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What does a doppler asses?

It assesses any weak or absent pulses


Venous examination inspection

Varicosities - dilated tortuous veins, long & short saphenous veins
Venous eczema
Venous ulcers - gaiter area, sloughy poorly defined edges, painfree,
Lipadodermatosclerosis - scarring of skin making champagne bottle shaped leg
Atrophie blanche - healed venous ulcers (ivory white atrophic plaques)
Pitting oedema


Venous exam palpation

- temp
- tenderness
Tap test - place finger distal point, percuss proximally & assess for fluid thrill
Cough impulse - place finger at SFJ, if +ve sign of saphena varix
Direction test - place finger on distal varicocity, milk proximally, lift finger off - does it re-fill?


Venous exam auscultation

Varicosity bruit at SFJ


Venous exam special tests

Trendelenberg - lift leg, milk proximally, place finger over SFJ, ask pt to stand, if varicosity re-fills = incompetence lower down
Tourniquet - same but use a tourniquet to find level of incompetence
Perthe's test - keep tourniquet on once found level, ask to stand on tiptoes, if legs change colour & become painful sign that there is deep venous disease eg DVT (affects management as can't remove superficial veins if relying on deep veins to be disease free)


Atrophie blanche

Healed venous ulcer with ivory white plaques on skin



Scarring of the skin due to chronic venous disease, resulting in inverted champagne shape of lower limb


Peripheral vascular exam

Trophic changes (shiny dry skin, loss of hair, gangrene)
Colour (pallor, mottling)
Pressure ulcers (toes & heels)
Cap refill
Pulses (AAA -> feet), rate & rhythm)
Bruit (femoral)
Beurger's angle
Beurger's test

Offer: full CV exam, LL neuro and venous exam, handheld doppler (weak/absent pulses)

Ix: BP (> 10mmhg difference is significant), ECG, ABPI, duplex US, bloods (fbc, clotting, HDL, urine dip, BM,
Mx: CT angio +/- surgical intervention (angioplasty)


DVT exam

Unable to weight bear
Unilateral swollen, tender, red & hot leg
10cm below tibial tuberosity > 3cm than other calf
Pitting oedema
Lung bases & sacral oedema
Wells score
PE risk
Ix: d dimer, US
Tx: heparin 5-7 days, come into hospital 5 days