Insufficienza venosa Flashcards
A 72-year-old woman with hypertension comes to the physician because of swelling and pain in both legs for the past year. The symptoms are worse at night and improve in the morning. Current medications include losartan and metoprolol. Her temperature is 36°C (96.8°F), pulse is 67/min, and blood pressure is 142/88 mm Hg. Examination shows normal heart sounds; there is no jugular venous distention. Her abdomen is soft and the liver edge is not palpable. Examination of the lower extremities shows bilateral pitting edema and prominent superficial veins. The skin is warm and there is reddish-brown discoloration of both ankles. Laboratory studies show a normal serum creatinine and normal urinalysis. Which of the following is the most likely underlying cause of this patient’s symptoms?
A female patient of advanced age with bilateral leg swelling, skin discoloration, and pain most likely has chronic venous insufficiency and varicose veins. In CVI, defective venous valve leaflets result in reflux of venous blood back into the periphery, leading to increased venous pressure (hydrostatic pressure) and subsequent extravasation of venous blood into the interstitium. Plasma proteins in the interstitium in turn cause edema and tissue hypoperfusion, which results in inflammation, atrophy, and possibly ulcer formation.
Decreased lymphatic flow
Decreased lymphatic flow can result in lymphedema, a type of nonpitting edema that results due to the accumulation of filtered lymph fluid in the interstitium. This patient’s pitting edema, chronic skin changes, and lack of risk factors for lymphedema (radiation therapy, surgery, tumor obstruction) suggest a different underlying mechanism.
