This document provides tips for using a PowerPoint presentation (PPT) for active learning sessions: 1. Blank slides are included for topics to allow students to provide input before content is shown. 2. The presenter should show blank slides, ask students what they know, then show the content slide. 3. This process should be repeated for revisions to reinforce learning. 4. It can also be used for self-study by viewing content after providing own input for blank slides.

1. Tips on using my ppt.
1. You can freely download, edit, modify and put your
name etc.
2. Don’t be concerned about number of slides. Half the
slides are blanks except for the title.
3. First show the blank slides (eg. Aetiology ) > Ask
students what they already know about ethology of
today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2. Learning Objectives

3. Learning Objectives
1. Introduction & History
2. Relevant Anatomy, Physiology
3. Aetiology
4. Pathophysiology
5. Pathology
6. Classification
7. Clinical Features
8. Investigations
9. Management
10. Prevention
11. Guidelines
12. Take home messages

4. Introduction & History.
•

5. Introduction
• Chronic episodic attacks of digital
ischemia provoked by exposure to cold or
emotional stress.
• Characterized by sequential colour
changes:-
– white [(pallor),> blue (cyanosis) >and red
(rubor).

6. Aetiology

7. Aetiology
• Idiopathic
• Congenital/ Genetic
• Nutritional Deficiency/excess
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative / lifestyle
• Iatrogenic
• Psychosomatic
• Poisoning/ Toxins/ Drug induced

8. Etiology
• Idiopathic
• Congenital
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative

9. Etiology
– Primary or idiopathic RAYNAUDS PHENOMENON
– Secondary RAYNAUDS PHENOMENON :- underlying
disease or cause is present.
• Most common cause is connective tissue disease
particularly systemic sclerosis

10. Etiology:Primary Raynaud’s
phenomenon (Raynaud’s disease)
Trauma or vibration:-
– Reflex sympathetic dystrophy
– Vibration exposure
– Arteriovenous fistula
– Hypothenar hammer syndrome (ulnar artery
thrombosis)
– Intra-arterial drug administration

11. Etiology:Primary Raynaud’s
phenomenon (Raynaud’s disease)
 Connective tissue disease
and vasculitis
– Systemic sclerosis
– SLE
– Rheumatoid arthritis
– Sjögren’s syndrome
– Mixed connective tissue
disease
– Dermatomyositis
– Temporal arteritis
– Hepatitis B antigen vasculitis
 Obstructive arterial disease
– Atherosclerosis
– Thromboangiitis obliterans
(TAO)(Buerger’s disease)
– Hypothenar hammer
syndrome (ulnar artery
thrombosis)
 Neurological disease
– Thoracic outlet syndrome
(cervical rib)
– Carpal tunnel syndrome
– Hypothenar hammer
syndrome
– Reflex sympathetic
dystrophy

12. Etiology:Primary Raynaud’s
phenomenon (Raynaud’s disease)
 Haematological disease
– Cryoglobulinaemia
– Cold agglutinins
– Paroxysmal haemoglobinuria
– Waldenström’s
macroglobulinaemia
 Drugs and toxins
– Ergot
– β-Blockers
– Methysergide
– Bleomycin
– Amphetamines
– Imipramine
– Bromocriptine
– Clonidine
– Cyclosporin
– Oral contraceptives
– Vinyl chloride
– Nitroglycerin withdrawal
– Heavy metals
– Interferon alfa
 Miscellaneous
– Paraneoplastic syndrome
– Chronic renal failure
– Primary pulmonary hypertension
– Hypothyroidism
– Anorexia nervosa

13. Pathophysiology

14. Pathophysiology
• Not fully understood
• Exaggerated response to cold and emotional
stress.
• disturbance in vascular homeostasis leads to
uncontrolled vasoconstriction and
• studies have demonstrated down-regulation
of nitric oxide and up-regulation of
endothelin-1 in Raynaud’s phenomenon
patients.

15. Clinical Features
•

16. Clinical Features
• Demography
• Symptoms
• Signs
• Prognosis
• Complications

17. Demography

18. Demography
• Age of onset:- usually under 40 years, but it
may occur over this age.
• Age and sex distribution of secondary cases
is that of underlying disease, and is not
therefore so restricted to female sex.
• Raynaud’s phenomenon affects the hands
and, less often, the feet; Changes elsewhere
are exceptional, although the nose, ear lobe,
tongue etc can be involved

19. Symptoms

20. Symptoms & Signs
• A typical attack consists of sudden pallor of
one or more digits, followed after a few
minutes by cyanosis or/and sometimes by
erythema.
• Attacks are usually precipitated by cold,
either local or of the whole body, by
pressure or by psychological stimuli

21. Prognosis

22. Prognosis
• Morbidity
• Mortality rate
• 5 year survival in Malignancy

23. Prognosis
• The disease tends to run a variable course:
– in primary Raynaud’s phenomenon the
outcome is good in 80% of cases, but some
disability occurs in 20%;
– in secondary Raynaud’s phenomenon the
prognosis is that of the underlying

24. Complications

25. Complications
– Telangiectases of the nail fold,
– Thinning and ridging of the nail, and
– Atrophy or sclerosis of the fingers
(sclerodactyly).
– Skin necrosis:- rare in primary Raynaud’s
phenomenon but not uncommon in secondary
Raynaud’s phenomenon and may result in
destruction of the digits.

26. Investigations

27. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histology
– Germ line Testing and Molecular Analysis
• Diagnostic Laparotomy.

28. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histlogy

29. Laboratory Studies

30. Laboratory Studies
• CBC, ESR, urinalysis,
• In Patient with ANA , specific antigen like
Sm antigen or topoisimerase or centomere
or DsDNA to rule out SLE or scleroderma

31. Diagnostic Studies
Imaging Studies

32. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

33. Diagnostic Studies
Imaging Studies
• X-RayRoutine X-ray chest to look for
cervical rib or evidence of ILD.

34. Management

35. Management
• lifestyle changes to minimize exposure to
cold;
• Dressing warmly with loose-fitting, layered
clothing; and keeping thermostat a few
degrees higher than normal.
• Limiting time spent outdoors in winter,
wearing insulated gloves, and using hand or
foot warmers are usually helpful.

36. Management
• Patients should be taught to recognize and
terminate attacks promptly by returning to a
warmer environment and applying local
heat to hands (..g., by placing their hands in
warm water or by using a hair dryer).
• Stop smoking and to avoid secondhand
smoke,
• Stress modification and social support to
minimize vasoconstriction induced by
hyperactivity of sympathetic nervous
system

37. Non Operative Therapy

38. Non Operative Therapy
• Calcium channel blockers
• Sildenafil
• Prostaglandins
• Iloprost:- a prostacyclin analogue
• Bosentan:- an endothelin receptor
antagonist(ERA)
• Losartan :- angiotensin II receptor
antagonist
• Topical glyceryl trinitrate

39. Questions
• Full question
• Short Note
• Long case
• Short case
• MCQs

40. Get this ppt in mobile
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3. Open Google lens.
4. Scan qr code from
next slide.

41. Get this ppt in mobile

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