varicose veins, DVT and leg ulcers Flashcards
what is a leg ulcer
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
what is a leg ulcer
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
venous ulcer presentation
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
what can cause failure of the calf muscle pump
not walking; trauma
what causes venous hypertension
failure of the venous and lymphatic drainage systems to clear fluid pooling in lower leg tissues
what are varicose veins
dilated tortuous superficial veins
how do varicose veins occur
increased venous pressure leads to disruption of one-way valves causing incompetence; reversal of venous blood flow causes increased venous pressure
CEAP varicose vein classification
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
varicose veins symptoms (8)
pain; itching; aching; phlebitis (inflammation in vein); thrombophlebitis (clot in vein); bleeding; ulceration; skin changes
investigations for varicose veins
pulses; ABPI; torniquet test; venous duplex; iliac/femoral MRV (if previous DVT)
when are compression stockings not advised
if the pt has PAD as they can further restrict the blood flow
why are varicose veins treated
to prevent ulceration
varicose vein treatment (3)
radiofrequency ablation; foam sclerotherapy; high tie and stripping
venous ulcer treatment
graded compression stockings; varicose vein treatment; leg elevation
why might radiofrequency ablation not be applicable
wrong vein anatomy - must be a very straight vein
DVT treatment
catheter directed thrombolytic therapy; anticoagulate; LMWH/warfarin
what is vrichow’s triad
- venous stasis (HF, immobility)
- vascular injury (trauma, phlebitis, chemotherapy)
- hypercoagulability (protein C + S, antithrombin, malignancy, pregnancy)
what does virchow’s triad show
three contributing factors in the formation of thrombosis
what should be considered when there is an upper limb DVT
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
VTE presentation
pain; heaviness; swelling; extensive DVT (massive oedema, cynanosis, Homan’s sign)
what is Homan’s sign
Discomfort in the calf muscles on forced dorsiflexion of the foot with the knee straight
PE symptoms
SOB, palpitations, pleuritic chest pain, cough, heamoptysis
VTE investigations (6)
- FBC
- coag screening (prolonged PT may be seen)
- D-dimer (non specific)
- troponin (poss raised in PE)
- ABG (hypoxaemia)
- ECG - sinus tachy, right axis deviation, ST changes
what does VTE show on CXR
wedge shaped opacity; atelectasis; pleural effusion
