BUERGER’S SYNDROME final report

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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BUERGER’S SYNDROME final report

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