Varicose veins, DVT and leg ulcers Flashcards
Define leg ulcer
loss of skin below the knee on the leg or foot which takes more than 2 weeks to heal
break in the continuity of the covering epithelium of the skin or mucous membrane
Varicose veins pathophysiology
increased venous pressure, disruption of one way valves causing incompetence
What is the classification for varicose veins?
CEAP
C0 = no visible venous disease
C1 = telangiectasia or reticular veins
C2 = varicose veins
C3 = oedema
C4 = skin changes (eg. pigmentation, eczema, lipodermatosclerosis, atrophie blanche)
C5 = healed venous ulcer
C6 = venous ulcer
Varicose veins symptoms
pain
itching
aching
phlebitis - inflammation in vein
thrombophlebitis - clot in vein
bleeding
ulceration
Varicose veins investigation
pulses
ABPI
tourniquet test/trendelenberg test
venous duplex
Varicose veins treatment
radiofrequency ablation
foam sclerotherapy
high tie and stripping
Venous ulcer treatment
compression therapy
treatment of varicose veins
leg elevation
not healed after 2 weeks = refer to specialist leg ulcer clinic or vascular specialist
What pressure is compression bandaging?
40mmHg
History of venous and arterial ulcers
venous = hx of varicose veins, DVT, venous insufficiency or venous incompetence
arterial = hx suggestive of PAD, IC and/or rest pain
Classic site of venous and arterial ulcers?
venous = over medial gaiter region of the leg
arterial = usually over the toes, foot and ankle
Edges of venous and arterial ulcers
venous = sloping
arterial = punched out
Wound bed of venous and arterial ulcers
venous = often covered with slough
arterial = often covered with varying degrees of slough and necrotic tissue
Exudate level of venous and arterial ulcers
venous = usually high
arterial = usually low
Pain of venous and arterial ulcers
venous = pain not severe unless associated with excessive oedema or infection
arterial = usually low
Oedema of venous and arterial ulcers
venous = usually associated with limb oedema
arterial = oedema not common
Associated features of venous and arterial ulcers
venous = venous eczema, lipodermatosclerosis, atrophie blanche, haemosiderosis
arterial = trophic changes, gangrene may be present
Treatment of venous and arterial ulcers
venous = compression along ablation of superficial incompetence
arterial = appropriate surgery for arterial insufficiency, drugs of limited value
VTE investigations
FBC - Hb, wcc, platelets
Coag screen - may show prolonged PT
D-dimer - non-specific but good NPV
Troponin - can be raised in PE
ABG - hypoxaemia, resp failure
ECG - sinus tachycardia, right axis deviation, ST changes
VTE imaging
CXR - wedge shape opacity, atelectasis, pleural effusion
Duplex
VQ scan
CTPA
General causes of painful swollen leg
central cause = bilateral
peripheral cause = unilateral
Central causes of painful swollen leg
Cardiac - CCF, pericarditis
Renal - nephrotic syndrome
Hepatic - cirrhosis, portal hypertension
Venous - outflow obstruction
Endocrine - myxoedema
Allergic - angioedema
Nutrition - hypoproteinaemia
Drugs
Obesity - lipedema
Peripheral causes of painful swollen leg
Lymphatic - filariasis, radiation, surgery, compression from tumour
Trauma - bruise, sprain, tendon rupture
Infection - cellulitis
Gout
Venous
AV malformation
Hereditary - Milroy’s disease (congenital lymphatic abnormality)
