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الجامعة السورية الجامعة السورية

الجامعة السورية - PowerPoint Presentation

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الجامعة السورية - PPT Presentation

الخاصة كلية الطب البشري قسم الجـراحـة الدكــتـور عاصم قبطان MD FRCS wwwsurgiguidecom 2 nd lecture ID: 779638

kubtan gangrene occlusion embolism gangrene kubtan embolism occlusion arterial absent artery thrombus venous clinical function part pallor infected types

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Slide1

الجامعة السورية الخاصة

كلية الطب البشري قسم الجـراحـة الدكــتـور عاصم قبطانMD – FRCSwww.surgi-guide.com2nd lecture

1

M.A.Kubtan

Slide2

Acute Arterial Occlusion

Definition :Is sudden occlusion of an artery commonly caused by Emboli , or Thrombus .M.A.Kubtan2

Slide3

Definition Embolus

: Is an abnormal mass of undissolved material which is transported in the circulation from one part to another .Thrombus : Is thrombotic lesion occurs on a plaque of pre-existing atheroma ending with complete acute occlusion of the artery . M.A.Kubtan3

Slide4

Classification of Embolism Thrombi and clot may be bland or infected.

Gas : Air and Nitrogen .Fat .Tumour .Miscellaneous .M.A.Kubtan4

Slide5

Embolic OcclusionIt is often a thrombus that has become detached from the Lt Atrium in cardiac

arrhythemia ( atrial fibrellation , or mural thrombus following myocardial infarction .Less common are aneurysm and thrombi formed on atheromatous plaques causing artery to artery embolism .M.A.Kubtan5

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Clinical features of Arterial Occlusion It is an emergency and requires immediate treatment

Leg >>>> pain , pallor >>>> parisis >>>> pulslessness ,paraesthesia ( anaesthesia ) . The limb is cold and toes cannot be moved in contrast with venous occlusion when muscle function is not affected .The diagnosis can be made on clinical bases .Symptoms may progress to complete loss of function , coldness and mottling.M.A.Kubtan6

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Types of embolism and complicationsCompartment syndrome .

Intra-arterial thrombosis .Mesenteric artery occlusion .Air embolism .Bacterial infected clot embolism .Malignant cells ( Hypernephroma , Cardiac myxoma ) Fat embolism .Therapeutic embolisation.M.A.Kubtan7

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M.A.Kubtan8

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M.A.Kubtan9

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M.A.Kubtan10

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TreatmentTotal heparinisation

( Intravenous Heparin 5000 U ) .Relief of pain since it is sever and constant .Thrombolysis when indicated .Embolectomy .M.A.Kubtan11

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Abdominal Aortic ThrombosisM.A.Kubtan

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M.A.Kubtan13

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Fogarty catheter for removal of EmbolusM.A.Kubtan

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Removal of organized thrombusM.A.Kubtan

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Saddle Aortic ThrombosisM.A.Kubtan

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Thrombus removed from SFA & POP AM.A.Kubtan

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M.A.Kubtan18

Slide19

GANGRENE

Implies death of macroscopic portion of tissue It is often affects distal part of limb because of arterial obstruction .Gas gangrene caused by anaerobic infection . M.A.Kubtan19

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Clinical featuresAbsent arterial pulsation .

Absent venous return.Absent capillary response to pressure .Absent sensation .Absent warmth .Absent function .Changes in colour : Pallor , duscky grey ,mottled , purple >>> dark-brown , greenish-black ,black.M.A.Kubtan20

Slide21

Types of gangreneDry gangrene .

Moist gangrene the affected part becomes swollen ,and discoloured . Crepitus may be palpated .this condition is quite common in feet of diabetics.M.A.Kubtan21

Slide22

Specific varaieties of gangree

Diabetic gangrene .Bedsores .Drug abuse .Injecting of drugs into arteries .Frost bite .Venous gangrene M.A.Kubtan22

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Frostbite of the foot note the clear demarcation lineM.A.Kubtan

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M.A.Kubtan24

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M.A.Kubtan25

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Treatment of gangreneAccording to stage .

In diabetic gangrene : Oxygenation , Antibiotics ,Extensive debridement.Amputation .M.A.Kubtan26