case study review

Ed Mathes emathes at servtech.com
Mon Oct 12 09:48:55 EST 1998


skyamsen wrote:

> Please help to review my interpretation of this case study.  feel free to
> comment and point out the mistakes.  Thanks
>
> 1. How might you connect the episode of gangrene in the toe with the final
> pathology in this man?
>
> Ans:
>  The site of atheroma
> could be on an aorta serving the lower portion of the body.

Could be THE aorta not AN aorta...there is only one aorta.

The gangrenous toe was probably due to an embolic event.

The embolism could have come from the heart if the person had atrial
fibrillation and not adequately anticoagulated.

Other sources include ulcerated plaques in the aorta, iliac arteries, femoral
arteries.


> The gangrenous
> toe could be caused by vascular occlusion of the supplying blood vessel.

Yes, indeed.  The embolism would travel down until it could go no further,
clotting off that blood vessel.

But remember, smoking like he did, atherosclerosis affects all arteries.  COuld
have been the final occlusion of the applicable artery in the foot.  Also
unsure if this particular patient was diabetic.

> The decrease in systolic pressure before death is due to the rupture of the
> aneurysm which caused the blood clot in the retroperitoneum
> region(retroperitoneum haemorrhage).  The internal loss of blood made the
> man go into hypovolaemic shock.  The area of pain is consistent with the
> site of rupture, behind the kidney.

Actually, the site of the rupture was probably the posterior aortic wall.  he
blood just happened to track into the retroperitoneum behind that particular
kidney.  Post-mortem should identify the actual site of the rupture.

What is the most common site for aortic rupture?


--
Edward J. Mathes, RPA-C
Internal Medicine                         \\\\\\I//////
emathes at servtech.com               (  @ @  )
 -------------------------------------oOOo-(_)-oOOo-----------------------------

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