-Presentation: Muscle pain during exercise, worse uphill, relieved by rest, largely legs affected. Have a claudication distance. -Associations: cold feet, sores, loss of hair, ED. 2. Critical limb ischaemia - Presentation: Inability of vascular tree to meet metabolic demands at rest, so have rest pain requiring analgesia > 2w. Starts in extremities e.g. toes. Often burning pain at night requiring dependency to relieve. 3. limb ischaemia - Presentation: 5 Ps: Pain (severe), pallor, perishingly cold, pulseless, paraesthisiae. -- Surgical emergency; have 4-6h to save limb. damage: 30 mins (paraesthesia) —Nerve damage: 6 h —Muscle damage: 48h (skin mottling) —Skin —Management: Amputation —Dead: embolectomy or thrombyolysis/revascularisation as appropriate. —Viable: Blockage of an artery, more severe if not had time for collaterals —Pathophysiology: to develop. 38%. Sudden, no PVD, 80% AF, post-MI, post aneurysm. —Embolic: in situ: 40%. Less acute, known claudicant, abnormalities in the —Thrombotic other limb. - Doppler and ABPI: used with BP cuff, as deflates Doppler picks up systolic pressure in artery. Ensure pt is lying down. P(leg)/P(arm) —ABPI: offs: —Cut may indicate calcification —>1.3 is normal —1-1.3 moderate claudication —0.6-0.9 indicates critical limb ischaemia: severe/rest pain —<0.6 impending gangrene —<0.3 Venous disease Varicose veins —Superficial: venous insufficiency —Deep: —Presentation: asymptomatic, aching, heaviness, cramps, itching —Hx: varicose veins, ulcers (medial malleolus, haemosiderin causes brown —Ex: edges, eczema), lipodermatosclerosis Ulcers GI Medicine and Surgery The Acute Abdomen
-Presentation: Muscle pain during exercise, worse uphill, relieved by rest, largely legs affected. Have a claudication distance. -Associations: cold feet, sores, loss of hair, ED. 2. Critical limb ischaemia - Presentation: Inability of vascular tree to meet metabolic demands at rest, so have rest pain requiring analgesia > 2w. Starts in extremities e.g. toes. Often burning pain at night requiring dependency to relieve. 3. limb ischaemia - Presentation: 5 Ps: Pain (severe), pallor, perishingly cold, pulseless, paraesthisiae. -- Surgical emergency; have 4-6h to save limb. —Nerve damage: 30 mins (paraesthesia) —Muscle damage: 6 h —Skin damage: 48h (skin mottling) —Management: —Dead: Amputation —Viable: embolectomy or thrombyolysis/revascularisation as appropriate. —Pathophysiology: Blockage of an artery, more severe if not had time for collaterals to develop. —Embolic: 38%. Sudden, no PVD, 80% AF, post-MI, post aneurysm. —Thrombotic in situ: 40%. Less acute, known claudicant, abnormalities in the other limb. - Doppler and ABPI: used with BP cuff, as deflates Doppler picks up systolic pressure in artery. Ensure pt is lying down. —ABPI: P(leg)/P(arm) —Cut offs: —>1.3 may indicate calcification —1-1.3 is normal —0.6-0.9 moderate claudication —<0.6 indicates critical limb ischaemia: severe/rest pain —<0.3 impending gangrene Venous disease —Superficial: Varicose veins —Deep: venous insufficiency —Presentation: —Hx: asymptomatic, aching, heaviness, cramps, itching —Ex: varicose veins, ulcers (medial malleolus, haemosiderin causes brown edges, eczema), lipodermatosclerosis Ulcers GI Medicine and Surgery The Acute Abdomen