Surgical Examinations

Question 0

Venous Exam: TCME

Answer 0

1. Abdominal exam
2. Pelvic exam, including VE or genitalia and DRE
   - both with the aim of excluding masses which could cause venous obstruction and therefore venous insufficiency in the legs

Question 1

Venous Exam: On Inspection

Answer 1

Cyanosis
Amputations (look at fingers and toes!)
Skin changes
   Haemosiderin deposition
   Venous eczema
   Lipodermatosclerosis +/- inverted champagne bottle legs
   Oedema
    Atrophie blanche
    Telangectasia
Varicose veins
Venous ulcers

Question 2

Venous Exam: Tap Test

Answer 2

1. Palpate the saphenofemoral junction
2. Tap the varicosity

If the valves are incompetent, there will be a clear path between the two and a thrill will be felt at the SFJ

Question 3

Venous Exam: Tourniquet Test

Answer 3

1. Elevate the leg and milk the veins to empty them
2. Apply a tourniquet
3. Drop the leg or stand

• rapid filling means the incompentence has not been cut off, so it is below the tourniquet
• slow filling (from the deep veins) means the incompetence is above the tourniquet

Repeat with the tourniquet in different locations

NB. The Trendelenburg test is the same but with fingers over the SFJ as the occlusion not a tourniquet

Question 4

Venous Exam: Dopplers

Answer 4

1. Apply ultrasound probe over a vein
2. Squeeze the calf distal to the probe

• one whoosh is normal blood being squeezed up
• two whooshes suggests incompetence and blood rushing back down again