Varicose Veins PDF

🧑🧑🧒🧒 Varicose Veins It is permanently elongated, dilated vein/veins with tortuous path causing pathological circulation. There is reversal of blood flow through its faulty valves Risk factors : heredity; female sex; occupation that deman...

🧑🧑🧒🧒 Varicose Veins It is permanently elongated, dilated vein/veins with tortuous path causing pathological circulation. There is reversal of blood flow through its faulty valves Risk factors : heredity; female sex; occupation that demands prolonged standing; immobility; raised intra- abdominal pressure like in sports, tight clothing, pregnancy, raised progesterone level and altered estrogen-progesterone ratio, chronic constipation, high heels. Etiology : - - Saphenofemoral junction is 4cm below 19 so lateral tubercle. to public - I - - - - - - - - I Pathogenesis : 2 theories. # 2. White cell trapping theory : Inappropriate activation of trapped leucocytes V tade- > trapped ↓ release proteolytic enzymes Activation ↓ L destruc"Nevation cell destruction and ulceration. 1  CEAP Classification: 01234 from 2 , alternate has extras. - = Clinical features: day Symptoms : I. Most patients present with dilated veins in the leg. minimum atstart ofthearon's engorgement). 2 swelling of the legs. It is due to an increased volume of fluid in skin and subcutaneous tissues, increased interstitial fluid, impaired lymphatic How to remember ? drainage, and increased hydrostatic pressure. 7 we see Ptfal 3. Dragging pain or a dull aching pain d/t ~ heaviness ↳ limb. Pain(dullache) by rest/clivating - dilated veins > - Relieved the Night cramps > eswelling - > - Ulcer , cozema , > - suddenpain a i 4 Night cramps occur due to change in the diameter of veins. dermatitis , bleeding also occur due to the prevention of nutrients and oxygen from # 7t point. reaching the muscles due to pooling of deoxygenated blood,. 5 Sudden pain in the calf region with fever and oedema of the ankle region suggests deep vein thrombosis (DVT). /some patients may be asymptomatic) 6. may present with ulceration, eczema, dermatitis, and bleeding. 7. Symptoms of pruritus/itching and skin thickening. - -  Ankle flare Signs : Visible dilated veins in the leg Veins are tortuous and dilated. - - - - A single dilated varix at the SF junction is called saphena varix. It is due to saccular dilatation of the upper end of the long saphenous vein at the saphenous opening A localised, dilated segment of the vein, if present, is an indication of a blowout. It signifies an underlying perforator Ankle flare is a group of reticular veins near the medial malleolus. Complications such as ulceration, bleeding, eczema, and dermatitis may be present. Pigmentation is often seen. 1. Cough impulse test (Morrissey’s test): Patient standing position on. examiner keeps the finger at the SF junction and asks the patient to cough. Fluid thrill, an impulse felt by the fingers, is indicative of ‘saphenofemoral incompetence’. 2. Brodie-Trendelenburg test: Vein is emptied by elevating the limb and a tourniquet is tied just below the sapheno-femoral junction (or using thumb, SF junction is occluded). Patient is asked to stand quickly. When tourniquet or thumb is released, rapid filling from from above signifies saphenofemoral incompetence. Above If> - This is Trendelenburg test I. Below Perforator BP In Trendelenburg test II, after standing tourniquet is not released. Filling of blood from below upwards rapidly can be observed within 30-60 seconds. It signifies perforator incompetence. 3. Multiple tourniquet test : done to determine exact site of perforators. 4. Schwartz test : It is done with the patient in the standing position. Place the fingers of the left hand over a dilated segment of the vein and tap the vein with the right index finger. A palpable impulse suggests a superficial column of blood in the vein and incompetent valves between the segment. 5 Modified Perthes’ test : to rule out deep vein thrombosis. The patient is asked to stand and a tourniquet is applied at SF junction. without the vein. emptying He is then asked to take a brisk walk-tip toe walking ↓ ↑ so Pain & swelling DVT ↳. CI for Surgery.. 6 Fegan's test : On standing, the site where the perforators enter the deep fascia bulges and this is marked. Then on lying down, button like depression (crescent like) in the deep fascia is felt at the marked out points which confirms the perforator site. Examination of the abdomen has to be done to look for pelvic tumours, lymph nodes, which may compress over the veins to cause varicosity Investigations : - - - - - - ↳s v VAS A ~ f f Ultrasound abdomen, peripheral smear, platelet count etc. can be done depending on the cause of varicose veins -Sx anatomy. consu