Varicose Veins and Their Etiology
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Questions and Answers

What does the Trendelenburg test II indicate if filling of blood from below upwards is observed within 30-60 seconds?

  • Normal perforator function
  • Superficial vein thrombosis
  • Deep vein thrombosis
  • Perforator incompetence (correct)

    • The Modified Perthes' test is used to confirm the presence of deep vein thrombosis.

    True

    What does the Schwartz test assess in a vein?

    Incompetent valves between the segments of the vein

    Fegan's test involves marking the site where the perforators enter the deep fascia and observing a __________ on lying down.

    <p>button-like depression</p> Signup and view all the answers

    Match the following tests with their purposes:

    <p>Trendelenburg test II = Assess perforator incompetence Multiple tourniquet test = Determine exact site of perforators Schwartz test = Check for superficial column of blood Modified Perthes' test = Rule out deep vein thrombosis</p> Signup and view all the answers

    What is one key symptom that patients with dilated veins in the leg may experience?

    <p>Swelling of the legs</p> Signup and view all the answers

    Night cramps in patients with dilated veins occur due to narrowing of veins.

    <p>False</p> Signup and view all the answers

    What type of pain is commonly associated with dilated veins in the legs?

    <p>Dull aching pain</p> Signup and view all the answers

    Increased _______ pressure can lead to swelling in the legs.

    <p>hydrostatic</p> Signup and view all the answers

    Match the symptoms to their descriptions:

    <p>Swelling of the legs = Increased interstitial fluid accumulation Dull aching pain = Heaviness in the limb Night cramps = Change in diameter of veins Ulcers = Prevention of nutrients reaching the muscles</p> Signup and view all the answers

    What condition can occur due to pooling of deoxygenated blood in the limbs?

    <p>Ulcers</p> Signup and view all the answers

    Patients with increased hydrostatic pressure may experience bleeding.

    <p>True</p> Signup and view all the answers

    What factors contribute to the swelling of the legs in patients?

    <p>Increased volume of fluid, impaired lymphatic drainage, increased hydrostatic pressure</p> Signup and view all the answers

    What is one reason for examining the abdomen in relation to varicose veins?

    <p>To locate pelvic tumours and lymph nodes</p> Signup and view all the answers

    Ultrasound of the abdomen is one of the investigations that can be conducted to evaluate varicose veins.

    <p>True</p> Signup and view all the answers

    What types of tests may be performed to investigate the cause of varicose veins?

    <p>Ultrasound abdomen, peripheral smear, platelet count</p> Signup and view all the answers

    One potential complication of lymph node compression over veins is _____ in the legs.

    <p>varicosity</p> Signup and view all the answers

    Match the investigation with its purpose:

    <p>Ultrasound abdomen = Visualize pelvic tumours or abnormalities Peripheral smear = Assess blood cell counts Platelet count = Determine clotting ability MRI = Detailed imaging of soft tissues</p> Signup and view all the answers

    What is the primary characteristic of varicose veins?

    <p>Permanently elongated and dilated veins</p> Signup and view all the answers

    Chronic constipation is a risk factor for developing varicose veins.

    <p>True</p> Signup and view all the answers

    Name one risk factor associated with the development of varicose veins.

    <p>female sex</p> Signup and view all the answers

    The CEAP classification for varicose veins ranges from ___ to ___.

    <p>0 to 6</p> Signup and view all the answers

    Which of the following is part of the etiology of varicose veins?

    <p>Raised estrogen-progesterone ratio</p> Signup and view all the answers

    Match the risk factors for varicose veins with their descriptions:

    <p>Heredity = Genetic predisposition to venous issues Prolonged standing = Occupation-related stress on veins High heels = Footwear that increases leg strain Pregnancy = Hormonal changes and increased belly pressure</p> Signup and view all the answers

    What is the primary issue with the valves in varicose veins?

    <p>Faulty valves cause reversal of blood flow.</p> Signup and view all the answers

    The white cell trapping theory suggests that trapped leucocytes activate and cause cell destruction in varicose veins.

    <p>True</p> Signup and view all the answers

    What condition is suggested by sudden pain in the calf region with fever and oedema?

    <p>Deep vein thrombosis (DVT)</p> Signup and view all the answers

    Ankle flare is characterized by the presence of reticular veins near the lateral malleolus.

    <p>False</p> Signup and view all the answers

    What does a single dilated varix at the saphena junction indicate?

    <p>Saphena varix</p> Signup and view all the answers

    The _____ test indicates saphenofemoral incompetence through a fluid thrill felt at the SF junction.

    <p>Cough impulse</p> Signup and view all the answers

    Match the signs and tests with their respective descriptions:

    <p>Visible dilated veins = A sign of venous insufficiency Brodie-Trendelenburg test = Tests for saphenofemoral incompetence Ankle flare = Reticular veins near the medial malleolus Saphena varix = Dilated varix at the saphena junction</p> Signup and view all the answers

    Which of the following symptoms may result from complications of DVT?

    <p>Ulceration</p> Signup and view all the answers

    The Brodie-Trendelenburg test involves elevating the limb and tying a tourniquet below the sapheno-femoral junction.

    <p>True</p> Signup and view all the answers

    What skin changes may occur due to venous insufficiency?

    <p>Eczema and dermatitis</p> Signup and view all the answers

    Study Notes

    Varicose Veins

    • Varicose veins are dilated, elongated veins with a tortuous path, causing abnormal blood flow.
    • Risk factors include heredity, female sex, prolonged standing, immobility, increased intra-abdominal pressure (e.g., pregnancy, sports), tight clothing, high heels, and altered estrogen/progesterone ratios.

    Etiology of Varicose Veins

    • Varicose veins are more common in the lower limbs due to upright posture and the need to support a column of blood.
    • Primary varicose veins are due to:
    • Congenital valve incompetence.
    • Weakness or wasting of muscles and connective tissues in the vein walls.
    • Stretching of the deep fascia.
    • Inherited factors (e.g., FOXC2 gene mutations).
    • Conditions like Klippel-Trenaunay syndrome, avalvulia, and Parkes-Weber syndrome.
    • Secondary varicose veins are due to:
    • Recurrent thrombophlebitis.
    • Prolonged standing, like in certain occupations.
    • Obstructions to venous return (tumours, fibrosis, etc).
    • Pregnancy.
    • Obesity.
    • Chronic constipation.
    • Valve incompetence.

    Pathogenesis of Varicose Veins

    • White cell trapping theory: inappropriate leucocyte activation leads to proteolytic enzyme release, cell destruction, and ulceration.
    • Incompetent venous valves lead to blood pooling and chronic ambulatory venous hypertension.
    • Red blood cell lysis leads to haemoglobin breakdown and pigment release (haemosiderin).
    • This contributes to pigmentation, inflammation, and subsequent dermatitis.
    • Chronic venous ulceration can occur due to a combination of factors.

    Clinical Features and Symptoms

    • Most patients present with dilated veins, swelling, dull aching pain (relieved by elevation), and heaviness in the legs.
    • Impaired lymphatic drainage, increased interstitial fluid, and increased hydrostatic pressure contribute to swelling.
    • Night cramps may occur due to changes in vein diameter and restriction of nutrient/oxygen supply to muscles.
    • Sudden calf pain, swelling, fever, ankle oedema (deep vein thrombosis), pruritus (itching), and skin thickening are also common indicators.
    • Bleeding, dermatitis, and ulceration are possible complications.

    Diagnostic Tests and Investigations

    • Cough impulse test (Morrissey's test): Fluid thrill felt with cough indicates saphenofemoral incompetence.

    • Brodie-Trendelenburg test: Rapid filling from above indicates saphenofemoral incompetence; delayed filling from below indicates perforator incompetence.

    • Multiple tourniquet test: Used to determine perforator competency by observing vein filling.

    • Schwartz test: Palpable impulse in dilated veins with incompetent valves between them.

    • Modified Perthes' test for deep vein thrombosis (DVT) assessment.

    • Doppler Ultrasound: Detects blood flow and detects incompetent valves.

    • Venography and Plethysmography: Used less often now due to better diagnostic technologies.

    • Complete physical examination: Examination of the abdomen for tumour & lymph nodes is crucial because they can interfere with the flow pathways.

    • Examination of the leg helps to assess specific details such as location and size of the dilated veins and the presence of associated skin changes.

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    Description

    Explore the intricate details of varicose veins, focusing on their characteristics, risk factors, and underlying causes. This quiz delves into both primary and secondary causes, highlighting genetic factors and environmental influences. Perfect for students and professionals in the medical field.

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