Venous and lymph disease

Question 1

What is venous drainage split into in lower limb

Answer 1

Superficial - found in subcutaneous tissue and eventually drain into deep veins
Deep - located in deep fascia around lower limbs and accompany major arteries

Question 2

What are the 2 main superficial veins

Where are they and what do they drain into

Answer 2

Great Saphenous - medial side of leg and drains into femoral vein

Small saphenous - Posterior aspect of leg and drains into popliteal vein

Question 3

What is the main venous drainage in the foot

What does some of this penetrate deep into the leg to form

Answer 3

Dorsal venous arch

-Anterior tibial vein

Question 4

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

Answer 4

MEdial and plantar veins

->Form posterior tibial and fibular veins

Popliteal vei.

Question 5

What does the popliteal vein form when it enters thigh

Answer 5

Femoral vein

Question 6

What will happen if vein valves become incompetent

Answer 6

Increased retrograde flow which will increase pressure in the thin-walled superficial vein

This would cause them to dilate and become torturous

Question 7

What are varicose veins

Answer 7

tortuous, dilated veins which occur due to incompetent venous valves causing further reflux of blood into superficial veins, causing them to become tortuous

Question 8

What forms varicose veins

Answer 8

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

Question 9

Risk factors for varicose veins

Answer 9

Increased age
F>M
Obesity
Sedentary lifestyle
Pregnancy
Smoking

Question 10

Clinical features of varicose veins

Answer 10

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

Question 11

Complications of varicose veins

Answer 11

• Venous ulcers
• Excessive bleeding from minor trauma
• Thrombophlebitis (inflammation and thrombosis of superficial vein. Is red and painful)

Venous eczema
Lipodermatosclerosis

Question 12

Venous vs arterial ulcer differences

Answer 12

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

Question 13

Diagnosis of varicose veins

Answer 13

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

Question 14

Conservative management of varicose veins

Answer 14

Compression stocking

• Improves venous return
• However must rule out arterial disease

Question 15

Surgical management of varicose veins

Answer 15

Vein ablation

• Laser ablation
• Chemical ablation

Complete removal of vein

Question 16

What is lymphedema

Answer 16

Lymphoedema is a chronic swelling resulting from failure of lymphatic drainage.

Question 17

What is primary lymphedema

Answer 17

occurs due to intrinsic genetic abnormality of lymphatic system

Question 18

What is secondary lymphedema

Answer 18

occurs when there is damage to otherwise normally functioning lymphatic system

Question 19

Causes of lymphedema

Answer 19

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)