Tag: TREATMENT

Buerger Disease

BUERGER DISEASE


BUERGER’S DISEASE (THROMBOANGITIS OBLITERANS)

  • Buerger’s disease is a non- atherosclerotic, progressive, segmental, occlusive inflammatory disorder involving small and medium sized arteries with cell mediated sensitivity to Type I and Type II collage in upper and lower extremities.
  • Inflammatory process does involve adjacent nerves and veins.
  • Triad of thromboangitis obliterans- occlusion of small and medium sized vessels, superficial thrombophelbitis, Raynaud’s phenomenon.

ETIOLOGY-

  • Mainly seen in smokers and tobacco users.
  • Common in Jewish people
  • Hormonal influence
  • Familial nature
  • Poor hygiene

PATHOLOGY-

  • Smoke → vasospasm & hyperplasia initma → thrombus & obliteration medium sized vessels → Panarteritis → Artery, vein & nerve are involved  → Blockage leads to collateral open up → Blood supply to ishchaemic areas → Compensatory peripheral vascular disease
  • Microabscesses, giant cells are found.

CLASSIFICATION-

  • Type I- upper limb TAO (rare)
  • Type II- involving legs & infrapopliteal
  • Type III- femoropopliteal
  • Type IV- aortoiliofemoral
  • Type V- generalised

CLINICAL FEATURES-

  • Common in male smokers between 20- 40 years
  • Intermittent claudication in foot & calf progressing to rest pain, ulceration & gangrene.
  • Absence of atheromas.
  • Small & medium sized vessels such as dorsalis, pedis, posterior tibial, popliteal are commonly involved.

INVESTIGATIONS-

1. Arterial Doppler & Duplex scan

2. Transformed retrograde angiogram-

  • Shows blockage
  • Cork screw appearance of the vessel
  • Inverted tree/ spider leg collaterals
  • Severe vasospasm causing rippled artery

3. Transbranchial angiogram- if femorals are not felt then transbranchial angiogram is done.

4. USG abdomen- shows abdominal aorta for block 

TREATMENT-

  • Stop smoking
  • Vasodilators- nifedipine, xanthinol nicotinate
  • Antithrombin activity- low dose of aspirin
  • Analgesics
  • Lumbar sympathectomy- for rest pain and ulcerations
  • Omentoplasty, profundoplasty
  • Amputation in gangrene

Exam Important

PATHOLOGY-

  • Smoke → vasospasm & hyperplasia initma → thrombus & obliteration medium sized vessels → Panarteritis → Artery, vein & nerve are involved  → Blockage leads to collateral open up → Blood supply to ishchaemic areas → Compensatory peripheral vascular disease
  • Microabscesses, giant cells are found.

ETIOLOGY-

  • Mainly seen in smokers and tobacco users.
  • Common in Jewish people
  • Hormonal influence
  • Familial nature
  • Poor hygiene

CLINICAL FEATURES-

  • Common in male smokers between 20- 40 years
  • Intermittent claudication in foot & calf progressing to rest pain, ulceration & gangrene.
  • Absence of atheromas.
  • Small & medium sized vessels such as dorsalis, pedis, posterior tibial, popliteal are commonly involved.
Don’t Forget to Solve all the previous Year Question asked on BUERGER DISEASE

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Buerger Disease

Buerger Disease

Q. 1

All of the following are the clinical feature of thromboangitis obliterans except :

 A Raynaud’s phenomenon

 B

Claudication of extremeties

 C

Absence of popliteal pulse

 D

Migratory superficial thrombophlabitis

Q. 1

All of the following are the clinical feature of thromboangitis obliterans except :

 A

Raynaud’s phenomenon

 B

Claudication of extremeties

 C

Absence of popliteal pulse

 D

Migratory superficial thrombophlabitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Absence of popliteal pulse


Q. 2

Commonest site of thromboangitis obliterans is 

 A

Femoral artery

 B

Popiteal artery

 C

iliac artery

 D

None

Q. 2

Commonest site of thromboangitis obliterans is 

 A

Femoral artery

 B

Popiteal artery

 C

iliac artery

 D

None

Ans. D

Explanation:

Ans. is ‘None’ 
Distal circulation is involved in Buerger’s disease, usually distal to popliteal and brachial artery.


Q. 3

Thromboangitis obliterans is associated with

 A

HLA B27

 B

HLA – DR4

 C

HLA – B5

 D

HLA – DR2

Q. 3

Thromboangitis obliterans is associated with

 A

HLA B27

 B

HLA – DR4

 C

HLA – B5

 D

HLA – DR2

Ans. C

Explanation:

Ans. is ‘c’ i.e., HLA – B5 

Thromboangitis obliterans (Berger disease)

  • Thrombangitis obliterans is a distinctive disease that is characterized by segmental, thrombosing acute and chronic inflammation of medium sized and small sized arteries, and sometimes secondarily extending to veins and nerves.
  • Thromboangitis obliterans occurs almost exclusively among heavy-cigarrete-smoking persons.
  • It is more common in men but incidence is increasing in women because of increasing smoking habit in women. o Buerger disease is associated with HLA B-5 and HLA-A9.
  • In thrombongitis obliterans there is acute and chronic segmental inflammation of vessels with accompanied thrombosis in the lumen.
  • Typically, the thrombus contains microabscesses with a central focus of neutrophils surrounded by gran u lomatous inflammation.
  • Later, the inflammatory process extends into contiguous veins and nerves and in time all three structures (arteries, veins and nerves) become encased in fibrous tissue, a characterstic that is very rare with other form of vasculitis.
  • Clinical manifestations
  • Thrombangitis obliterans affects vessels of upper and lower extremities.
  • Symptoms are due to vascular insufficiency, i.e. Ischemia of toes, feet and fingers that can lead to ulcer and frank gangrene.
  • Due to neural involvement, there may be severe pain, even at rest.

Q. 4 True about Buerger disease

 A

Affects larger artery only

 B

Younger males are more commonly affected

 C

Phlebitis migrans is characteristic

 D

Cold intolerance

Q. 4

True about Buerger disease

 A

Affects larger artery only

 B

Younger males are more commonly affected

 C

Phlebitis migrans is characteristic

 D

Cold intolerance

Ans. B:C:E

Explanation:

Answer- B,Younger males are more commonly affected C,Phlebitis migrans is characteristic E,Veins may involved
Also called as Thromboangiitis Obliterans
It is a inflammatory occlusive vascular disorder involving small and medium sized arteries and veins in upper and lower extremities.
It involves tibial and radial arteries and sometimes secondarily extending to veins and nerves of extremities.
The clinical features of thromboangiitis obliterans includes a triad of claudication of the affected extremity, Raynaud’s phenomenon, and migratory superficial vein thrombophlebitis.

Quiz In Between



Ectopic Testis

ECTOPIC TESTIS


ECTOPIA TESTIS

  • An ectopic testicle descends normally through the inguinal canal but then moves into an abnormal position in the groin area.
  • The main hazard is liability to injury.
  • Sites of ectopic testis-

a) Superficial inguinal pouch

b) Perineum

c) Root of the penis

d) Femoral triangle (thigh)

  • Ectopic testis is usually fully developed

EMBRYOLOGY-

  • Testis reaches the scrotum by the scrotal tail gubernaculum.
  • The gubernaculums helps to guide the descent of the testicles.
  • Most ectopic testicles are palpable.

TREATMENT-

  • Surgical treatment after age of about 6 months but no later than 2 years
  • Orchidopexy in a new scrotal pouch.
COMPLICATIONS- 
  • Liability to injury (torsion)

Exam Important

  • Sites of ectopic testis-

a) Superficial inguinal pouch

b) Perineum

c) Root of the penis

d) Femoral triangle (thigh)

  • Ectopic testis is usually fully developed
COMPLICATIONS- 
  • Liability to injury (torsion)
Don’t Forget to Solve all the previous Year Question asked on ECTOPIC TESTIS

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Ectopic Testis

ECTOPIC TESTIS

Q. 1 Ectopic testis is found in all location except ‑

 A

Lumbar

 B

Perineal

 C

Intra abdominal

 D

Inguinal

Q. 1

Ectopic testis is found in all location except ‑

 A

Lumbar

 B

Perineal

 C

Intra abdominal

 D

Inguinal

Ans. C

Explanation:

Ans. is C

  • Sites of ectopic testis-

a) Superficial inguinal pouch
b) Perineum
c) Root of the penis
d) Femoral triangle (thigh)


Q. 2

Complication of ectopic testis is ‑

 A

Seminoma

 B

Atrophy

 C

Torsion

 D

All

Q. 2

Complication of ectopic testis is ‑

 A

Seminoma

 B

Atrophy

 C

Torsion

 D

All

Ans. C

Explanation:

Ans. is ‘c’ i.e., Torsion 

Quiz In Between



Mucocele Of Gall Bladder

MUCOCELE OF GALL BLADDER


Mucocele of the Gall bladder

  • It is one of the complications of Gall stones.
  • Caused due to obstruction of the stone at the neck of the bladder.
  • In course of time the bile is absorbed and replaced by the mucus secreted by the Gall bladder epithelium. Due to this the Gall bladder may because distended and palpable.

Treatment

  • The t/t is early cholycystectomy.
  • If early t/t is not done following complications can occur
  • Empyema
  • Perforation
  • Gangrene

Exam Important

  • It is one of the complications of Gall stones.
  • Caused due to obstruction of the stone at the neck of the bladder.
  • In course of time the bile is absorbed and replaced by the mucus secreted by the Gall bladder epithelium. Due to this the Gall bladder may because distended and palpable.

Treatment

  • The t/t is early cholycystectomy.
Don’t Forget to Solve all the previous Year Question asked on MUCOCELE OF GALL BLADDER

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Mucocele Of Gall Bladder

Mucocele of Gall Bladder

Q. 1

The treatment of choice for a mucocele of gall bladder is –

 A Aspiration of mucous

 B

Cholecystectomy

 C

Cholecystostomy

 D

Antibiotics and observation

Q. 1

The treatment of choice for a mucocele of gall bladder is –

 A

Aspiration of mucous

 B

Cholecystectomy

 C

Cholecystostomy

 D

Antibiotics and observation

Ans. B

Explanation:

Ans. is ‘b’ i.e., Cholecystectomy 

  • Mucocele of the Gall bladder ‑

It is one of the complications of Gall stones.

Caused due to obstruction of the stone at the neck of the bladder.

In course of time the bile is absorbed and replaced by the mucus secreted by the Gall bladder epithelium. Due to this the Gall bladder may because distended and palpable.

  • Treatment

The t/t is early cholycystectomy.

–  If early t/t is not done following complications can occur‑

Empyema

Perforation

– Gangrene

Quiz In Between



Lymphangiosarcoma

LYMPHANGIOSARCOMA


  ANGIOSARCOMA (LYMPHANGIOSARCOMA)

  • Lymphangiosarcoma arises from lymph vessel endothelium.
  • They are high grade and aggressive tumours.
  • It usually occurs after radical lymph node dissection (Stewart – Treves syndrome)
  • It may develop as a complication of a long standing lymphodema.

CLINICAL FEATURES-

  • Most of them occur in head and neck, breast, liver.
  • Acute worsening of oedema
  • Hameorrhage and ulceration.

TREATMENT-

  • Surgery (excision) followed by radiotherapy and combination of chemotherapy.

Exam Important

  • Lymphangiosarcoma arises from lymph vessel endothelium.
  • They are high grade and aggressive tumours.
  • It usually occurs after radical lymph node dissection (Stewart – Treves syndrome)
  • It may develop as a complication of a long standing lymphodema.

CLINICAL FEATURES-

  • Most of them occur in head and neck, breast, liver.
  • Acute worsening of oedema
  • Hameorrhage and ulceration.
Don’t Forget to Solve all the previous Year Question asked on LYMPHANGIOSARCOMA

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Lymphangiosarcoma

Lymphangiosarcoma

Q. 1

Lymphangiosarcoma occurs in?

 A Lymphangiomas
 B

Lymphomas

 C Lymphedema
 D

Serous cavity tumors

Q. 1

Lymphangiosarcoma occurs in?

 A Lymphangiomas
 B

Lymphomas

 C Lymphedema
 D

Serous cavity tumors

Ans. C

Explanation:

Lymphedema REF: Sabiston 18th ed chapter 69

“Lymphangiosarcoma is a rare tumor that develops as a complication of long-standing (usually more than 10 years) lymphedema”

Clinically, patients present with acute worsening of the edema and appearance of subcutaneous nodules that have a propensity toward hemorrhage and ulceration. The tumor can be treated, as other sarcomas, with preoperative chemotherapy and radiation followed by surgical excision, which usually takes the form of radical amputation. Overall, the tumor has a poor prognosis


Q. 2 The most common site of lymphangiosarcoma is

 A

Liver

 B

Spleen

 C

Post mastectomy edema of arm

 D

Retroperitoenum

Q. 2

The most common site of lymphangiosarcoma is

 A

Liver

 B

Spleen

 C

Post mastectomy edema of arm

 D

Retroperitoenum

Ans. C

Explanation:

Ans. is ‘c’ i.e., Post mastectomy edema of arm 
Lymphangiosarcoma is a rare tumor that develops as a complication of long standing (usually more than 10 years) lymphedema.

Quiz In Between



Mondor Disease

MONDOR DISEASE


MONDOR’S DISEASE

  • Mondor disease is a spontaneous thrombophlebitis of the superficial veins of the breast and anterior chest wall.
  • Also called as String phlebitis due to tender, cord like structure.

ETIOLOGY-

  • Unknown

 CLINICAL FEATURES-

  • Presented as a thrombosed subcutaneous cord (3cm) attached to skin.
  • On raising arm, shallow subcutaneous grooves appear alongside cord like thrombosed vein.
  • Frequently involved veins are-

a) Lateral thoracic vein

b) Thoracoepigastric vein

c) Superficial epigastric vein

  • Self limiting disease
  • Pain in lateral aspect of breast or anterior chest wall.

INVESTIGATIONS-

  • Biopsy is indicated

TREATMENT-

  • NSAIDS and warm compresses
  • Restriction of motion and brassiere support of breast

Exam Important

  • Mondor disease is a spontaneous thrombophlebitis of the superficial veins of the breast and anterior chest wall.
  • Also called as String phlebitis due to tender, cord like structure.
Don’t Forget to Solve all the previous Year Question asked on MONDOR DISEASE

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Mondor Disease

Mondor Disease

Q. 1 Mondor’s disease of breast is a variant of:

 A

Mycotic infection

 B

Malignancy

 C

Thrombophlebitis

 D

Lymphadenitis

Q. 1

Mondor’s disease of breast is a variant of:

 A

Mycotic infection

 B

Malignancy

 C

Thrombophlebitis

 D

Lymphadenitis

Ans. C

Explanation:

Mondor’s disease is a variant of thrombophlebitis that involves the superficial veins of the anterior chest wall and breast.

In 1939, Mondor described the condition as “string phlebitis,” a thrombosed vein presenting as a tender, cord-like structure.

Frequently involved veins include the lateral thoracic vein, the thoracoepigastric vein, and, less commonly, the superficial epigastric vein.

Typically, a woman presents with acute pain in the lateral aspect of the breast or the anterior chest wall.


A tender, firm cord is found to follow the distribution of one of the major superficial veins 
 
Ref: Schwartz’s principle of surgery 9th edition, chapter 17.

Q. 2

Mondor’s disease is ‑

 A

Thrombophlebitis of the Superficial veins of Breast

 B

Carcinoma of the breast

 C

Premalignant condition of the breast

 D

Filariasis of the breast

Q. 2

Mondor’s disease is ‑

 A

Thrombophlebitis of the Superficial veins of Breast

 B

Carcinoma of the breast

 C

Premalignant condition of the breast

 D

Filariasis of the breast

Ans. A

Explanation:

Ans is ‘a’ i.e., Thrombophlebitis of Superficial veins of Breast

  • Mondor’s disease
  • is thrombophlebitis of the superficial veins of anterior chest wall and breast although it has also been seen in the arm.
  • frequently involved veins are lateral thoracic vein, thoracoepigastric vein and superficial epigastric veins.
  • aetiology is unknown
  • also known as ‘string phlebitis’, it presents as a tender cord-like structure.
  • The women may present with acute pain in the lateral asepct of breast or the anterior chest wall. A tender cord-like superficial thrombosed vein is formed and when the skin over the breast is stretched by raising the arm, a narrow shallow subcutaneous groove alongside the cord becomes apparent.
  • rarely it may be bilateral.
  • Management

it’s a benign self-limited disorder
The differential diagnosis is lymphatic permeation from an occult carcinoma of breast
When the diagnosis is uncertain or a mass is present near the cord, a biopsy may be done. Treatment

  • antiinflammatory drugs and warm compresses
  • restricted arm movements as well as brassiere support of breast
  • it usually resolves within 4 to 6 weeks. When symptoms persists or are refractory to treatment, the involved vein segment may be excised.

Q. 3 About Mondor’s disease –

 A

Superficial thrombophlebitis

 B

Lymphatic infiltration tumour cell

 C

Cord like apperance of subcutanous veins

 D

a and c

Q. 3

About Mondor’s disease –

 A

Superficial thrombophlebitis

 B

Lymphatic infiltration tumour cell

 C

Cord like apperance of subcutanous veins

 D

a and c

Ans. D

Explanation:

Answer (a) Superficial thrombophlebitis; (c) Cord like apperance of sub. cut. veins 

  • In Mondor’s disease the thrombophlebitis is mostly limited to areas around the breast and there is no evidence of thrombophlebitis in other parts of body.
  • Lymphatic infiltration from tumor cells is a differential diagnosis of Mondor’s disease.

Quiz In Between



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