Examination Of Lower Limb For Varicose Veins And Venous Insufficiency Flashcards

(40 cards)

1
Q

What are the steps of this examination?

A

Inspect the legs, identify the saphenofemoral junction, cough test, tap test, trendelenburg test, perthe’s test, auscultation, abdominal examination

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2
Q

What are you inspecting the legs for?

A

Varicosities, venous eczema, hair loss, oedema, lipdermatosclerosis, haemosiderin deposition, genius ulceration, scars

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3
Q

Where are varicosities likely?

A

Particularly in the distribution of the long saphenous vein (medial though and leg) and short saphenous vein (lateral leg)

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4
Q

Why would you get oedema?

A

Due to venous stasis

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5
Q

What is lipodermatosclerosis?

A

Scarring of the skin and fat

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6
Q

Where is the saphenofemoral junction?

A

4cm lateral and 4cm inferior to the pubic tubercle

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7
Q

Why do we identify the saphenofemoral junction?

A

To inspect for a saphenovarix (varicosities at the SFJ)

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8
Q

How do you perform the cough test?

A

Putting your finger on the SFJ and asking the patient to cough. Palpate for thrills at the SFJ.

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9
Q

How do you perform the tap test?

A

Put your finger on the SFJ and putting a finger of your other hand on any varicosities in the long saphenous vein distribution. Tap on the SFJ.

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10
Q

What would you find on the tap test?

A

If the SFJ is incompetent, you will feel the transmitted percussion wave in the varicosities further down the leg

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11
Q

What is the trendelenburg test?

A

Ask the patient to lie flat. Raise the leg and keep it raised for a few minutes to exsanguinate as much blood as possible. Apply a torniquet high around the thigh. Ask the patient to stand up and inspect to see whether the varicose veins refill, repeat the test at the mid-thigh perforators, the saphenopopliteal junction and the mid-calf perforators

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12
Q

What is the purpose of Perthe’s test?

A

To assess the patency of the deep veins

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13
Q

How do you perform the Perthe’s test?

A

Ask the patient to lie down. Without exsanguinating the leg, apply a tourniquet around the thigh. Ask the patient to stand and rock up and down onto their tiptoes ten times.

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14
Q

What are the results of the Perthe’s test?

A

If the superficial veins empty, the deep veins must be patent.

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15
Q

How do you perform auscultation ?

A

Using a doppler probe on the SFJ. Squeeze the thigh.

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16
Q

What are normal results of the Doppler?

A

You should hear a single ‘whoosh’ as the blood is squeezed from the long saphenous vein into the femoral vein.

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17
Q

What are abnormal results of a Doppler?

A

A second ‘whoosh’ indicates incompetence of the SFJ as the blood falls back into the long saphenous vein past the incompetent valve

18
Q

Why do you examine the abdomen?

A

To exclude an abdominal or pelvis cause of raised venous pressure.

19
Q

What are the stages of a peripheral vascular examination?

A

Inspection, pulses, eyes, tongues, abdomen, light-touch sensation, capillary refill, auscultation, buerger’s test, ABPI

20
Q

What are you inspecting on general inspection?

A

Colour, build, comfort, position

21
Q

What are you inspecting the hands for?

A

Colour, capillary refill, nicotine staining

22
Q

What are you checking and comparing the radial pulses?

A

Rate, rhythm, volume, radioradial delay

23
Q

What are you looking for in the eyes?

A

Subconjunctival pallor (anaemia) and corneal arcus (hyperlipidaemia)

24
Q

What are you looking for in the lips and tongue?

A

Dehydration and central cyanosis

25
What are you looking for in the abdomen?
Scars, visible masses and visible pulsations
26
What are you inspecting in the legs, feet and toes?
Symmetry, colour, temperature, oedema, trophic changes, varicose eczema, lipodermatosclerosis, venous guttering, ulceration
27
What trophic changes are you looking at?
Loss of hair, shiny skin, wasting of subcutaneous tissues
28
What are you looking for in ulceration?
Site, shape, size, margins, colour, exudate, odour
29
What pulses do you palpate?
Radial, ulnar, brachial, carotids, aorta, femoral, popliteal, dorsalis pedis, posterior tibial
30
What do you check in the toes?
Light touch sensation and capillary refill
31
What pulses do you auscultate?
Carotids, subclavian, aorta and femoral arteries
32
How do you perform buerger's test?
Elevate both legs to 45 degrees, sit the patient up and ask them to hang their legs down over the side of the bed
33
What does pallor of the feet when elevate indicate?
Ischaemia
34
What affects the angle to which the legs have to be lifted in Buerger's test?
The poorer the arterial supply, the less the angle to which the legs have to be raised for them to become pale
35
What colour do the ischaemia legs go?
The skin at first becomes blue, then red.
36
Why does the skin go blue?
Blood is deoxygenated in its passage through the ischaemic tissue
37
Why do the legs go red?
Due to reactive hyperaemia from post-hypoxic vasodilation
38
Do you do Bueger's test with one leg or both legs ?
Both legs at the same time
39
How do you measure the ABPI?
Dividing the highest systolic blood pressure in the arteries at the ankle by the higher of the two systolic blood pressures in the arm
40
What ABPI indicates significant arterial disease
Less than 0.8