Diagnosis of Buerger's disease
Buerger's disease Diagnosis: Book Excerpts
Diagnostic Tests for Buerger's disease: Online Medical Books
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GANGRENE:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Does it involve the upper or lower extremity? Involvement of the upper extremities should suggest Raynaud's disease, scleroderma, and other collagen diseases.
- Are there good peripheral pulses? The complete absence of a peripheral pulse, particularly if it is sudden onset, should suggest an arterial embolism. If it is gradual onset, suspect arteriosclerosis or diabetic ulcer.
- Are there signs of systemic disease? If there are other signs of systemic disease, collagen disease, macroglobulinemia, and cryoglobulinemia should be suspected.
- Is the gangrene sudden in onset? A sudden onset of the gangrene should make one suspect clostridia infections or arterial embolism.
- Is there a positive culture? The culture will be positive in clostridia infections, anthrax, and cancrum oris.
DIAGNOSTIC WORKUP
Routine orders include a CBC, sedimentation rate, chemistry panel, VDRL test, serum protein electrophoresis, ANA titer, and glucose tolerance test. The gangrenous area should be cultured. Plain x-rays of the area sometimes are helpful. If there are diminished pulses, especially if the onset is acute, angiography will be useful. A muscle biopsy or skin biopsy will be useful in diagnosing collagen diseases. The Sia water test and serum immunoelectrophoresis will be useful in diagnosing macroglobulinemia and cryoglobulinemia.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Peripheral Edema:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Venous insufficiency
–Caused by incompetent venous valves
–Skin characteristically has superficial varicose veins associated with a reddish-brown pretibial discoloration (“venous stasis skin changes”)
–Swelling is typically worse after legs are held in a dependent position and is least noticeable after a night's sleep
-
Congestive heart failure
–Associated with pitting peripheral edema
–Other signs of heart failure include a third
heart sound, cardiomegaly, and hepatomegaly
-
Cellulitis
–Usually unilateral
–Edematous legs are typically red, warm,
and inflamed
–The patient may exhibit signs of systemic toxicity with fever and leukocytosis
- Deep venous thrombosis
–Typically unilateral swelling
–May exhibit a palpable cord representing a thrombosed vein
–Homan's sign (pain in the calf with passive dorsiflexion of the foot)
–Virchow's triad (hypercoagulable states, venous stasis, and vessel injury) are risk factors
- Cirrhosis
–Advanced liver disease results in hypoalbuminemia and poor venous return through cirrhotic liver tissue
–Other stigmata of chronic liver disease include caput medusae, ascites, and spider angiomata
-
Nephrotic syndrome
–Glomerular damage results in protein loss and decreased oncotic pressure
-
Less common etiologies (“zebras”) include filariasis (lymphatic infection by Wuchereria bancrofti worm), myxedema (seen in patients with severe hypothyroidism), Milroy's disease (congenital lymphedema), chronic lymphedema (e.g., lymphatic damage due to surgery, such as vein harvesting for CABG), and gout
Workup and Diagnosis
-
History and physical examination should focus on time course, associated symptoms (e.g., dyspnea, urinary changes, fever), unilateral versus bilateral involvement, pitting versus nonpitting edema, and risk factors for DVT
-
Initial labs may include CBC, electrolytes, BUN/creatinine, urinalysis, coagulation studies, LFTs, serum albumin, and thyroid function tests
-
Chest X-ray may reveal signs of pulmonary edema or cardiomegaly
-
Duplex ultrasound of the legs is useful in diagnosing deep venous thrombosis
-
Echocardiography may reveal a depressed ejection fraction in cases of congestive heart failure
-
Blood cultures are often indicated in immunocompromised or systemically ill patients
-
Renal or liver biopsy may be necessary to diagnose cirrhosis or renal pathology leading to nephrotic syndrome
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Buerger's disease:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
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.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Buerger's disease:
Diagnosis
(Handbook of Diseases)
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.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
GANGRENE:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
All patients should have a CBC, sedimentation rate, venereal disease
research laboratory (VDRL) test, chemistry panel, and serum protein
electrophorosis. In cases of the Raynaud phenomenon, an ANA and RA
titer should also be done. Aerobic and anaerobic cultures of exudates
from the wound should also be taken. Plain x-rays of the area involved are
recommended. If an embolism or obstruction of the large arteries is
suspected, contrast angiography needs to be done. An ice water test, Sia
water test, and serum immunoelectrophoresis will be useful in cases of the
Raynaud phenomenon. A rheumatology consult is wise.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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