Professional Documents
Culture Documents
KURSK-2010
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I. Introduction
B/ be able
• To find main complains, symptoms and signs of the diseases , accumulate
anamnesis in cases and staging this disease.
• To realize objective examination of patients with this diseases.
both kidneys are in the same blood supply conditions, in second once - one of them
has normal, another - abnormal arterial supply due to occlusion site between both
kidney arterial openings. Due to it, the kidney with primary normal arterial flow will
transform into “switching kidney”. It means, that primary the kidney is working in
arterial hypertension conditions and surgical restoration of normal blood flow through
the occlusion site will lead to relative hypotension in primary normal kidney. So,
renin-angiotensin-aldosteron mechanism is activating again and systemic arterial
hypertension is relapsing.
Clinical picture.
All patient complaints are subdivided into 6 main syndromes:
1. Brain hypertension complaints
2. Overload left heart chambers and coronary insufficiency
3. Loin pain syndrome
4. Accompany lesions of another vascular regions
5. General inflammation syndrome /due to aorta-arteriitis/
6. Secondary hyperaldosteronism
It is meeting in literature the idea of “malignant arterial hypertension”. It
includes in itself the combination of main and accompanying signs. The first
subdivision group consists of dyastolic arterial pressure about 130-140 mm mc col,
severe lesions of eye found vessels, organical disorders of kidney arteries.
The second signs group consists of hypertonic enchephalopathy, brain blood
supply lesions, acute left ventrical insufficiency, kidney insufficiency.
Diagnosis.
From anamnesis:
Refractory arterial hypertension, occurred in childhood or youth
Transformation of benign hypertension into malignant in patients, older 40
years
Time connection between arterial hypertension start and any surgical
instrumental diagnostic or treated procedures on aorta and kidneys
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aterosclerosis /about 99 %/
non specific aorta-arteriitis
occlusive thrombangitis
postthrombotic and postembolic occlusion
diabetes mellitus angiopathy
Vascular occlusions placed more often in aorta or common iliac artery bifurcation.
Ascending iliac thrombosis is stopping on aorta bifurcation level till the time of
blood stream velocity reduce through the another common iliac artery. So, more
common atherosclerotic lesions sites in aorta and main arteries bifurcations are
explained by considerable blood flow reduction. Some importance is belonged to
chronic trauma of vascular wall due to “systolic blows” to souround rigid tissue, such
as promontorium and arterial bifurcations places against background of arterial
hypertension. It leads to vase vasorum lesions and aorta wall ischemia.
In cases of thrombangiitis morphological picture is characterizing by small
arterial and vein vessels thrombosis combination with souround tissue inflammation.
Pathological physiology.
In main artery occlusion condition the most important role in blood supplying
belongs to muscular vascular branches. Capillary and tissue cells substances
exchange can be against the background of systemic arterial blood pressure more then
60 mm. merc. col. only. If perfuse pressure is decreasing below of periferal resistance
level, pressure arterio-vein gradient is disappearing and microcyrculation is being
arrested. Critical value of perfuse pressure is about 20-30 mm.merc.col. The level
stops any blood tissue exchange completely. It is developing capillary atony. Arterial
blood supplying decrease leads to accumulation of acid substances first of all in
muscular tissue. pH fall irritates nerve ends and constant severe pain appears. Oxygen
starvation in accompany with nerves lesions lead to trophic ulcers.
In general, the condition of region limb blood supply depends on main and
collateral artery blood flow and microcyrculatory condition.
Clinical picture
All types of chronic lower limbs ischemia can be characterized by 4 stages.
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1 stage - against the background of physical efforts patients have complains to undue
fatiguability of lower limbs on distance more then 1 km. There are early signs of skin
blood supply insufficiency: pallor, superficial temperature fall, numbness and
paresthesia
2 A stage - it’s characterized by claudication appearance after walking more then in
200 m. There are some new signs of skin blood supply insufficiency - disgidrose,
hairs shedding.
2 B stage - The claudication is appearing early then 200 m walking. There are skin
atrophy, hyperceratos.
3 stage - It’s decompensative stage. The claudication appears at rest or walking less
then 25 m
4 stage - It’s ulcero-necrotis stage. First of all it’s characterized by tissue distraction
in accompany with severe constant pain syndrome.
In development of endarteritis it’s divided two clinical forms - local with
lesions of one or both lower extremities and general once, with not only extremities,
but visceral arteries lesions too.
Symptoms of limbs arterial insufficiency have specific traits according
nosological forms.
Non-specific aorta-arteriits is meeting in adult patients before 40 years old.
Disease development is undulating. In anamnesis there are some signs of general
inflammation. Lesions localize in middle segment of aorta and its bifurcation.
Claudication is always symmetric and its expression is low.
Thrombangitis is meeting in mail patients only before 30 years old. Vascular
lesions place in distal limb segments - on leg and foot.
Diabetes mellitus angiopathy is meeting in both sex persons after 50 years old.
The development of the disease is growing progressively in accompany with eyes and
kidney signs. The lesions take place in distal part of extremity.
Diagnosis
The level of artery occlusion and chronic limb ischemia can be found by general
examination, palpation, oscultation of main arteries, so as functional tests.
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