Lower limb chronic venous insufficiency and varicose vein examination Flashcards
What is the first thing to do in this exam?
Wash hands
Introduce yourself :
Hello, my name is Beth Smith and I’m one of the third year medical students.
What patient details do you confirm?
Name
DOB (+ Age)
check band if one present
Explain the LLCVI / VV exam to a patient
I’ve been asked to examine the veins in your legs today, it’s going to involve me having a look, a feel and a listen to any veins that bulge out. is that okay?
What are the last steps of the introduction?
GAIN CONSENT
Ask them to appropriately undress (pants off)
- ask if that is okay
Do they want a chaperone?
Ask if they are in any pain
On inspection what are we looking for?
Varicosities;
Venous eczema;
Venous ulceration;
Scars;
Identify the saphenofemoral junction (SFJ)
Where in particular do you want to look for varicosities?
The distribution of the long saphenous vein (medial thigh + leg) and short saphenous vein (back of leg).
Describe the appearance of venous eczema
An oedematous area of
hardened skin that is hyperpigmented and erythermatous
Explain why varicose ezcema occurs
Occurs due to venous HTN -> fluid collection in tissues -> fluid stasis -> activation of the innate immune response -> inflammation.
why does the oedema occur?
Venous stasis
What else causes the appearance of the ezcema?
Lipodermatosclerosis (scarring of the skin + fat)
Haemosiderin deposition (orange-brown patches).
Describe the appearance of a venous ulcer
Are they painful?
Where are they usually located?
Large, irregular border with sloping edges.
Shallow in depth, mildly painful.
Usually in the gaiter area above the medial malleolus.
What is the gaiter area?
below the knee and above the ankle
Why might scars be present?
Previous surgery
Healed ulceration.
Where is the SFJ?
4 cm lateral and 4 cm inferior to the pubic tubercle
What should we do / cover when palpating?
Temperature
Visible varicosities
Cough test
Tap test
How and where do we feel for temperature?
Place back of hand on varicosities
What might increased temperature of a varicosity indicate?
Phlebitis
When palpating visible varicosities what would indicate thrombophlebitis?
If vessel feels hard, ‘cord-like’ + there’s pain it’s strongly suggestive of thrombophlebitis.
How do you perform a cough test?
Put finger on the SFJ + ask patient to cough.
Palpate for thrills at the SFJ.
How do you perform a tap test?
Put finger on the SFJ
Put other finger on any varicosity in the long saphenous vein distribution.
Tap on the varicose vein being assessed
If there is a thrill felt in the SFJ upon tapping a varicosity what does that indicate?
That there is continuity of the vein secondary to incompetent valves as venous valves should prevent the thrill transmitting along the entirety of the vessel.
What do we auscultate?
What part of the stethoscope do we use?
Any varicosities
The bell
If a bruit is heard what do this indicate?
turbulent blood flow
?underlying AV malformation.
As soon as the exam has finished what should you do?
(LLCVI/ VV)
Thank the patient
Wash hands
Offer to help them dress
Explain that you are going to talk to the examiner now.
To complete the examination….
(LLCVI/ VV)
I’d like to perform an abdominal + peripheral arterial examination and Doppler ultrasound of any varicosities”.
Summarise a normal LLCVI / VV exam
“Today I performed a varicose vein examination on [name] a [age] year old [gender].”
On general inspection, [name] appeared comfortable at rest.
There was no peripheral signs of venous insufficiency in the legs.
Both the cough test and tap test were negative.
To conclude, this is consistent with a normal varicose vein examination.
