Venous and Lymphatic Disease - Presentation, Investigation and Therapy

Question 1

Have a clear understanding of the role and function of the venous system in the lower legs

Answer 1

• Valves
• Calf muscle pump
• Veins drain into deep system: within muscle compartments can withstand higher pressure

Question 2

Recognise the changes of chronic venous insufficiency

Answer 2

• Failure of calf muscle pump
• Superficial and deep venous reflex
• Venous obstruction

Question 3

Have a basic understanding of what investigation are required to confirm the diagnosis

Answer 3

• Tap test: tap SFJ and feel LSV over knee, transmission indicates valvular incompetence
• Tourniquet test: apply pressure to SFJ, on standing the varicose vein will not be visible
• Doppler: squeeze calf at SFJ, whoosh indicates incompetence
• USS

Question 4

Have a basic understanding of different treatment options

Answer 4

1. Endovenous treatment
2. Ultrasound-guided foam sclerotherapy
3. Open surgery
   Intervention shouldn’t be offered if deep system is obstructed.

Question 5

Have a basic understanding of problems that may arise when the lymphatic system in the lower limbs is diseased

Answer 5

a

Question 6

Define varicose vein

Answer 6

• Dilated and tortuous superficial vein

- Most commonly found in the lower limbs

Question 7

Describe the causes of venous valvular failure

Answer 7

• Surgical or traumatic disruption
• DVT
• Hormonal changes e.g. pregnancy
• Large pelvic tumour

Question 8

Describe the pathophysiology of venous valvular failure

Answer 8

• Valve fails
• Venus pressure increases
• Vein dilates
• More valves fail

Question 9

Describe the risk factors of venous disease

Answer 9

• Age
• Female
• Pregnancies
• DVT
• Standing for a long time
• Family history

Question 10

Describe the diagnosis of venous disease

Answer 10

• Burning
• Itching
• Heaviness
• Tightness
• Swelling
• Discolouration
• Phlebitis (inflammation of vein)
• Bleeding
• Disfiguration
• Eczema
• Ulceration

Question 11

Under the NICE guidelines, when should management be offered for venous disease?

Answer 11

• Bleeding varicose veins
• Symptomatic
• Recurrent
• Skin changes due to chronic venous insufficiency
• Superficial thrombosis
• Leg ulcer

Question 12

Describe the pathophysiology of venous insufficiency

Answer 12

• Venous insufficiency
• Venous hypertension
• Endothelial leak
• Oedema
• Increased perfusion distance
• Impaired healing
• Inflammation
• Fibrinogen, tissue damage
• Impaired tissue perfusion

Question 13

Describe venous ulcers

Answer 13

Break in skin between knee and ankle joints, present for >4 weeks.

• Gaiter area
• Granulomatous red base
• Shallow
• Irregular margins
• Exudative, oedematous
• Painless, pulses present

Question 14

Describe the investigations of venous leg ulcers

Answer 14

• History
• Examination
• Ankle-brachial pressure index

Question 15

Describe the treatment of venous leg ulcers

Answer 15

• Exclude arterial disease (ABPI)
• Wound care
• Elevation
• Compression bandages
• Shockwave therapy