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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. The exam includes several parts: *Position/lighting/draping *Inspection *Palpation * Auscultation *Special maneuvers Position/lighting/draping Position – patient should be lying in the supine position and the bed or examination table should be flat. The patient's hands should remain at their sides with their head resting on a pillow. Lighting – adjusted so that it is ideal. Draping – the legs should be exposed, the groin and thigh covered. 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) * ulcers – arterial ulcers tend to be on the borders / sides of th ...
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Sign (medicine)
Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showing on a medical scan. A symptom is something out of the ordinary that is experienced by an individual such as feeling feverish, a headache or other pain or pains in the body. Signs and symptoms Signs A medical sign is an objective observable indication of a disease, injury, or abnormal physiological state that may be detected during a physical examination, examining the patient history, or diagnostic procedure. These signs are visible or otherwise detectable such as a rash or bruise. Medical signs, along with symptoms, assist in formulating diagnostic hypothesis. Examples of signs include elevated blood pressure, nail clubbing of the fingernails or toenails, staggering gait, and arcus senilis and arcus juvenilis of the eyes. Indication ...
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Edema
Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's Tissue (biology), tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area may feel heavy, and joint stiffness. Other symptoms depend on the underlying cause. Causes may include Chronic venous insufficiency, venous insufficiency, heart failure, kidney problems, hypoalbuminemia, low protein levels, liver problems, deep vein thrombosis, infections, angioedema, certain medications, and lymphedema. It may also occur after prolonged sitting or standing and during menstruation or pregnancy. The condition is more concerning if it starts suddenly, or pain or shortness of breath is present. Treatment depends on the underlying cause. If the underlying mechanism involves Hypernatremia, sodium retention, decreased salt intake and a diuretic may be used. Elevating the legs and support stockings may be useful ...
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Toe Pressure
Blood pressure in toes can be measured using special equipment, and is often valuable in assessment of severe peripheral artery disease, in particular in patients with diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ... where measurement of ankle pressure / ABPI is often unreliable (because of local stiffening of arterial wall). __TOC__ Measurement Feet are often cold and to make sure measurement is not affected by local vasoconstriction, the patient's feet may be pre-warmed in water or by warm air to a skin temperature of around 30 °C. Measurement is done with the patient lying flat, with feet at heart level, using sphygmomanometry: the big toe is slightly emptied of blood by squeezing, and a small cuff is inflated around the base of the toe. Cuff pressure is then slowly ...
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Oedema
Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area may feel heavy, and joint stiffness. Other symptoms depend on the underlying cause. Causes may include venous insufficiency, heart failure, kidney problems, low protein levels, liver problems, deep vein thrombosis, infections, angioedema, certain medications, and lymphedema. It may also occur after prolonged sitting or standing and during menstruation or pregnancy. The condition is more concerning if it starts suddenly, or pain or shortness of breath is present. Treatment depends on the underlying cause. If the underlying mechanism involves sodium retention, decreased salt intake and a diuretic may be used. Elevating the legs and support stockings may be useful for edema of the legs. Older people are more commonly affected. The word is ...
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Bruit
Bruit, also called vascular murmur, is the abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery. The bruit may be heard (" auscultated") by securely placing the head of a stethoscope to the skin over the turbulent flow, and listening. Most bruits occur only in systole, so the bruit is intermittent and its frequency dependent on the heart rate. Anything increasing the blood flow velocity such as fever, anemia, hyperthyroidism, or physical exertion, can increase the amplitude of the bruit. Etymology It is naturalized from the French word for "noise", although another notes that and are also common, and others give only for the cardiac sense. Associated terms Describing location of a partial obstruction * Peripheral vascular disease; femoral artery stenosis * Renal artery stenosis * Stroke, carotid artery stenosis * Aortic aneurysm * Tinnitus – a sym ...
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Femoral Artery
The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the femoral triangle. It enters and passes through the adductor canal, and becomes the popliteal artery as it passes through the adductor hiatus in the adductor magnus near the junction of the middle and distal thirds of the thigh. Structure The femoral artery enters the thigh from behind the inguinal ligament as the continuation of the external iliac artery. Here, it lies midway between the anterior superior iliac spine and the symphysis pubis (Mid-inguinal point). Segments In clinical parlance, the femoral artery has the following segments: *The common femoral artery (CFA) is the segment of the femoral artery between the inferior margin of the inguinal ligament and the branching point of the deep femoral artery/profunda femoris artery. Its ...
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Femoral Artery
The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the femoral triangle. It enters and passes through the adductor canal, and becomes the popliteal artery as it passes through the adductor hiatus in the adductor magnus near the junction of the middle and distal thirds of the thigh. Structure The femoral artery enters the thigh from behind the inguinal ligament as the continuation of the external iliac artery. Here, it lies midway between the anterior superior iliac spine and the symphysis pubis (Mid-inguinal point). Segments In clinical parlance, the femoral artery has the following segments: *The common femoral artery (CFA) is the segment of the femoral artery between the inferior margin of the inguinal ligament and the branching point of the deep femoral artery/profunda femoris artery. Its ...
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Knee
In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis. It is often termed a ''compound joint'' having tibiofemoral and patellofemoral components. (The fibular collateral ligament is often considered with tibiofemoral components.) Structure The knee is a modified hinge joint, a type of synovial joint, which is composed of three functional compartments: the patellofemoral articulation, consisting of the patella, or "kneecap", and the patellar groove on the front of the femur through which it slides; and the medial and lateral tibiofemoral articulations linking the femur, or thigh bone ...
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Popliteal Artery
The popliteal artery is a deeply placed continuation of the femoral artery opening in the distal portion of the adductor magnus muscle. It courses through the popliteal fossa and ends at the lower border of the popliteus muscle, where it branches into the anterior tibial artery, anterior and Posterior tibial artery, posterior tibial arteries. The deepest (most anterior) structure in the fossa, the popliteal artery runs close to the joint capsule of the knee as it spans the Intercondylar fossa of femur, intercondylar fossa. Five genicular branches of the popliteal artery supply the capsule and ligaments of the knee joint. The genicular arteries are the superior lateral, superior medial, middle, inferior lateral, and inferior medial genicular arteries. They participate in the formation of the periarticular genicular anastomosis, a network of vessels surrounding the knee that provides collateral circulation capable of maintaining blood supply to the leg during full knee flexion, which ...
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Posterior Tibial Artery
The posterior tibial artery of the lower limb is an artery that carries blood to the posterior compartment of the leg and plantar surface of the foot. It branches from the popliteal artery via the tibial-fibular trunk. Structure The posterior tibial artery arises from the popliteal artery in the popliteal fossa. It is accompanied by a deep vein, the posterior tibial vein, along its course. It passes just posterior to the medial malleolus of the tibia, but anterior to the Achilles tendon. It passes into the foot deep to the flexor retinaculum of the foot. It runs through the tarsal tunnel. Branches The posterior tibial artery gives rise to: * medial plantar artery. * lateral plantar artery. * fibular artery, which is said to rise from the bifurcation of the tibial-fibular trunk and the posterior tibial artery. * calcaneal branch to the medial aspect of the calcaneus. Function The posterior tibial artery supplies oxygenated blood to the posterior compartment of the leg and t ...
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Pulse
In medicine, a pulse represents the tactile arterial palpation of the cardiac cycle (heartbeat) by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body, such as at the neck ( carotid artery), wrist (radial artery), at the groin (femoral artery), behind the knee (popliteal artery), near the ankle joint (posterior tibial artery), and on foot (dorsalis pedis artery). Pulse (or the count of arterial pulse per minute) is equivalent to measuring the heart rate. The heart rate can also be measured by listening to the heart beat by auscultation, traditionally using a stethoscope and counting it for a minute. The radial pulse is commonly measured using three fingers. This has a reason: the finger closest to the heart is used to occlude the pulse pressure, the middle finger is used get a crude estimate of the blood pressure, and the finger most distal to the heart (usually the ring finger) is used to nullify the eff ...
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