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