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mrcs med school > Varicose veins, Lymphoedema > Flashcards

Varicose veins, Lymphoedema Flashcards

1
Q

Pathophysiology of varicose veins

A

One-way flow from supficial → deep normally maintained by valves

Valve failure → ↑ pressure in sup veins → varicosity

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2
Q

3 main sites for varicose veins

A
  1. Saphenofemoral Junction: 3cm below and 3cm lateral to pubic tubercle
  2. Saphenopopliteal Junction: popliteal fossa
  3. Perforators: draining Great saphenous vein
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3
Q

Hunter’s varicose vein

A

medial thigh perforator

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4
Q

Cockett’s varicose vein

A

3 medial calf perforators

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5
Q

primary causes of varicose veins

A
  • Congenitally weak or absent valves
  • Prolonged standing
  • Pregnancy
  • Obesity
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6
Q

Secondary causes of varicose veins

A

DVT

Constipation

Overactive pumps (e.g. cyclists)

Klippel-Trenaunay

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7
Q

Klippel Trenaunay syndrome

A

Port wine stain

Varicose veins

Limb hypertrophy (bone/soft tissue)

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8
Q

Symptoms of varicose veins

A

Pain

Tingling

Bleeding

Swelling

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9
Q

Skin changes of varicose veins

A

Venous stars

Haemosiderin deposition

Lipodermatosclerosis (panniculitis)

Atrophie blanche

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10
Q

Venous stars

A

From raised intravenous pressure

Cannot be obliterated by pressure

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11
Q

Panniculitis

A

inflammation of fat

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12
Q

Lipodermatosclerosis

A

A type panniculitis

Induration (hardening) of the skin of lower legs in venous insufficiency

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13
Q

Atrophie blanche

A

White scar on lower leg

sign of vascular inflammation

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14
Q

Thrombophlebitis

A

clot in vein, could be supreficial or deep

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15
Q

Varicose eczema aka

A

gravitational eczema

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16
Q

Investigations for varicose veins

A
  1. Duplex ultrasonography
  2. Bloods: FBC, U+E, clotting, G+S
  3. CXR, ECG
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17
Q

When to refer a patient with varicose veins

A

Bleeding

Pain

Ulceration

Superficial thrombophlebitis

Severe impact on QoL

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18
Q

classification of chronic venous disease

A

CEAP classification

  • Clinical signs (1-6 + sympto or asympto)
  • Etiology
  • Anatomy
  • Pathophysiology
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19
Q

Conservative management of varicose veins

A

Lose weight

Relieve constipation

Education (Avoid prolonged standing, Regular walks)

Class II Graduated Compression (Stockings 18-24mmHg, symptomatic relief and slows progression)

Skin Care (Maintain hydration with emollients, Treat ulcers rapidly)

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20
Q

indications for minimally invasive therapies for varicose veins

A

small below knee varicosities not involving great saphenous vein or short saphenous vein

21
Q

Endovascular techniques for varicose veins

A
  • Injection sclerotherapy: 1% Na tetradecyl sulphate
  • Endovenous laser or radiofrequency ablation
22
Q

VNUS

A

Radiofrequency ablation

Catheter inserted and heated to 120 C

Closes the vein

23
Q

EVLA

A

Endovenous laser ablation

24
Q

Injection sclerotherapy

A

Sclerosant foam or liquid

Liquid for small veins below knee

25
Q

Post-operative care following endovascular therapy for varicose veins

A
  • Compression bandage for 24hrs
  • Compression stockings for 1mo
26
Q

Indications for surgical management of varicose veins

A
  • Saphenofemoral Junction incompetence
  • Major perforator incompetence
  • Symptomatic: ulceration, skin changes, pain
27
Q

Surgical procedures for varicose veins

A

Ligation (eg Trendelenberg)

Microphlebectomy

Subfascial endoscopic perforator surgery (SEPS)

28
Q

Trendelenberg surgery

A

Saphenofemoral ligation

29
Q

Microphlebectomy

A

Multiple avulsions (cuts) to skin to remove the vein, sutures may not be required

30
Q

Post-op care following surgery for varicose veins

A

Bandage tightly

Elevate for 24h

Discharged with compression stockings and to walk daily.

31
Q

Complications of varicose vein surgery

A

Damage to cutaneous nerve (e.g. long saphenous)

Recurrence: may approach 50%

32
Q

Bilateral causes of leg swellings

A

↑ Venous Pressure

↓ Oncotic Pressure

Lymphoedema

Myxoedema (Hyper- / hypo-thyroidism)

33
Q

Causes of reduced oncotic pressure

A

Nephrotic syndrome

Hepatic failure

34
Q

Drug causing raised venous pressure

A

nifedipine

35
Q

unilateral causes of leg swellings

A

Raised venous pressure (Venous insufficiency, DVT)

Infection or inflammation

Lymphoedema

36
Q

What is lymphoedema?

A

Collection of interstitial fluid due to blockage or absence of lymphatics

37
Q

Primary causes of lymphoedema

A

Congenital absence

Praecox

Tarda

38
Q

Lymphoedema praecox

A

After birth but <35yrs

F>M

80% of primary lymphoedema

39
Q

Lymphoedema tarda

A

>35yrs

10 % of cases

40
Q

Milroy’s syndrome genetics

A

Autosomal dominant

F>M

41
Q

Milroy’s syndrome sx

A

Bilateral swelling/lymphoedema of lower extremities

+/- hydrocele

42
Q

Secondary causes of lymphoedema

A

FIIT

  • Fibrosis: e.g. post-radiotherapy
  • Infiltration
  • Infection: TB, Filariasis
  • Trauma: block dissection of lymphatics
43
Q

Infiltration causes of lymphoedema

A

Cancer of prostate, lymphoma

44
Q

Filariasis

A

Parasitic disease caused by round worms

Main worm: Wuchereria bancrofti

45
Q

Investigations for lymphoedema

A

Doppler US

Lymphoscintigraphy

CT / MRI

46
Q

Lymphoscintigraphy

A

Radioactive radiotracer injected into skin

Travels up the lymphatics

Device on the outside identifies the sentinele node

47
Q

Conservative management of lymphoedema

A

Skin care

Compression stocking

Physio

Treat or prevent comorbid infections

48
Q

Surgical mx of lymphoedema

A

Debulking operation:

  • liposuction to reduce the volume of the limb (fat hypertrophy secondary to lymphoedema)
  • radical debulking (removing all the skin and fat and do skin graft)

mrcs med school (44 decks)

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