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Buerger's Test
Buerger's test is performed in an assessment of arterial sufficiency. It is named after Leo Buerger. The ''vascular angle'', which is also called ''Buerger's angle'', is the angle to which the leg has to be raised before it becomes pale, whilst lying down. In a limb with a normal circulation the toes and sole of the foot, stay pink, even when the limb is raised by 90 degrees. In an ischaemic leg, elevation to 15 degrees or 30 degrees for 30 to 60 seconds may cause pallor. (This part of the test checks for ''elevation pallor''.) A vascular angle of less than 20 degrees indicates severe ischaemia. From a sitting position, in normal circulation, the foot will quickly return to a pink colour. Where there is peripheral artery disease the leg will revert to the pink colour more slowly than normal and also pass through the normal pinkness to a red-range colouring (''rubor'' - redness) often known as ''sunset foot''. This is due to the dilatation of the arterioles in an attempt to ...
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Leo Buerger
Leo Buerger (English ; ) (Vienna, September 13, 1879 – New York, October 6, 1943) was an Austrian American pathologist, surgeon and urologist. Buerger's disease is named for him. Family and education Buerger was born in Vienna into a Jewish family, who immigrated to the United States when he was seven (either in 1886 or 1887). He attended several elementary schools in New York, Chicago, and Philadelphia. Buerger matriculated to the City College of New York, where he earned a B.A. in 1897, followed by studies at the College of Physicians and Surgeons, the medical school of Columbia University, where he obtained both his M.A. and M.D. in 1901. He developed his surgical skills in Breslau, Germany (now Wrocław, Poland) in 1905–06. There he also studied urology and arterial disease, fields in which he excelled later in life. He was married twice; his first wife was Germaine Schnitzer, a French pianist trained in Vienna whom he married on 5 May 1913. They had two chil ...
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Lying (position)
Lyingalso called recumbency, prostration, or decubitus in medicine ()is a type of human position in which the body is more or less horizontal and supported along its length by the surface underneath. Lying is the most common position while being immobilized (e.g. in bedrest), while sleeping, or while being struck by injury or disease. Positions When lying, the body may assume a great variety of shapes and positions. The following are the basic recognized ones. * Supine: lying on the back on the ground with the face up. * Prone: lying on the chest with the face down ("lying down" or "going prone"). See also "Prostration". * Lying on either side, with the body straight or bent/curled forward or backward. ** The fetal position is lying or sitting curled, with limbs close to the torso and the head close to the knees. ** The recovery position (coma position), one of a series of variations on a lateral recumbent or three-quarters prone position of the body, into which an un ...
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Circulatory System
In vertebrates, the circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the body. It includes the cardiovascular system, or vascular system, that consists of the heart and blood vessels (from Greek meaning ''heart'', and Latin meaning ''vessels''). The circulatory system has two divisions, a systemic circulation or circuit, and a pulmonary circulation or circuit. Some sources use the terms ''cardiovascular system'' and ''vascular system'' interchangeably with ''circulatory system''. The network of blood vessels are the great vessels of the heart including large elastic arteries, and large veins; other arteries, smaller arterioles, capillaries that join with venules (small veins), and other veins. The circulatory system is closed in vertebrates, which means that the blood never leaves the network of blood vessels. Many invertebrates such as arthropods have an open circulatory system with a he ...
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Ischaemic
Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue, i.e., hypoxia and microvascular dysfunction. It also implies local hypoxia in a part of a body resulting from constriction (such as vasoconstriction, thrombosis, or embolism). Ischemia causes not only insufficiency of oxygen but also reduced availability of nutrients and inadequate removal of metabolic wastes. Ischemia can be partial (poor perfusion) or total blockage. The inadequate delivery of oxygenated blood to the organs must be resolved either by treating the cause of the inadequate delivery or reducing the oxygen demand of the system that needs it. For example, patients with myocardial ischemia have a decreased blood flow to the heart and are prescribed w ...
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Pallor
Pallor is a pale color of the skin that can be caused by illness, emotional shock or stress, stimulant use, or anemia, and is the result of a reduced amount of oxyhaemoglobin and may also be visible as pallor of the conjunctivae of the eyes on physical examination. Pallor is more evident on the face and palms. It can develop suddenly or gradually, depending on the cause. It is not usually clinically significant unless it is accompanied by a general pallor (pale lips, tongue, palms, mouth and other regions with mucous membranes). It is distinguished from similar presentations such as hypopigmentation (lack or loss of skin pigment) or simply a lightly-melanated complexion. Causes * migraine attack or headache * excess estradiol and/or estrone * osteoporosis * emotional response, due to fear, embarrassment, grief, rage * anorexia * anemia, due to blood loss, poor nutrition, or underlying disease such as sickle cell anemia * iron deficiency * vitamin B12 deficien ...
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Peripheral Artery Disease
Peripheral artery disease (PAD) is a vascular disorder that causes abnormal narrowing of arteries other than those that supply the heart or brain. PAD can happen in any blood vessel, but it is more common in the legs than the arms. When narrowing occurs in the heart, it is called coronary artery disease (CAD), and in the brain, it is called cerebrovascular disease. Peripheral artery disease most commonly affects the legs, but other arteries may also be involved, such as those of the arms, neck, or kidneys. Peripheral artery disease (PAD) is a form of peripheral vascular disease. Vascular refers to the arteries and veins within the body. PAD differs from peripheral veinous disease. PAD means the arteries are narrowed or blocked—the vessels that carry oxygen-rich blood as it moves from the heart to other parts of the body. Peripheral veinous disease, on the other hand, refers to problems with veins—the vessels that bring the blood back to the heart. The classic symptom ...
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Arteriole
An arteriole is a small-diameter blood vessel in the microcirculation that extends and branches out from an artery and leads to capillary, capillaries. Arterioles have vascular smooth muscle, muscular walls (usually only one to two layers of smooth muscle cells) and are the primary site of vascular resistance. The greatest change in blood pressure and velocity of blood flow occurs at the transition of arterioles to capillaries. This function is extremely important because it prevents the thin, one-layer capillaries from exploding upon pressure. The arterioles achieve this decrease in pressure, as they are the site with the highest resistance (a large contributor to total peripheral resistance) which translates to a large decrease in the pressure. Structure In a healthy vascular system, the endothelium lines all blood-contacting surfaces, including arteries, arterioles, veins, venules, capillaries, and heart chambers. This healthy condition is promoted by the ample production of n ...
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Hyperaemia
Hyperaemia (also hyperemia) is the increase of blood flow to different tissues in the body. It can have medical implications but is also a regulatory response, allowing change in blood supply to different tissues through vasodilation (widening of blood vessels). Clinically, hyperaemia in tissues manifests as erythema (redness of the skin) because of the engorgement of vessels with oxygenated blood. Hyperaemia can also occur due to a fall in atmospheric pressure outside the body. The term comes . Regulation of blood flow Functional hyperaemia is an increase in blood flow to a tissue due to the presence of metabolites and a change in general conditions. When a tissue increases its activity, there is a well-characterized fall in the partial pressure of oxygen and pH, along with an increase in partial pressure of carbon dioxide, and a rise in temperature and the concentration of potassium ions. The mechanisms of vasodilation are predominantly local metabolites and myogenic eff ...
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Erythromelalgia
Erythromelalgia, or Mitchell's disease (after Silas Weir Mitchell (physician), Silas Weir Mitchell), is a rare vascular peripheral pain disorder in which blood vessels, usually in the Human leg, lower extremities or hands, are episodically blocked (frequently on and off daily), then become hyperemic and Inflammation, inflamed. There is severe burning pain (in the small fiber sensory nerves) and Erythema, skin redness. The attacks are periodic and are commonly triggered by heat, pressure, mild activity, exertion, insomnia or Psychological stress, stress. Erythromelalgia may occur either as a primary or secondary disorder (i.e. a disorder in and of itself or a symptom of another condition). Secondary erythromelalgia can result from small fiber peripheral neuropathy of any cause, polycythemia vera, essential thrombocythemia, hypercholesterolemia, mushroom poisoning, mushroom or mercury poisoning, and some autoimmune disorders. Primary erythromelalgia is caused by mutation of the volta ...
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Peripheral Vascular Examination
A peripheral vascular examination is a medical examination to discover signs of pathology in the peripheral vascular system. It is performed as part of a physical examination, or when a patient presents with leg pain suggestive of a cardiovascular pathology, typically peripheral artery disease. The exam includes several parts: Position/lighting/draping, Inspection, Palpation, Auscultation, and Special maneuvers. Position/lighting/draping For this procedure the patient is positioned lying in the supine position on a flat bed or examination table. The patient's hands should remain at their sides with their head resting on a pillow. Lighting needs to be adjusted so that it is ideal. Proper draping has the legs should be exposed, the groin and thigh covered, with drapes are usually placed between the legs. Inspection On inspection the clinician looks for signs of: * trauma * previous surgery (scars) * muscle wasting/muscle asymmetry * edema (swelling) * erythema (redness) * ulce ...
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Claudication
Claudication is a medical term usually referring to impairment in walking, or pain, discomfort, numbness, or tiredness in the legs that occurs during walking or standing and is relieved by rest. The perceived level of pain from claudication can be mild to extremely severe. Claudication is most common in the calves but it can also affect the feet, thighs, hips, buttocks, or arms. The word ''claudication'' comes . Claudication that appears after a short amount of walking may sometimes be described by US medical professionals by the number of typical city street blocks that the patient can walk before the onset of claudication. Thus, "one-block claudication" appears after walking one block, "two-block claudication" appears after walking two blocks, etc. The term ''block'' would be understood more exactly locally but is on the order of 100 meters (328 feet). Types Intermittent vascular Intermittent vascular (or arterial) claudication (Latin: ''claudicatio intermittens'') mos ...
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