History-Taking

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History-Taking Physical Examination in Vascular
Diseases
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• Aim To reach for a Presumptive Diagnosis

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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.

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Donts 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.

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The Present Complains

• Ask the patient to tell you what made him to seek
  medical advice.
• Record the answer in patients words.

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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.

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History of Presenting Complains

• S Site
• O Onset
• C Character
• R Radiation
• A Association
• T Timing/Duration
• E Exacerbating alleviating factors
• S - Severity

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Direct Questioning

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

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• Past Medical History
• Drug History
• Family History
• Social History
• Habits

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• Vascular Diseases
• - Arterial
• - Venous
• - Lymphatic

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Arterial Diseases

• Electively Chronic Symptoms
• Acutely Limb threatening disorders
• Pain
• Intermittent Claudication
• Rest pain
• Tissue loss
• Ulcer
• Gangrene

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

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• 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

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• 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.

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• Ulcer area of discontinuity of surface
  epithelium
• Gangrene Dead tissue
• - Duration, Site.
• - what drew the patients attention to the
  ulcer
• - other symptoms
• - progression
• - persistance
• - multiplicity

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Examination

• Inspection
• - Expose
• - Compare

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• Look For

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

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• Vascular Angle
• Or Buergers angle
• Normal-straight leg can be raised by 90 foot
  rmains pink.
• Ischemia elevation to 15-30cause pallor
• Dependant rubor

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

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Palpation

• Temperature
• which foot warm/cold.
• level at which change occurs
• Tenderness
• Capillary filling

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Feel for P. pulses grade
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• Peripheral Nerves Examination
• - Sensory
• - Motor
• Auscultation
• - Bruit

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Venous diseases

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

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• Primary Venous valve failure
• Secondary Post thrombotic
• - Congenital Malformations

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Examine both supine standing
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Touniquet TestIdentify clinically site of
reflux from deep to superficial
veins-Identify incompetant perforators tie
tourniquet above suspected perforator
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Lymphatic diseases

• Lymphangitis inflamation of lymphatics.
• Lymphedema faiure of lymph drainage.
• Protein rich fluid accumulates in tissue

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Lymphedema

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

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• Secondary
• Infection
• Surgery
• Radiation
• Trauma