Venous and lymph disease Flashcards
What is venous drainage split into in lower limb
Superficial - found in subcutaneous tissue and eventually drain into deep veins
Deep - located in deep fascia around lower limbs and accompany major arteries
What are the 2 main superficial veins
Where are they and what do they drain into
Great Saphenous - medial side of leg and drains into femoral vein
Small saphenous - Posterior aspect of leg and drains into popliteal vein
What is the main venous drainage in the foot
What does some of this penetrate deep into the leg to form
Dorsal venous arch
-Anterior tibial vein
What veins are there in the plantar aspect of the foot and what do these combine to form
What do these then unite to form
MEdial and plantar veins
->Form posterior tibial and fibular veins
Popliteal vei.
What does the popliteal vein form when it enters thigh
Femoral vein
What will happen if vein valves become incompetent
Increased retrograde flow which will increase pressure in the thin-walled superficial vein
This would cause them to dilate and become torturous
What are varicose veins
tortuous, dilated veins which occur due to incompetent venous valves causing further reflux of blood into superficial veins, causing them to become tortuous
What forms varicose veins
Elevated venous pressure due to various risk factors Venous valves become incompetent Reflux of blood into superficial veins Veins become dilated and tortuous Varicose Veins
Risk factors for varicose veins
Increased age F>M Obesity Sedentary lifestyle Pregnancy Smoking
Clinical features of varicose veins
Enlarged veins
Pruritus
Oedema
Yellow or red-brown skin pigmentation (due to RBC breakdown causing haemosiderin release)
Generalised or local pain in leg better when walking but worse when standing
Complications of varicose veins
- Venous ulcers
- Excessive bleeding from minor trauma
- Thrombophlebitis (inflammation and thrombosis of superficial vein. Is red and painful)
Venous eczema
Lipodermatosclerosis
Venous vs arterial ulcer differences
Venous- Shallow
● Sloping, gradual outline
● Generally minimal pain
● Often fairly large
● Very wet, lots of exudate
● Usually present at
medial malleolus
Arterial● Deep
● Punched out
● Painful
● Often fairly small
● Usually present at:
○ Toe joints
○ Heel
○ Lateral malleolus
Diagnosis of varicose veins
Clinical history and exam
Duplex USS scan looks at structure of vein and valves
Looks at blood flow through veins to check for retrograde flow
Conservative management of varicose veins
Compression stocking
- Improves venous return
- However must rule out arterial disease
Surgical management of varicose veins
Vein ablation
- Laser ablation
- Chemical ablation
Complete removal of vein
What is lymphedema
Lymphoedema is a chronic swelling resulting from failure of lymphatic drainage.
What is primary lymphedema
occurs due to intrinsic genetic abnormality of lymphatic system
What is secondary lymphedema
occurs when there is damage to otherwise normally functioning lymphatic system
Causes of lymphedema
Cancer treatment, infection, trauma Venous oedema Oedema assoc. with immobility Obesity Heart Failure Oedema of advanced cancer or other advanced condition (e.g liver disease)
