1. Definition of symptom(10pts): Claudication is a health condition in which the cramping pain is felt in the lower leg after an exercise such as walking (Lane et al., 2017). Claudication is often caused by obstruction of arteries or inadequate flow of blood to the muscle tissues. The pain is felt while walking and subsides with rest. pathophysiology of claudication

1. Pathophysiology of Symptom(15pts):

The pathophysiology of claudication has five steps including reduced limb perfusion, vascular disfunction, impaired angiogenesis and reduced microcirculatory flow, skeletal muscle alteration and mitochondrial dysfunction, and systemic and local inflammation. In the first step reduced limb perfusion, obstructive perfusion creates drops in the blood flow and blood pressure which, in turn, reduces the ankle pressure (Hamburg & Creager, 2017) more. Vascular dysfunction is the second step where vascular endothelium produces substances such as nitric oxide. Reduced amounts of nitric oxide in the leg impends blood flow augmentation with exercise (Hamburg & Creager, 2017). Vascular dysfunction may also worsen the vasoconstrictive effects of catecholamines. In the third step, impaired angiogenesis and reduced microcirculatory flow, several factors that regulate angiogenesis (Hamburg & Creager, 2017). The factors include fibroblast growth factor, hypoxia-inducible factor, and hepatocyte growth factor. Stimulation of angiogenesis increases the rate of skeletal muscle perfusion which restores an individual to normal status. Skeletal muscle alteration and mitochondrial dysfunction is the fourth step. Changes in the skeletal muscle structure due to factors such as increased fats and type 1 fiber content limits the functioning of the muscle (Hamburg & Creager, 2017). Mitochondrial dysfunction also impairs the metabolism of skeletal muscle because it hinders the utilization of oxygen. The fifth and the final step in the process is the systemic and local inflammation. Inflammation of blood vessels plays a part in the generation of claudication (Hamburg & Creager, 2017). Inflammation may be caused by skeletal muscle ischemia and extreme arterial obstruction. Vascular inflammation reduces nitric oxide bioactivity.

1. Disease 1(2pts):

Peripheral artery disease (PAD)

Spinal stenosis

Vasculitis

1. Pathophysiology of Symptom(8pts):

Peripheral artery disease or peripheral arterial disease, as commonly called, is a circulatory condition that occurs when narrowed blood vessels reduce the flow of oxygen-rich blood to the limbs and other parts of the body (Hamburg & Creager, 2017). The narrowing of blood vessels in PAD is caused by a build-up of fatty acids in the inner layers of the arteries. The narrowed blood vessels can also burst to cause further interference with the normal flow of blood to the limbs.

Spinal stenosis is a health condition caused by the narrowing of the spinal cord (Genevay et al., 2018). Wear and tear of the spine prompt the formation of a bone spur that can grow into the spinal canal. This condition causes the nerves and the spinal cord not to have enough space. As a result, the condition causes numbness, cramping pain, and weakness.

Vasculitis is a condition that describes the inflammatory of blood vessels, which affects the flow of blood to body tissues and organs. It is believed that vasculitis occurs when the immune system of the body attacks the blood vessels by mistake. The immune system attacks healthy blood vessels such as arteries, veins, and capillaries. The blood vessels attacked can thickening, narrow, or weakening, thus affecting the normal flow of blood (Laverty & McHenry, 2019).

1. Symptom: Specific to Disease 1(2pts):

The disease-specific symptom of peripheral artery disease is painful cramping in the hips and thighs (Laverty & McHenry, 2019).

The disease-specific symptom of spinal stenosis weakness in the arms or legs (Laverty & McHenry, 2019).

The disease-specific symptom of vasculitis is a muscle and joint pain (Laverty & McHenry, 2019).

1. Pathophysiology of Symptom E Disease (8pts):

The pathophysiology of cramping in the hips and thighs entails tendon inflammation that around thighs and hips. The inflammation of tendons is caused by overuse or strain on a joint. The pain may be felt on the outside of the hip, the upper thigh, or the outer buttock (Hamburg & Creager, 2017).

The pathophysiology of weakness in the arms and legs entails a feeling that extra energy is required to move arms or legs. The weakness is caused by an insufficient supply of oxygen, fats, protein, and carbohydrates, making the cells weak due to reduced ability to produce energy.

The pathophysiology of muscle and joint pain stems from inflammation disease or blood vessel injury. Injured blood vessels cause blood to clot, which, in turn, interrupts the normal flow of blood to body organs. The pain is short-lived and affects a few muscles or a small part of the body.

Genevay, S., Courvoisier, D. S., Konstantinou, K., Kovacs, F. M., Marty, M., Rainville, J., … & Atlas, S. J. (2018). Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria. The Spine Journal, 18(6), 941-947. https://doi.org/10.1016/j.spinee.2017.10.003

Hamburg, N. M., & Creager, M. A. (2017). Pathophysiology of intermittent claudication in peripheral artery disease. Circulation Journal, 81(3), 281-289. https://doi.org/10.1253/circj.cj-16-1286

Lane, R., Harwood, A., Watson, L., & Leng, G. C. (2017). Exercise for intermittent claudication. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd000990.pub4

Laverty, U., & McHenry, M. (2019). 40. A case of large vessel vasculitis presenting with limb claudication symptoms. Rheumatology Advances in Practice, 3(1). https://doi.org/10.1093/rap/rkz028.009