Presentation is loading. Please wait.

Presentation is loading. Please wait.

History-Taking & Physical Examination in Vascular Diseases.

Similar presentations

Presentation on theme: "History-Taking & Physical Examination in Vascular Diseases."— Presentation transcript:

1 History-Taking & Physical Examination in Vascular Diseases

2 Aim – To reach for a Presumptive Diagnosis

3 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.

4 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.

5 The Present Complains Ask the patient to tell you what made him to seek medical advice. Record the answer in patients words.

6 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.

7 History of Presenting Complains S – Site O – Onset C – Character R – Radiation A – Association T – Timing/Duration E – Exacerbating & alleviating factors S - Severity

8 Direct Questioning Specific questions about the diagnosis you have in mind. - Risk factors. - Review of relevant system.

9 Past Medical History Drug History Family History Social History Habits

10 Vascular Diseases - Arterial - Venous - Lymphatic

11 Arterial Diseases Electively – Chronic Symptoms Acutely – Limb threatening disorders Pain Intermittent Claudication Rest pain Tissue loss Ulcer Gangrene

12 Acute arterial occlusion Sudden onset Severe, Shocking pain Diffuse Associated Symptoms

13 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

14 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.

15 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

16 Examination Inspection - Expose - Compare

17 Look For

18 Ulcer site, shape, size, no. edge, floor, deapth, discharge, surrounding area. Base


20 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

21 Venous Filling Normal – veins of foot are full of blood Ischemia – veins are collapsed & looks like pale blue gutters - Guttering of veins

22 Palpation Temperature which foot – warm/cold. level at which change occurs Tenderness Capillary filling

23 Feel for P. pulses & grade

24 Peripheral Nerves Examination - Sensory - Motor Auscultation - Bruit

25 Venous diseases Common Presentation - Varicose veins Asyptomatic, Cosmetic, Dull aching pains, Feeling of heaviness, Itching/Eczema, superficial thrombophlebitis, bleeding, Ulceration, Saphenavarix.

26 Primary – Venous valve failure Secondary – Post thrombotic - Congenital Malformations


28 Examine both supine & standing

29 Touniquet Test –Identify clinically site of reflux from deep to superficial veins -Identify incompetant perforators – tie tourniquet above suspected perforator

30 Lymphatic diseases Lymphangitis – inflamation of lymphatics. Lymphedema – faiure of lymph drainage. Protein rich fluid accumulates in tissue

31 Lymphedema Primary - congenital – at birth - Precox - adolescence - Tarda - middle age Lymphatic abnormalities – aplasia, hypoplasia, hyperplasia.

32 Secondary : -Infection -Surgery -Radiation -Trauma

Download ppt "History-Taking & Physical Examination in Vascular Diseases."

Similar presentations

Ads by Google