varicose veins, DVT and leg ulcers

Question 1

what is a leg ulcer

Answer 1

a loss of skin below the knee on the leg/foot which takes >2 weeks to heal; may follows molecular death of the surface epithelium or traumatic removal

Question 1

what is a leg ulcer

Answer 1

a loss of skin below the knee on the leg/foot which takes >2 weeks to heal; may follows molecular death of the surface epithelium or traumatic removal

Question 2

venous ulcer presentation

Answer 2

occur on the medial side of the leg/malleoli; irregular with neoepithelium surrounding them; pink and granulating (but may be covered with a yellow-green slough); surrounding skin may have lipodermatosclerosis, eczema, atrophy and varicose veins present; may also be leg pain, although this is not usually severe

Question 3

what can cause failure of the calf muscle pump

Answer 3

not walking; trauma

Question 4

what causes venous hypertension

Answer 4

failure of the venous and lymphatic drainage systems to clear fluid pooling in lower leg tissues

Question 5

what are varicose veins

Answer 5

dilated tortuous superficial veins

Question 6

how do varicose veins occur

Answer 6

increased venous pressure leads to disruption of one-way valves causing incompetence; reversal of venous blood flow causes increased venous pressure

Question 7

CEAP varicose vein classification

Answer 7

C0 - no visible venous disease;
C1 - telangectasia/reticular veins;
C2 - varicose veins;
C3 - oedema
C4 - skins changes (pigmentation, eczema, atrophie blanche etc.);
C5 - healed venous ulcers;
C6 - venous ulcers

Question 8

varicose veins symptoms (8)

Answer 8

pain; itching; aching; phlebitis (inflammation in vein); thrombophlebitis (clot in vein); bleeding; ulceration; skin changes

Question 9

investigations for varicose veins

Answer 9

pulses; ABPI; torniquet test; venous duplex; iliac/femoral MRV (if previous DVT)

Question 10

when are compression stockings not advised

Answer 10

if the pt has PAD as they can further restrict the blood flow

Question 11

why are varicose veins treated

Answer 11

to prevent ulceration

Question 12

varicose vein treatment (3)

Answer 12

radiofrequency ablation; foam sclerotherapy; high tie and stripping

Question 13

venous ulcer treatment

Answer 13

graded compression stockings; varicose vein treatment; leg elevation

Question 14

why might radiofrequency ablation not be applicable

Answer 14

wrong vein anatomy - must be a very straight vein

Question 15

DVT treatment

Answer 15

catheter directed thrombolytic therapy; anticoagulate; LMWH/warfarin

Question 16

what is vrichow’s triad

Answer 16

1. venous stasis (HF, immobility)
2. vascular injury (trauma, phlebitis, chemotherapy)
3. hypercoagulability (protein C + S, antithrombin, malignancy, pregnancy)

Question 17

what does virchow’s triad show

Answer 17

three contributing factors in the formation of thrombosis

Question 18

what should be considered when there is an upper limb DVT

Answer 18

thoracic outlet syndrome - a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed

Question 19

VTE presentation

Answer 19

pain; heaviness; swelling; extensive DVT (massive oedema, cynanosis, Homan’s sign)

Question 20

what is Homan’s sign

Answer 20

Discomfort in the calf muscles on forced dorsiflexion of the foot with the knee straight

Question 21

PE symptoms

Answer 21

SOB, palpitations, pleuritic chest pain, cough, heamoptysis

Question 22

VTE investigations (6)

Answer 22

1. FBC
2. coag screening (prolonged PT may be seen)
3. D-dimer (non specific)
4. troponin (poss raised in PE)
5. ABG (hypoxaemia)
6. ECG - sinus tachy, right axis deviation, ST changes

Question 23

what does VTE show on CXR

Answer 23

wedge shaped opacity; atelectasis; pleural effusion

Question 24

when is thrombolysis considered in DVT

Answer 24

if lieofemoral DVT and significant symptoms

Question 25

how to distinguish central vs peripheral causes for painful swollen leg

Answer 25

central - bilateral;
peripheral - unilateral

Question 26

central causes of painful swollen legs (6)

Answer 26

cardiac - CHF, pericarditis;
renal - nephrotic syndrome;
hepatic - cirrhosis, portal hypertension;
venous - outflow obstruction etc.

Question 27

peripheral causes of painful swollen leg (8)

Answer 27

lymphatic - radiation, surgery, tumpur compression;
trauma - bruise, tendon rupture;
infection - cellulitis;
gout
venous

Question 28

peripheral causes of painless swollen leg (2)

Answer 28

filariasis (parasite); Milroy’s disease (congenital lymphatic abnormality)