Week 226 - Varicose Veins Flashcards
Week 226 - Varicose Veins: What are the three main types of oedema?
- Lymphoedema
- Lymphovenous oedema
- Dependency oedema
Week 226 - Varicose Veins: In terms of capillary filtration what occurs during lymphoedema, lymphovenous oedema and dependency oedema?
- Lymphoedema - Normal capillary filtration.
- Lymphovenous filtration - Increased
- Dependency oedema - Increased
Week 226 - Varicose Veins: What is dependency oedema?
Oedema caused by immobile limbs resulting in reduced venous return.
Week 226 - Varicose Veins: What is lymphoedema?
- Caused by inadequate drainage.
- There is normal capillary filtration.
- An increase in protein concentration.
Week 226 - Varicose Veins: What is lipoedema?
- Symmetrical fatty deposits, bilaterally.
* Possible due to disturbed venous function.
Week 226 - Varicose Veins: Which three types of chronic oedema lead to lymphatic overload/failure?
- Lymphovenous oedema
- Dependency Oedema
- Lipoedema
Week 226 - Varicose Veins: What is the definition of chronic oedema?
Persistent (>3 months) swelling due to excess accumulation of fluid in the tissues.
Week 226 - Varicose Veins: What are the signs and symptoms of lymphovenous oedema?
- Subcutaneous tissues are generally soft and pitting.
- Swelling reduces with elevation.
- Skin and tissue changes occur over time.
- Patients often complain of discomfort and restlessness.
- Rarely affects areas other than the lower limb.
Week 226 - Varicose Veins: What skin changes can occur with lymphovenous oedema?
- Haemosiderin staining
- Ulceration
- Varicose eczema
- Lipodermatosclerosis
- Varicose veins + telangiectasia
Week 226 - Varicose Veins: Dependency oedema is usually present in those with immobile limbs, which conditions can exacerbate it?
- Arthritis
- Chronic respiratory/cardiac problems.
- Age
- Advanced cancer, cardiac or renal failure.
Week 226 - Varicose Veins: What are the signs of dependency oedema?
- Skin is usually translucent and shiny in appearance.
- Subcutaneous are very soft and pit.
- Can lead to lymphorrhoea.
- Generally responds well to elevation.
Week 226 - Varicose Veins: What is the incidence of lymphoedema?
2 per 1000
Week 226 - Varicose Veins: What are the primary types of lymphoedema?
- Congenital - Aplasia, Hypoplasia, Hyperplasia, Valvular incompetence.
- Hereditary - Milroy’s Disease, Sex linked, Dominant trait.
Week 226 - Varicose Veins: What are the secondary causes of lymphoedema?
- Parasitic infection.
- Obstruction/obliteration of vessels (Due to surgery, tumour, radiotherapy)
- Trauma
- Infection
- Venous disease
- Immobility
Week 226 - Varicose Veins: What are the complications of chronic oedema?
- Dry/flaky skin
- Eczema
- Contact dermatitis
- Fungal infections
- Hyperkeratosis
- Papillomatosis
- Lymphangiomata
- Lymphorrhoea
- Ulceration
- Folliculitis
- Fibrosis
- Cellulitis
Week 226 - Varicose Veins: What is Papillomatosis?
A possible complication of chronic oedema.
Wart like raised areas of skin due to hyperplasia and enlargement of contiguous dermal papillae.
Week 226 - Varicose Veins: What is Lymphangiomata?
A benign tumour formed of dilated and newly created lymph vessels, a possible complication of lymphoedema.
Week 226 - Varicose Veins: What is the first line treatment for cellulitis?
• Amoxicillin 500mg TDS +/- Flucloxacillin
Erythromycin if penicillin allergy
Week 226 - Varicose Veins: What is the management/treatment of lymphoedema?
- Multilayer lymphoedema bandaging.
- Skin care
- Exercises
- Compression garments
- Self-massage
- Patient education including weight management.
Week 226 - Varicose Veins: What type of bandage should be used for management of lymphoedema (Long-stretch or short-stretch)? What is the advantages?
- Short-stretch
- Doesn’t create champagne shape or cause distortion of forefoot and toes.
- Promotes tissue healing.
Week 226 - Varicose Veins: What are the five treatment options for varicose veins?
1) Surgery
2) Radiofrequency ablation (RFA)
3) Endo venous laser treatment (EVLT)
4) Foam sclerotherapy
5) Compression
Week 226 - Varicose Veins: What are the characteristics of a typical venous leg ulcer?
- Large, shallow, painless.
* Tend to appear around the medial and lateral malleoli.
Week 226 - Varicose Veins: What is the broad pathology behind the development of venous ulcers?
- Incompetent valves in the veins of the legs lead to blood being pushed into the superficial veins.
- This causes oedema, which can lead to venous eczema and ulceration.
Week 226 - Varicose Veins: What are the characteristics of a typical arterial ulcer?
- Often distal, found on the toes or the dorsum of the foot.
* Deeper and more painful than venous ulcers.
Week 226 - Varicose Veins: What is the broad treatment for venous leg ulcers?
1) Gradual compression.
2) Debridement and cleaning.
3) Dressing
4) Antibiotics in infected ulcers.
5) Topical steroids may be useful for treating surrounding areas.
