Examination Of Lower Limb For Varicose Veins And Venous Insufficiency Flashcards
What are the steps of this examination?
Inspect the legs, identify the saphenofemoral junction, cough test, tap test, trendelenburg test, perthe’s test, auscultation, abdominal examination
What are you inspecting the legs for?
Varicosities, venous eczema, hair loss, oedema, lipdermatosclerosis, haemosiderin deposition, genius ulceration, scars
Where are varicosities likely?
Particularly in the distribution of the long saphenous vein (medial though and leg) and short saphenous vein (lateral leg)
Why would you get oedema?
Due to venous stasis
What is lipodermatosclerosis?
Scarring of the skin and fat
Where is the saphenofemoral junction?
4cm lateral and 4cm inferior to the pubic tubercle
Why do we identify the saphenofemoral junction?
To inspect for a saphenovarix (varicosities at the SFJ)
How do you perform the cough test?
Putting your finger on the SFJ and asking the patient to cough. Palpate for thrills at the SFJ.
How do you perform the tap test?
Put your finger on the SFJ and putting a finger of your other hand on any varicosities in the long saphenous vein distribution. Tap on the SFJ.
What would you find on the tap test?
If the SFJ is incompetent, you will feel the transmitted percussion wave in the varicosities further down the leg
What is the trendelenburg test?
Ask the patient to lie flat. Raise the leg and keep it raised for a few minutes to exsanguinate as much blood as possible. Apply a torniquet high around the thigh. Ask the patient to stand up and inspect to see whether the varicose veins refill, repeat the test at the mid-thigh perforators, the saphenopopliteal junction and the mid-calf perforators
What is the purpose of Perthe’s test?
To assess the patency of the deep veins
How do you perform the Perthe’s test?
Ask the patient to lie down. Without exsanguinating the leg, apply a tourniquet around the thigh. Ask the patient to stand and rock up and down onto their tiptoes ten times.
What are the results of the Perthe’s test?
If the superficial veins empty, the deep veins must be patent.
How do you perform auscultation ?
Using a doppler probe on the SFJ. Squeeze the thigh.
What are normal results of the Doppler?
You should hear a single ‘whoosh’ as the blood is squeezed from the long saphenous vein into the femoral vein.
What are abnormal results of a Doppler?
A second ‘whoosh’ indicates incompetence of the SFJ as the blood falls back into the long saphenous vein past the incompetent valve
Why do you examine the abdomen?
To exclude an abdominal or pelvis cause of raised venous pressure.
What are the stages of a peripheral vascular examination?
Inspection, pulses, eyes, tongues, abdomen, light-touch sensation, capillary refill, auscultation, buerger’s test, ABPI
What are you inspecting on general inspection?
Colour, build, comfort, position
What are you inspecting the hands for?
Colour, capillary refill, nicotine staining
What are you checking and comparing the radial pulses?
Rate, rhythm, volume, radioradial delay
What are you looking for in the eyes?
Subconjunctival pallor (anaemia) and corneal arcus (hyperlipidaemia)
What are you looking for in the lips and tongue?
Dehydration and central cyanosis
What are you looking for in the abdomen?
Scars, visible masses and visible pulsations
What are you inspecting in the legs, feet and toes?
Symmetry, colour, temperature, oedema, trophic changes, varicose eczema, lipodermatosclerosis, venous guttering, ulceration
What trophic changes are you looking at?
Loss of hair, shiny skin, wasting of subcutaneous tissues
What are you looking for in ulceration?
Site, shape, size, margins, colour, exudate, odour
What pulses do you palpate?
Radial, ulnar, brachial, carotids, aorta, femoral, popliteal, dorsalis pedis, posterior tibial
What do you check in the toes?
Light touch sensation and capillary refill
What pulses do you auscultate?
Carotids, subclavian, aorta and femoral arteries
How do you perform buerger’s test?
Elevate both legs to 45 degrees, sit the patient up and ask them to hang their legs down over the side of the bed
What does pallor of the feet when elevate indicate?
Ischaemia
What affects the angle to which the legs have to be lifted in Buerger’s test?
The poorer the arterial supply, the less the angle to which the legs have to be raised for them to become pale
What colour do the ischaemia legs go?
The skin at first becomes blue, then red.
Why does the skin go blue?
Blood is deoxygenated in its passage through the ischaemic tissue
Why do the legs go red?
Due to reactive hyperaemia from post-hypoxic vasodilation
Do you do Bueger’s test with one leg or both legs ?
Both legs at the same time
How do you measure the ABPI?
Dividing the highest systolic blood pressure in the arteries at the ankle by the higher of the two systolic blood pressures in the arm
What ABPI indicates significant arterial disease
Less than 0.8
