Buerger's disease
Buerger's disease: Excerpt from Handbook of Diseases
Buerger’s disease, also known as thromboangiitis obliterans, is an inflammatory, nonatheromatous occlusive condition that causes segmental lesions and subsequent thrombus formation in small- and medium-sized arteries (and sometimes the veins), resulting in decreased blood flow to the feet and legs. It may produce ulceration and, eventually, gangrene.
Causes
Although the cause of Buerger’s disease is unknown, a definite link to smoking exists. Incidence is higher in Asians and people of Eastern European descent, especially among men younger than age 40.
Signs and symptoms
Buerger’s disease typically produces intermittent claudication (pain in muscles resulting from inadequate blood supply) of the instep, which is aggravated by exercise and relieved by rest. During exposure to low temperatures, the feet initially become cold, cyanotic, and numb; later, they redden, become hot, and tingle. Occasionally, Buerger’s disease also affects the hands, possibly resulting in painful fingertip ulcerations.
Associated signs and symptoms may include impaired peripheral pulses, migratory superficial thrombophlebitis and, in later stages, ulceration, muscle atrophy, and gangrene.
Diagnosis
Patient history and physical examination strongly suggest Buerger’s disease. Supportive diagnostic tests include:
❑ Doppler ultrasonography to show diminished circulation in the peripheral vessels
❑ plethysmography to help detect decreased circulation in the peripheral vessels
❑ arteriography to locate lesions and rule out atherosclerosis.
Treatment
No specific treatment for Buerger’s disease exists, except abstention of tobacco. Arterial bypass of larger vessels may be used in some cases, as well as local debridement, depending on symptoms and severity of ischemia. An antibiotic may also be useful as well as an exercise program that uses gravity to fill and drain the blood vessels or, in severe disease, a lumbar sympathectomy to increase blood supply to the skin. Amputation may be necessary if the patient suffers from nonhealing ulcers, intractable pain, or gangrene.
Special considerations
Clinical tip Strongly urge the patient to permanently stop smoking, to enhance the effectiveness of treatment. If necessary, refer him to a self-help group to facilitate the process.
❑ Warn the patient to avoid precipitating factors, such as emotional stress, exposure to extreme temperatures, and trauma.
❑ Teach the patient proper foot care, especially the importance of wearing well-fitting shoes and cotton or wool socks. Show him how to inspect his feet daily for cuts, abrasions, and signs and symptoms of skin breakdown, such as redness and soreness. Remind him to seek medical attention immediately after any trauma.
❑ To minimize discomfort and ulcerations of the feet, use a padded footboard or bed cradle to prevent pressure from bed linens. Protect the feet with soft padding. Wash them gently with a mild soap and tepid water, rinse thoroughly, and pat dry with a soft towel.
❑ Provide the patient with emotional support. If necessary, refer the patient for psychological counseling to help him cope with restrictions imposed by this chronic disease.
❑ If the patient has undergone amputation, assess rehabilitative needs, especially regarding changes in body image. Refer him to physical therapists, occupational therapists, and social service agencies as needed.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Buerger's disease
More Medical Textbooks Online about Buerger's disease
Review other book chapters online related to Buerger's disease:
Medical Books Excerpts
- GANGRENE
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- GANGRENE
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
|
|
» Next page:
GANGRENE (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
