医学课件雷诺病

雷诺病 Raynaud disease 更多医学精品 尽在医学吧 /rayshiu 雷诺病Raynaud disease Raynauds is a rare disorder that affects the arteries. Raynauds is sometimes called a disease, syndrome, or phenomenon. The disorder is marked by brief episodes of vasospasm (narrowing of the blood vessels). Vasospasm of the arteries reduces blood flow to the fingers and toes. In people who have Raynauds, the disorder usually affects the fingers. In about 40 percent of people who have Raynauds, it affects the toes. Rarely, the disorder affects the nose, ears, nipples, and lips. 返回 What Is Raynauds? 雷诺病Raynaud disease In most cases, the cause of Raynauds isnt known. Some of the reasons may be: The disorder of sympathetic nerve Vascular sensitivity Structure of blood vessel Genetic factors 返回 Causes of Raynauds 雷诺病Raynaud disease 返回 Pathophysiology 雷诺病Raynaud disease People who have primary Raynauds can have attacks in response to cold temperatures or emotional stress. Raynauds attacks usually affect the fingers and toes. Rarely, the attacks affect the nose, ears, nipples, or lips Clinical manifestation 雷诺病Raynaud disease During a Raynauds attack, the arteries become very narrow for a brief period. As a result, little or no blood flows to affected body parts. This may cause these areas to: Turn pale or white and then blue Feel numb, cold, or painful Turn red, throb, tingle, burn, or feel numb as blood flow returns to the affected areas Raynauds attacks can last less than a minute or as long as several hours. Attacks can occur daily or weekly. Clinical manifestation 雷诺病Raynaud disease 雷诺病Raynaud disease Attacks often begin in one finger or toe and move on to other fingers or toes. Sometimes only one or two fingers or toes are affected. Different areas may be affected at different times. Severe cases of secondary Raynauds can cause skin sores or gangrene. “Gangrene“ refers to the death or decay of body tissues. Fortunately, severe Raynauds is rare. Clinical manifestation 雷诺病Raynaud disease Medical history Physical exam The results from tests. How Is Raynauds Diagnosed? 雷诺病Raynaud disease Medical history : Change color or feel numb or painful when theyre exposed to cold temperatures Turn white, blue, or both when theyre exposed to cold temperatures 雷诺病Raynaud disease Physical exam: Look at fingers and toes to check the health of the skin and nails and to check blood flow to these areas. Cold Stimulation Test Clench Test Nailfold Capillaroscopy 雷诺病Raynaud disease Lab test: ESR CRP ANA Color doppler ultrasonography Arteriography 雷诺病Raynaud disease Diognosis points: 1.Clinical manifestionagesexcold and stress can can trigger “Raynauds attacks.” bilateral involvement 2.At least 2 years 3.No causes to vasospasm 雷诺病Raynaud disease Raynauds RP Age 10-20y 30-40y Sex female male Severity less more Necrosis rare common Spread symmetry asymmetry Nailfoldcapillary normal abnormal Causes unknown disease, other factor Differential Diagnosis 雷诺病Raynaud disease The aims of treatment are to reduce the number and severity of attacks and to prevent tissue damage and loss of tissue in the fingers and toes. Most doctors are conservative in treating patients with primary Raynauds phenomenon because they do not get tissue damage. For these patients, doctors tend to recommend nondrug treatments before moving onto medications. For patients with secondary Raynauds phenomenon, medications are more often prescribed, because severe attacks with ulcers or tissue damage are more likely. Treatment 雷诺病Raynaud disease Treatment In the most severe cases, Raynauds causes ulcers and serious tissue damage that does not respond to medications. Doctors may use a surgical procedure called a digital sympathectomy with adventitial stripping (which involves removing the tissue and nerves around the blood vessels supplying the affected digits). Although this procedure may result in reducing symptoms and healing tissue, it only helps temporarily and therefore is reserved for difficult cases. 雷诺病Raynaud disease The most common treatments and