Case Study Help

skyamsen at
Fri Oct 2 02:21:52 EST 1998

A 69-year-old man was a heavy smoker and presented to his doctor with a
painful, black big toe.  This was gangrenous on examination and he was
admitted to hospital urgently for treatment and surgical amputation.  He
made a good recovery and was well for a year.  He then started to develop
pain in the lower back which came and went but was not severe enough to
complain to his doctor.  On one occasion, however, he experienced
excruciating pain in the lower right back and rapidly became shocked and
collapsed with a pulse rate of 120/min and a systolic blood pressure of 60
mmhg.  He was rushed to hospital but died in the ambulance.

A postmortem examination was performed at which a large abdominal aneurysm
was found ruptured.  There were 3 litres of fresh blood clot in the
retroperitoneum, tracking up behind the right kidney.  The aorta showed
severe atheroscierosis elsewhere.

1. How might you connect the episode of gangrene in the toe with the final
pathology in this man?
2. What are the main risk factors for atheroscierosis?
3. What are the complications of an abdominal aortic aneurysm?

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