinflammation and clots in the small
and medium-sized arteries andveins of the upper and lower limbsthat obstructs blood flow, usuallyleading to gangrene.
A.K.A. Thromboangiitis Obliterans (TAO)
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HISTORY
First reported case in an article entitled "A strange form of
endarteritis and endophlebitis withgangrene of the feet."
1879
VonWiniwarter
Published a detailed description of thedisease in which he referred to"presenilespontaneous gangrene
Discussed the pathological findings in11 limbs amputated from Jewishpatients in Mt. Sinai Hospital in NewYork
1908
Leo Buerger
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ETIOLOGY
strongly associated
with...
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EPIDEMIOLOGY
Gender Males are affected more than females Ratio of approximately 75 :1
Age 20-40 years old
Race
> Oriental race; South-east Asia, India andMiddle East
Highest incidence: Natives of India, Korea,
Japan and Israeli Jews < African origin, northern European, USA
Incidence
8 cases per 100,000 in the generalpopulation
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ASSESSMENT FINDINGS
1) Two or more limbs are affected2) Numbness, tingling, burning
sensation, or pain in theaffected limb3) Intermitent Claudication4) Raynauds Phenomenon5) Decreased or absent peripheral
pulses6) Foot or hand may be pale and
cold or have redenned skin7) Enlarged, red, tender cord-like
veins8) Ulceration and gangrene
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ASSESSMENT FINDINGS
Intermittent Claudication cramp-like pain in the legs, usually the
calves, that occurs during exercise. It is
caused by accumulation of plaques (afatty substance) in the leg arteries,restricting blood supply to the muscles.Rest relieves the condition.
Raynauds Phenomenon spasms of the arteries of the fingers and
toes, typically brought on by cold, causingthe hands and feet to become pale, cold,numb, and sometimes painful.
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DIAGNOSTIC CRITERIA
1. Typically between 2040 years old and male,although recently females have been diagnosed.
2. Current (or recent) history of tobacco use.
3. Presence of distal extremity ischemia (indicated by
claudication, pain at rest, ischemic ulcers or gangrene)documented by noninvasive vascular testing such asultrasound.
4. Exclusion of other autoimmune diseases,hypercoagulable states, and diabetes mellitus by
laboratory tests.
5. Exclusion of a proximal source of emboli byechocardiography and arteriography.
6. Consistent arteriographic findings in the clinically
involved and noninvolved limbs.
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DIFFERENTIAL DIAGNOSIS
Atherosclerosis
Diabetes Mellitus
Vasculitis
Severe Raynaudsphenomenon
- lupus orscleroderma
Clotting disordersof the blood
- Hypercoagulablestates
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DIAGNOSTIC PROCEDURES
Revealsocclusion ofperipheralartery
rare: biopsyin anischemic areamay not heal
exclusion of asource ofrecurrentemboli
"corkscrew"appearanceof arteries
Angio-graphy Echocardiography
ArteriographyBiopsy
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DIAGNOSTIC PROCEDURES
Other tests (to rule out other disease)
1. Ultrasound2. FBC3. LFTs4. creatinine5. fasting glucose6. ESR or PV7. antinuclear antibody8. rheumatoid factor9. screening for hypercoagulability
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ANATOMY
CIRCULATORY SYSTEMHeart contractions pumps the blood
right chamber-lungs
picks up oxygen
left chamber-systemic
aorta
smaller arteriesarteriolesin the periphery
capillaries
Small to larger veins
inferior & superiorvena cava
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ANATOMY
Blood Vessels
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ANATOMY
Blood Vessels
1. Arteries - carry blood away from the heart- dia = 0.2 cm
2. Capillaries - lies between artery & vein- Oxygen, nutrients, and othersubstances transported in bloodthe arteries pass throughthin capillary walls into tissue cells- dia = 5-10 m
3. Veins - carry blood toward the heart
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PATOPHYSIOLOGY
Smoking (nicotine), 20-40 y/o, Male, Oriental race
Gangrene
Ulceration
Tissue death
Ischemia
Lack of nutrientsupply to tissues
Infection
Inflammationredness, swelling,heat, etc.
Partial or complete blockage of blood supply
Thrombosis at peripheral arteries and veins
Blood clotting
Raynaudsphenomenon
Pain
Intermittentclaudication
Dec. or absentperipheral
pulsePale extremities
Cold skin
Numbness, tingling,burning sensation,
pain
Skin colorchanges
Red orcyanotic
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MEDICAL MANAGEMENT
1. Drug Therapy
a. Vasodilators: papaverine, isoxsuprine HCl
(Vasodilan), nylidrin HCl (Arlidin), nicotinylalcohol (Roniacol), cyclandelate(Cyclospasmol), tolazoline HCl (Priscoline),to improve arterial circulation
b. Analgesicsto relieve pain
c. Anticoagulantsto prevent thrombusformation: Iloprost
d. Lipid-reducing drugs: cholestiramine(Questran), colestipol HCl (Cholestid),Choloxin, Atromid-S, Lopid, niacin
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MEDICAL MANAGEMENT
2. Surgery
a. Bypass graftingb. Endarterectomyc. Baloon catheter dilation
d. Lumbar sympathectomye. Amputation
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NURSING DIAGNOSIS
Activity intolerance
Anxiety
Alteration in comfort:pain
Fear
Impaired gas exchange
Anticipatory grieving
Potential for injury
Knowledge deficit
Self-concept disturbance:body image
Impaired physical mobility
Impaired skin integrity
Altered tissue perfusion
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NURSING INTERVENTIONS
1. Prepare patient for surgery.2. Provide patient teaching and discharge planning
concerning:Gentle massage and warmth to increasecirculation
Avoid conditions that reduce peripheral circulation,like cold temperaturesAvoid sitting or standing in one position for longperiodsDo not walk barefoot to avoid injury
Avoid tight or restrictive clothingTake good care of the hands and feetLow salt dietControl weight
Physical exerciseLow cholesterol diet
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QUIT
SMOKING!!!
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