| Abdominal aorta
|
||
| Palpation | ? pusatile and expansile | |
| Auscultation | ? bruits | |
| Lower Limb
|
||
| Inspection | Colour ?pale | |
| Beurgers test * | ||
| Inspection of veins ?venous guttering | ||
| Pressure areas; heel, malleoli, head of 5th metatarsal, tips of toes, between toes, ball of foot. ?trophic change ?ulceration ?gangrene | ||
| Palpation | Temperature, dorsal surface of hand | |
| Capillary refill, press pulp of toe for 5 seconds normal refill <2 seconds | ||
| Peripheral pulses | Femoral- midway between the symphysis pubis and anterior superior iliac spine | |
| Popliteal, flex the knee to 135 degrees with the heel resting on couch, place your thumbs on the tibial tuberosity and fingers over the lower part of the popliteal fossa. Move fingers from side to side until you catch the neurovascular bundle between them. Then press the bundle against the lower surface of the tibia to feel the pulse. | ||
| Posterior tibial 1/3rd of the way along the line between the medial malleolus and the point of heel | ||
| Dorsalis pedus between the midpoint of the malleoli to the cleft between the 1st and 2nd metatarsal | ||
| Auscultation | Femoral artery ?bruits | |
| Further tests | Ankle Brachial pressure index (ABPI) |
Beurgers test
Beurgers angle is the angle at which the leg must be raised before it becomes white due to hypo-perfusion. Normally angle = 90 degrees, in ischaemic legs the angle may be 15-30 degrees.
Lay the patient on the couch and elevate both legs to measure Beurger’s angle. Then ask the patient to sit up and hang the legs down the side of the couch. Normal legs stay a healthy pink colour. Ischaemic legs, slowly turn from white to pink and then become a flushed purple red colour caused by blood filling the dilated skin capillaries.