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Vascular surgery for dummies: clinical evaluation

a brief history taking and physical examination by Happy Friday Knight

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Vascular surgery for dummies: clinical evaluation

  2. 2. PATIENT CLINICAL EVALUATION IN VASCULAR DISEASE • Use patient history and physical examination to tell if the patient has arterial, venous, or lymphatic disease • Arterial: ตีบ (stenosis, occlusion) หรือ โป่ง แตก (aneurysm) • Venous: patent and competent • Lymphatic: obstruction/compression/absence of lymphatic channel  lymphedema
  3. 3. CLINICAL PRESENTATION • Patients usually come with • Pain • Weakness • Neurosensory complaint: wam, cool, numbness, hyperesthesia • Discoloration • Swelling • Ulceration • varicosities • History taking: • Initial onset: acute or chronic • Progression or changes • Location: unilateral/bilateral, proximal/distal • Character and quality of complaints • Extent of disability • Precipitating factors • Relieving factors • Associated or risk factors: MI, stroke, DM, HT, DLP, smoking
  4. 4. PHYSICAL EXAMINATION: ARTERIAL DISEASE INSPECTION 1.Skin changes: pale, cyanosis, rubor, mottling 2.Hair distribution 3.Nail growth 4.Edema 5.Ulceration and cellulitis PALPATION 1. Temperature and sensation: compare with another side 2. Pulse: compare both sides • Neck: carotid and temporal a. • Upper extremities: subclavian, axillary, antecubital fossa, wrist • Abdominal aortic pulse AUSCULTATION • Usually nothing • But if present, it can be bruit = stenosis