Surgery - PAOD
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SILLIMAN UNIVERSITY MEDICAL SCHOOL SUBMITTED TO: Dr. Emmanuel Katada SUBMITTED BY: de los Santos, Rosheil Mae C. Ditti, Fatimah Al-Zahra Divinagracia, Joshua LukeDocto, Christian Dave I. REPRESENTATIVE CASE IDENTIFYING DATA: Male, 87 Years old, retired teacher, Roman Catholic, married CHIEF COMPLAINT: Bilateral leg pain HISTORY OF PRESENT ILLNESS: 6 months PTA, intermittent crampy leg pain started aggravated when walking associated with occasional back pain, no swelling noted. Alleviated with rest. Upon admission, bilateral leg pain was noted. Pain scale in the calf area 6/10. Duration of pain is related to activity. PAST MEDICAL HISTORY: (+) Asthma, Hypertention (controlled), DM (controlled), had history of spondylosis 10 years ago PERSONAL AND SOCIAL HISTORY: Patient is vegetarian, adequate fluid intake, sedentary lifestyle (walks in the compound). (+) Smoker, 20 pack years until 2 years ago (+) Moderate alcohol intake (-) Illicit drug use PHYSICAL EXAMINATION Vital Signs: BP: 150/90 mmHg HR: 80/min RR: 20/min Temp: 37.6 C BMI: Within Normal Skin: Senile loss of turgor, dry skin, no bruises HEENT: All normal Neck: All normal Pulmonary: All normal Cardiovascular: All normal Abdomen: All normal Genitourinary:All normal Extremities: Lower extremities: Symmetrical, bilateral muscle atrophy, no swelling, no ulcer, no discoloration; hair loss in legs and toes; no deformities. Strong femoral and popliteal pulse; Dorsalis pedis and posterior tibial pulses are faintly palpable. (-) Homan’s sign; warm legs but feet are cold. Capillary refill time: 4 seconds. (-) bruits. Normoactive reflexes, (+) femoral stretch pain II. PRIMARY IMPRESSION DIAGNOSIS RULE IN RULE OUT III. DIFFERENTIAL DIAGNOSIS DIAGNOSES RULE IN RULE OUT IV. RATIONAL LABORATORY & DIAGNOSTIC TESTS LAB. TEST PATIENT RESULTS NORMAL VALUES INTERPRETATION/NECESSITY AVAILABILIT Y COST HEMATOLOGY Hemoglobin WBC
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PAOD
Transcript of Surgery - PAOD
SILLIMAN UNIVERSITY MEDICAL SCHOOLSUBMITTED TO: Dr. Emmanuel KatadaSUBMITTED BY: de los Santos, Rosheil Mae C. Ditti, Fatimah Al-Zahra Divinagracia, Joshua LukeDocto, Christian DaveI. REPRESENTATIVE CASEIDENTIFYING DATA: Male, 87 Years old, retired teacher, Roman Catholic, marriedCHIEF COMPLAINT: Bilateral leg painHISTORY OF PRESENT ILLNESS: 6 months PTA, intermittent crampy leg pain started aggravated when walking associated with occasional back pain, no swelling noted. Alleviated with rest. Upon admission, bilateral leg pain was noted. Pain scale in the calf area 6/10. Duration of pain is related to activity.PAST MEDICAL HISTORY: (+) Asthma, Hypertention (controlled), DM (controlled), had history of spondylosis 10 years agoPERSONAL AND SOCIAL HISTORY: Patient is vegetarian, adequate fluid intake, sedentary lifestyle (walks in the compound).(+) Smoker, 20 pack years until 2 years ago(+) Moderate alcohol intake(-) Illicit drug use
PHYSICAL EXAMINATIONVital Signs: BP: 150/90 mmHg HR: 80/min
RR: 20/min Temp: 37.6 C BMI: Within NormalSkin: Senile loss of turgor, dry skin, no bruisesHEENT: All normalNeck: All normalPulmonary: All normalCardiovascular: All normalAbdomen: All normalGenitourinary:All normalExtremities: Lower extremities: Symmetrical, bilateral muscle atrophy, no swelling, no ulcer, no discoloration; hair loss in legs and toes; no deformities. Strong femoral and popliteal pulse; Dorsalis pedis and posterior tibial pulses are faintly palpable. (-) Homan’s sign; warm legs but feet are cold. Capillary refill time: 4 seconds. (-) bruits. Normoactive reflexes, (+) femoral stretch painII. PRIMARY IMPRESSION
DIAGNOSIS RULE IN RULE OUT
III. DIFFERENTIAL DIAGNOSISDIAGNOSES RULE IN RULE OUT
IV. RATIONAL LABORATORY & DIAGNOSTIC TESTS
LAB. TESTPATIENTRESULTS
NORMAL VALUES
INTERPRETATION/NECESSITY AVAILABILITY COST
HEMATOLOGYHemoglobinWBC
SegmentersLymphocyte
MonocyteEosinophils
Platelet countMCVMCHC
BLOOD CHEMISTRYSerum sodiumSerum PoratssiumSGPTSerum AlbuminCRPTotal cholesterolCreatinineBUNURINALYSISSpecific gravitypHProtein
BloodPus cellsRBCSTOOL EXAM
P-DRUGSDRUG NAME EFFICACY SAFETY SUITABILITY COST
VI. MONITORING AND FOLLOW-UP1. Patients who are treated medically should be seen every 4-6 months to assess the effects of therapy. 2. Any changes in walking distance, or exercise performance should be reviewed. 3. Hypertension and diabetes should be controlled if necessary. 4. Repeat pulse examination should be performed and the ABI measured. If the patient’s symptoms are worsening, intervention and
referral to a vascular surgeon may be warranted.
NONMODIFIABLE:Age: > 65 years oldGender: MaleFamilial DispositionMODIFIABLE:SmokingHypertensionDiet (contributing to hyperlipidemiaObesitySedentary LifestylesDiabetes Mellitus
Development of fatty streaks of lipids
Deposited in the intima of arterial walls
Injury to the vascular endothelium
Attracts Inflammatory cells
Macrophages infiltrate the injured vascular endothelium
Releases biochemical substances, damages endothelium
Resulting to attraction of platelets and initiates clotting
Excessive accumulation of platelets/clotting
Thrombus formation
Emboli
Occlusion of arterial lumen
Ischemia
Ischemic Necrosis
Bilateral leg pain, Dorsalis pedis and posterior tibial pulses are faintly palpable, decreased hair growth/hair loss,warm legs but feet are cold. Capillary refill time: 4 seconds
Patient:Age: > 65 years oldGender: MaleHistory of SmokingHypertension (controlled)Sedentary LifestylesDiabetes Mellitus (controlled)
Peripheral Arterial Occlusion Disease
LEGEND: Risk Factors Pathophysiology Manifestations Disease Condition
