Chronic Venous Insufficiency and Lymphoedema Flashcards
What is CVI?
When veins can’t pump enough blood back to heart
Pathophysiology of CVI?
Venous hypertension due to a high AVP
Venous engorgement and stasis
Imbalance of starlings forces
What is AVP? Normal values?
Ambulatory venous pressure
When standing motionless, venous pressure roughly 90mmHg, when moving it falls to about 30 - known as AVP
If AVP high results in venous hypertension
What causes a high AVP?
Failing muscle pump, valves or an outflow obstruction
Aetiology of CVI?
Failure of calf muscle pump
What can cause the calf muscle pump to fail?
Superficial venous reflex Deep venous reflex Venous obstruction Neuro-muscular cause Obesity Inactivity
What are the signs/symptoms of CVI?
Ankle oedema
Venous ulceration
Venous eczema
Telangectasia
Haemosiderin pigmentation
Hypo-pigmentation (atrophie blanche)
Lipodermatosclerosis
What is telangectasia?
Widened venules cause threadlike red lines on skin
What is hypopigmentation?
Scar on skin due to poor perfusion
What is lipodermatosclerosis?
Skin change of lower legs due to venous insufficiency
What is a leg ulcer?
Breach in skin between ankle and knee joint
Present for 4 weeks
Differentials for a leg ulcer besides CVI
Diabetes
Rheumatoid Arthritis
Vasculitis
CT disease
Where will an ulcer of venous origin likely appear?
Above the medial or lateral malleoli
Where will an ulcer of arterial origin likely appear?
Anterior shin
Over the malleoli
Under the heel
Over the toe joints
What is a malleoli?
Bony prominence on both sides of ankle
