Untitled Quiz

Venous disorders are a topic in the Faculty of Medicine, Medicine & Surgery Program at King Salman International University.
The date of the presentation is 11/2024.
The professor is Sherief Mohsen.

The superficial system of the venous system includes the long saphenous and short saphenous.
Perforators allow blood to pass from superficial to the deep system.
Perforators on the medial side of the leg are 6, 12, and 18 cm above the sole of the foot.
The deep system includes intra and inter-muscular veins that accompany corresponding arteries.

Accompanies the femoral artery through an opening in the adductor magnus.
The saphenous nerve passes from the lateral to the medial superficial to it, passing anterior to the pectineus muscle's attachment.
The femoral vein is used in coronary grafts (CABG operations) and frequently injured during stripping operations.

Inflammation of superficial veins, often characterized by red, hot, tender, and hard veins
Causes: IV cannulation varicose veins, trauma, pregnancy, oral contraceptives, malignancy.
Treatment: hot foments, limb elevation, and NSAIDs.

A type of superficial thrombophlebitis that spontaneously resolves then reappears in another area.
Occurs with visceral cancer, Burger's disease, polycythemia, ulcerative colitis, and SLE.

Etiology or risk factors often involve Virchow's triad including decreased blood flow velocity, increased blood viscosity, and vascular wall injury
Pathology involves grey cluster (platelet adherence), Zahn lines (fibrin and red blood cells laminated deposition), loose thrombus (dangerous for pulmonary embolism) , tight thrombus and consolidation, and recanalization and valve destruction.

Venous thrombosis can be asymptomatic, occurring more commonly with unexplained post-op fever, tachycardia out of proportion to presentation, or swelling and pain, and tenderness localized to calf veins.
Common complications include pulmonary embolism
Early complications include phlegmasia alba dolens (partial superficial system occlusion, reflex arterial spasm) characterized by painful swelling and white skin discoloration, or phlegmasia cerulea dolens (complete superficial system occlusion) with painful cyanotic swelling.
Late complications involve post-phlebitic limb (secondary varicose veins) or venous gangrene.

Diagnostic and accurate investigations include colored duplex, spiral CT, radioactive fibrinogen, spiral CT, angiography, V/Q lung scan, and chest X-rays
Investigations in young patients or recurrent cases often involve protein C/S deficiency, antithrombin-3, and lupus anticoagulant and factor V Leiden.

Prophylaxis and treatment of deep vein thrombosis (DVT) may include Early ambulation, Active exercise, and post-operative hydration.
Treatment of complications such as acute pulmonary embolism often involves ICU care with morphine, oxygen, and anticoagulants. Thrombolytics like streptokinase may be used for massive or emergent situations in cases of pulmonary embolism, which may follow surgical or other procedures.
In some cases, if improvement isn't observed, an embolectomy is necessary.

Varicose veins are defined as dilated tortuous superficial veins.
Primary varicose veins (85%): associated with idiopathic congenital mesenchymal weakness or congenital valvular incompetence. This can be aggravated by factors like prolonged standing, high parity and female gender.
Secondary varicose veins (15%): Most commonly associated with deep vein thrombosis (DVT). A-V fistula, congenital disorders (Klippel-Trenaunay syndrome), aneurysm,or diseases/conditions including pregnancy, pelvic tumors, and other conditions can cause secondary varicose veins.
Clinical symptoms often include cosmetic disfigurement, pigmentation, itching, ulceration, dull ache, heaviness, warmth, and swelling, which is often worse when prolonged standing occurs.
Diagnosis involves clinical examination and often includes Doppler/duplex ultrasound and/or venography.
Treatment includes conservative measures (e.g. elastic stockings, limb elevation, topical measures) or surgical procedures like injection sclerotherapy, ligation, stripping, or even more complex operations.

Pulmonary embolism is a complication of deep vein thrombosis, occurring when a blood clot (embolus) travels to the lungs, obstructing blood flow.
Small emboli can be silent or asymptomatic.
Medium emboli can cause pulmonary infarction with pleuritic pain, dyspnea, and hemoptysis.
Large emboli can lead to sudden death as a result of a major stem obstruction.

Venous ulcers are a type of leg ulcer caused by chronic venous insufficiency, usually located above the medial malleolus. Risk factors include advanced age, obesity, smoking, a history of deep vein thrombosis, or inherited conditions of the veins.
Etiology includes activation of entrapped white blood cells within tortuous capillaries, release of proteolytic enzymes, and chronic inflammation/fibrosis
Pathology includes pain, swelling, and a progressive sore that may be punched out, painful, and/or pigmented at the edges or in the margin. The base may be uneven and uneven, and surrounding tissue may be indurated, with abnormal pigmentation or edema.
Associated complications often include infection, hemorrhage, osteomyelitis, periostitis, and Marjolin ulcers.
Treatment focuses on conservative measures (compression stockings, wound care, and elevation) and surgical interventions (including surgical debridement) for severe cases.

Chronic leg ulcers are categorized as traumatic, neuropathic, ischemic, or venous depending on the cause.
Common characteristics include the site of the ulcer, appearance of the edges (including whether or not they are punched out, pigmented or inflamed), appearance of the margin, and condition of the floor of the ulcer.
Possible accompanying symptoms include pain as well as the presence or absence of induration or any abnormal lymph nodes.

Malignant ulcers (Marjolin ulcers) can develop from burns or other ulcers. Possible types of cancers associated are squamous cell carcinoma (painless, raised, or everted edges) and basal cell carcinoma (painless, rolled edges).
Other ulcers, like those of tuberculous origin, are typically painful, have undermined edges, and cyanotic margins. Some may exhibit a matted lymph node in the area. Syphilis ulcers are painful and have punched-out edges with a wash leather appearance noted on the ulcer base.