Diabetic Gangrene

Diabetic Gangrene

The factors Contributing to the development of gangrene in a diabetic person are as follows:-

1.Arteriosclerosis.

2.Peripheral neuritis as a complication f diabetes, which reduces the sensations in the lower limb and predisposes to trauma  to the limb, which is not noticed.

3.Elevated blood sugar levels predispose to the development  of infections. That results  in development of a big, moist,gangrenous area from a small,dry gangrenous area.

Treatment

1.Control of diabetes with the following measures:-

           .Insulin.

           .Diabetic diet.

            .Exercises.

2. Careful dressing of the affected part every day.

3. Removal of gangrenous portion as soon as the diabetes is controlled and the patient is fit to undergo surgery.

 

Raynaud’s Disease and Thromboangitis Obliterans.

 

                       Comparision of Raynaud’s Disease and Thromboangitis Obliterans

 

Variable	Raynaud’s disease	Thromboangitis obliterans
Age	Young.	Middle.
Sex	Male<female.	Male>female.
Causes	Hypersensitivity to cold.	Use  of tobacco in any form, use of vibrating  tools.
Site of involvement	Upper limb.	Lower limb.
Treatment	.Avoid exposure to cold.	.Stop use of tobacco in any form.
	.Vasodilators.
	.Amputation is not often required.	Amputation.
	.Cervical sympathectoy.	Lumbar sympathectomy.

  

Phlebitis

Definition

It is a condition characterized by inflammation of the veins.

Aetiology

 

1.Age:any.

2.Sex :male=female.

3.Site:usually veins of the lower limbs.

4.Chronic or prolonged illness, e.g. typhoid.

5.Intravenous injection or irritant solutions.

6.Surgical injury to the vein.

7.Puerperium.

 

Clinical features

 

1.The part around a superficial vein is swollen.

2.There is pain over the affected vein.

3.There is swelling over the lower leg if the deep vein is thrombosed.

4. A  clot may get dislodged from a deep vein and embolize to the lungs.

 

Venous Thrombosis

 

Aetiology

 

1.Chronically bedridden patient.

2.Prolonged bed rest ostoperatively.

3.Combination contraceptive pills.

4.Pregnancy.

5.Puerperium.

6.Congestive cardiac failure.

 

Clinical features

 

1.It may be asymptomatic in mild cases, the first manifestation being that of pulmonary embolism.

2.Oedema of feet and lower legs.

3.Pain in the loer limbs.

4.Calf tenderness.

5.Low grade fever.

6.Calf pain on forced dorsiflexion of the foot.

Treatment

1.Elastic bandage to the lower limb.

2.Bed rest with splints or sand bag support to the lower limbs to prevent pulmonary embolism.

3.Anticoagulant therapy with heparin,followed by warfarin later.

 

Prevention

1.Avoid prolonged bed rest.

2.Leg exercise in high risk cases.

3.Low-dose heparinization in high risk cases.

4.Deep breathing exercise.