Buerger's disease
Buerger's disease: Excerpt from Professional Guide to Diseases (Eighth Edition)
Buerger’s disease (sometimes called thromboangiitis obliterans) — an inflammatory, nonatheromatous occlusive condition — causes segmental lesions and subsequent thrombus formation in the small and medium arteries (and sometimes the veins), resulting in decreased blood flow to the feet and legs. This disorder may produce ulceration and, eventually, gangrene.
Causes and incidence
Buerger’s disease is caused by vasculitis, an inflammation of blood vessels, primarily of the hands and feet. The vessels become constricted or totally blocked, reducing blood flow to the tissues and resulting in pain and, eventually, damage.
This disorder occurs in 6 of every 10,000 people. Incidence is highest among males ages 20 to 40 who have a history of smoking or chewing tobacco. It may be associated with a history of Raynaud’s disease and may occur in people with autoimmune disease.
Signs and symptoms
Buerger’s disease typically produces intermittent claudication of the instep, which is aggravated by exercise and relieved by rest. During exposure to low temperature, 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
❑ angiography or arteriography to locate lesions and rule out atherosclerosis.
Treatment
The primary goals of treatment are to relieve symptoms and prevent complications. Such therapy may include 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. Aspirin and vasodilators may also be used. Amputation may be necessary for nonhealing ulcers, intractable pain, or gangrene.
Special considerations
❑ Strongly urge the patient to stop smoking to enhance the treatment’s effectiveness. Symptoms may disappear if he stops his tobacco use. If necessary, refer him to a self-help group to stop smoking.
❑ 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 of skin breakdown, such as redness and soreness. Remind him to seek medical attention at once after any trauma.
❑ If the patient has ulcers and gangrene, enforce bed rest and 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 emotional support. If necessary, refer the patient for psychological counseling to help him cope with restrictions imposed by this chronic disease. If he 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: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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