Varicose vein examination

Varicose vein examinationCreated OnApril 5, 2020Last Updated OnApril 16, 2020byadmin You are here: Main Clinical Examination Varicose vein examination < All Topics Table of Contents Local examination ·         Inspection Expose the lower limbs properly with asking the patient to stand erect and examine both limbs from in front and behind to ensure that all aspects of legs are examined Look for any large visible veins (record their site- lateral is SSV and medial is GSV, extent & size on large drawings of the front and back of the limbs) It can be widespread or just a varix. Varix at the saphenous opening is known as Saphena Varix (differentials diagnosis of femoral hernia) which has a characteristic thrill on coughing, it disappear spontaneously on lying down and if         associated with GSV varicosity ,         tapping of the swelling(saphena varix) with a finger, will transmit the palpable fluid thrill in to the GSV lower down in the limb Look for any skin changes ( especially the skin of the lower third of the medial side of the calf) Colour : Local redness – Superficial Thrombophlebitis Phlegmasia Alba Dolens (white leg) – massive oedema due to occlusion of major draining veins. (pulse is palpable in these patients . which excludes arterial disease) Phlegmasia Cerulea Dolens (cyanotic mottled skin) – Massive tight oedema due to occlusion of the major veins and collateral veins where ankle pulses may not be palpable and can lead to venous gangrene Texture : stretched skin, eczema, pigmentation, ulceration, scars, loss of hair and brittle nails Venous ulcer characteristic Site Over medial malleolus Base Red, shallow Margin Slopping Skin Red& warm, edematous, pigmentation Discharge Copious Shape Vertically oval Pulses Present Palpation Look for any pitting oedema Feel for a cough impulse and thrill in the groin for the possibilities of Saphena Varix Deep vein patency must be confirm before any intervention of the superficial venous system due to varicose vein; otherwise intervention of superficial vein will produce gangrene of the leg Tourniquet test Lie down the patient on a couch which has a small foot stool below it Elevate the limb to be examined up to your shoulder (this to empty the veins) Get the tourniquet and pull it tightly around the upper thigh( bellow the SFJ) and make sure that its pressed firmly into the subcutaneous tissue of the thigh (to ensure the superficial veins completely occluded ) Now ask the patient to stand up quickly and observe the legs for 10-15 seconds The veins above the tourniquet will rapidly fill but those below seemed to be collapsed in a case of sapheno-femoral junction incompetence alone Confirm this by releasing the tourniquet and watching the veins below the tourniquet rapidly distended from above (regurgitation of blood along saphenous vein) If the veins below the tourniquet fill immediately when the patient stands up then there will be incompetence below the level of tourniquet Repeat this progressively down the whole length of the leg (to try to define all the sites of superficial to deep vein incompetence) and below the knee level to exclude short saphenous incompetence Trendelenburg test (modification of the tourniquet test, convenient to do) Empty the veins of the limb to be examined in laying down position Then apply pressure digitally over the sapheno-femoral junction (3.75 cm bellow the pubic tubercle) and make the patient stand. Now following to be noticed Vein is filling slowly from lower side means perforator defect Nothing happened means perforators are intact and probably SFJ is incompetent. It can be prove by releasing the pressure from SFJ and whole GSV will fill up rapidly from up Upon constant pressure in SFJ, vein is feeling from...

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