Flashcards in Chap 122 Raynauds Deck (24):
What is the cause of primary raynauds?
What are connective tissue causes of secondary raynauds?
inflammaroty muscle disease
What drugs can cause secondary raynauds?
What occupational cause can cause raynauds?
What illness that impair digital perfusion can cause secondary raynauds?
What are some large vessel disease that can cause secondary raynauds?
What are proposed pathogenic cases of raynauds?
impaired vasod (impaired NO and prostacyclin)
increased vasoconstriction (overproduction of ATII, ET-1)
structural vascular abnormalities
impaired vasod (calcitonin gene related peptide)
increased vasoc (abnormal adrenergic function)
central (stress induced)
Intravascular factos (plt WBC activation, increased thrombin generation)
What are important questions on hx?
CTD (difficulty swallowing, photosensitivity, mouth ulcers)
RF for athero
What investigations to do for raynauds?
nailfold cappilaroscopy (abnormalities)
angio/NIV for large vessel
Thermography (normal thermal gradients at room temp for PRP but not for sclerosis)
What is medical therapy for raynauds?
topical NO, nitrate
When to do sx? what sx options for raynauds?
when medical treatment fails
cervical sympathectomy (symptoms may return)
excision of calcific deposits
What is the angio anatomic classification of raynauds?
type I: occlusion of R or U artery, decreased flow in level 2-3 arteries
type II: as I but with stenosis of R or U artery
type IIIa: main disorder in common digital or digital arteries
type IIIb: rare, occlusion of the digital arteries to index finger caused by vibration
type IV: all level stenotic
Type V: global ischemia, paucity of vessels, scant flow on angio
What is the technique for digital sympathectomy?
bruner Z-shaped incision
stripp adventitia of common digital artery
How many neurone are in the motor sympathetic route?
Where is the thoracic sympathetic trunk located?
in the middle of the intercostal space either bottom edge of top rib or top edge of bottom rib
Name indications for cervicothoracic sympathectomy
ischemia of the hand
Long QT syndrome
What are surgical approaches to sympathectomy?
VATS (gold standard)
What is the target for CRPS vascular disease and raynauds?
stellate, G2 and G3
What are results of sympathectomy for raynauds?
60% compensatory hyperhidrosis
may no longer be recommended
What are results of sympathectomy for CRPS?
Success 85% needs to be done early
What are common complications to sympathectomy?
What are rare complications of sympathectomy?
Injry to vagus, phrenic, scla, sclv
What are causes of failure of sympathectomy?