Wound Healing Scab
Figure 15-16 Close-up of a necrobiosis lipoidica diabeticorum lesion.
Figure 15-16 Close-up of a necrobiosis lipoidica diabeticorum lesion.

Figure 15-17 Deep vein thrombosis, left leg.

Table 15-2 Precipitating Factors in Thromboembolism
Factor
Cause
Stasis
Arrhythmia Heart failure
Immobilization Obesity
Varicose veins Dehydration
Blood vessel injury
Trauma Fracture
Increased coagulability
Neoplasm
Oral contraceptives
Pregnancy
Polycythemia
Previous thromboembolism
Secondary to venous thrombosis, inflammation around the vein may result. Erythema, warmth, and fever then occur, and thrombophlebitis is present. In many cases, the examiner can palpate this tender, indurated vein in the groin or medial thigh. This is commonly referred to as a cord.
Deep vein thrombophlebitis is associated with symptomatic pulmonary embolism in approximately 10% of patients. If the embolus is large, main pulmonary artery obstruction may occur, which can result in death. It is estimated that an additional 45% of patients with thrombophlebitis have asymptomatic pulmonary emboli.
Several factors that are important in precipitating thromboembolism are outlined in Table 15-2.
An important and common peripheral vascular condition is Raynaud's disease or phenomenon. Classically, this condition is associated with three color changes of the distal fingers or toes: white (pallor), blue (cyanosis), and red (rubor). These color changes are related to arterio-spasm and decreased blood supply (pallor), increased peripheral extraction of oxygen (cyanosis), and return of blood supply (rubor). The patient may experience pain or numbness of the involved area as a result of the causes of pallor and cyanosis. During the hyperemic or rubor stage, the patient may complain of burning paresthesias. Between episodes, there may be no symptoms or signs of the condition.
Raynaud's disease, which is primary or idiopathic, must be differentiated from Raynaud's phenomenon, which is secondary. Table 15-3 lists some of the different characteristics of these conditions.
Gangrene is necrosis of the deep tissues resulting from a decreased blood supply. Features of the main vascular diseases causing gangrene of the lower extremities are summarized in Table 15-4.
Table 15-3 Differential Diagnosis of Raynaud's Disease and Raynaud's Phenomenon
Feature Raynaud's Disease Raynaud's Phenomenon
Table 15-3 Differential Diagnosis of Raynaud's Disease and Raynaud's Phenomenon
Feature Raynaud's Disease Raynaud's Phenomenon
Sex |
Female |
Female |
Bilaterality |
Present (often symmetric) |
± (asymmetric) |
Precipitated by cold |
Common |
Increases symptoms |
Ischemic changes |
Rare |
Common |
Gangrene |
Rare |
More common |
Disease association* |
No |
Yes |
*Such as scleroderma, systemic lupus erythematosus, dermatomyositis, or rheumatoid arthritis.
*Such as scleroderma, systemic lupus erythematosus, dermatomyositis, or rheumatoid arthritis.
Table 15-4 Differential Diagnosis of the Main Vascular Diseases Causing Gangrene
Feature Diabetes Atherosclerosis Thromboangiitis Obliterans Raynaud's Disease Arterial Embolism
Age |
Any |
Older than 60 years |
Younger than 40 years |
Younger than 40 years |
Any |
Sex |
Either |
Either |
Male |
Female |
Either |
Onset |
Gradual |
Gradual |
Gradual |
Gradual |
Sudden |
Pain |
Moderate |
Moderate |
Severe |
Moderate |
Often severe |
Distal pulses |
May be absent |
May be absent |
May be absent |
Present |
Absent* |
Useful Vocabulary | |||
Listed here are the specific roots that are important for understanding the terminology related to vascular disease. | |||
Root |
Pertaining to |
Example |
Definition |
angi(o)- |
blood vessel |
angiography |
Radiographic visualization of blood vessels |
embol(o)- |
wedge; stopper |
embolism |
Sudden blocking of a vessel by a clot |
phleb(o)- |
veins |
phlebotomy |
Incision into a vein for blood removal |
thrombo- |
clot |
thromboembolism Obstruction of a blood vessel by a clot that has broken loose from its site of formation | |
varico- |
twisted; swollen |
varicose |
Unnaturally swollen and twisted |

Arthritis Joint Pain
Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.
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