48 years male, Complaining numbness and coloured change in right midlle toes since one month. He is smoker and alcoholic . No history of trauma. Only given history of blisters and swelling and leads to ulceration on the base and middle toes of right leg, He is not diabetic and not hypertensive ? No history of burn and no drug intake . What is DD and right management ?

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With the background of smoking history diagnosis goes in favour of Bueger,s disease. D/D is Raynauds disease Management 1.Avoidance of smoking. 2.Use of thrombolytic agents ,3.Reserpine ,pentoxifylline,antiplatelet agents ad oral anticoagulant can be tried. 4.NSAIDS 5.Hyperbaric oxygen therapy 6Surgery - lumbar sympathectomy, intraarterial o infusion of 3.Reserpine 7.Intravenous iloprost a prostaglandin reduces the progression of disease but is an expensive treatment and commonly not available 8.Amputation last resort

Thanks. T. A .o.conservstive tt.if no amputation

Diabetic foot with gangrene probably

Do usg doppler. Will need amputation.

Conservatively or else amputation

Berger's disease

Diabetic ulcer

Appears to be cutaneous gangrene. Do an XRay to rule out osteomyelitis, do an colour Doppler to assess blood flow to lower limb. If osteomyelitis, do amputation. If no osteomyelitis and Doppler is normal, then do debridement of all dead tissues and decide further depending upon raw area..

BEURGER'S DISEASE (THROMBOANGITIS OBLITERANS),, D/D -RAYNAUDS PHENOMENON,,, RXX--SMOKING CESSATION,,, THROMBOLYTIC AGENTS,,, NSAIDS,,, ANTICOAGULANTS,, HYPERBARIC O2 THERAPY,,, DEBRIDMENT ALONG WITH DAILY C AND D,,,, ASEPTIC PRECAUTIONS TO BE TAKEN,,,, HIGHER AB"S IV,,, E

Burgers disease / Raynaud's disease Management:- 1. Do arterial Colour Doppler of right lower limb 2.Cessation of smoking 3.Pentoxyphylline 400 mg tid 4.NSAIDS 5.Thrombolytic agents hyperbaric oxygen therapy 6.Amputation last resort. Adv :- Vascular surgeon opinion.

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