tailieunhanh - Pearls in Medicine for Students: Part 2

(BQ) Part 1 of the document Respiratory care and Wilkins' clinical assessment (Seventh edition) has contents: Preparing for the patient encounter, the medical history and the interview, cardiopulmonary symptoms, vital signs, fundamentals of physical examination, and other contents. Invite you to refer. | Pearls in Medicine for Students Part 2 148 41 . Pearls in Medicine for Students CHAPTER Intermittent Claudication DEFINITION It is a cramp-like pain associated with tightness numbness and extreme fatigue in muscles and occurs most commonly in calf muscles on walking. The pain is relieved by rest and reappears when the person starts walking. The pain during walking may be so intense that the patient is bound to halt immediately. The pain is due to muscle ischaemia which is felt on walking. The actual distance a patient can walk before the onset of intermittent claudication is known as claudication distance which is a good index of severity of arterial occlusion. Later the pain becomes constant and aching in nature and persists even on rest . rest pain which is due to ischaemic changes in the somatic nerves so called cry of the dying nerves . POSSIBLE CAUSES A. With vascular insufficiency . narrowed arteries 1. Atheroma or embolism of lower limb arteries. 2. Buerger s disease. 3. Arteritis . syphilitic aorto-arteritis . 4. Coarctation of aorta 5. Leriche s syndrome embolism at branching of common iliac arteries . claudication of thigh and impotence . 6. Aortoiliac occlusion. 7. Diabetes mellitus. B. Without vascular insufficiency . normal arteries 1. Over-exertion . marathon runner . Intermittent Claudication 149 2. Severe anaemia. 3. McArdle s disease muscle phosphorylase . 4. Lumbar canal stenosis . neurogenic claudication . NEUROGENIC CLAUDICATION It is also known as claudication of cauda equina or lumbar canal stenosis. This entity is the end result of combination of disc lesion and a congenital narrowing of lumbar theca. The disease is made worse at middle age due to degenerative changes especially between L4 and L5 vertebra. Walking or prolonged standing interferes with the blood supply to the cauda equina which leads to root pain weakness of legs paraesthesia and even foot drop pulse remains normal . Ankle jerk may be diminished or .