Venous and Lymphatic Disease

Question 1

Varicose vein

Answer 1

A dilated and tortuous vein

Question 2

Varicose veins are often which kind of vein

Answer 2

Superficial

Question 3

Varicose veins are most commonly found in

Answer 3

The lower limbs

Question 4

Varicose veins are usually found in the

Answer 4

Saphenous veins

Question 5

Factors that assist flow of blood in the veins back to the heart

Answer 5

Valves
Calf muscle pump
Perforating veins to drain blood into the deep system

Question 6

Blood is drained into the deep veins because

Answer 6

They are within muscular compartments and can withstand higher pressure

Question 7

Causes of valvular failure

Answer 7

Surgical or traumatic disruption of valve
DVT - obstruction
Hormonal changes during pregnancy cause weakness
Large pelvic tumour

Question 8

Effects of one valve failing

Answer 8

Venous pressure increase
Dilation of the distal veins
Further valvular incompetence

Question 9

Risk factors of varicose veins

Answer 9

Age
Female
Pregnancies
DVT
Standing for long periods
Family history

Question 10

Symptoms of varicose veins

Answer 10

Burning
Itching
Heaviness
Tightness

Question 11

Examination findings of varicose veins

Answer 11

Swelling
Discolouration
Phlebitis - inflammation 
Bleeding
Disfiguration
Eczema
Ulceration

Question 12

Special test for diagnosing varicose veins

Answer 12

Tap test
Trendelenburg/tourniquet test
Doppler

Question 13

Tap test

Answer 13

Place one hand over the saphenofemoral junction and other over the long saphenous vein above the knee
Tap the saphanofemoral junction - a transmitted impulse at the knee indicates incompetence of the valves between the two hands

Question 14

Trendelendburg/tourniquet test

Answer 14

Drain superficial veins by raising the leg
Apply pressure over the saphenofemoral junction and keep it on as patient stands
On release if the veins refill then the saphenofemoral junction valve is incompetent
Tourniquet is same but with tourniquet instead of hands

Question 15

Doppler

Answer 15

Hold doppler probe over the saphenofemoral junction
Squeeze calf muscles
Hear a ‘whoosh’ as the blood flows upwards into the deep system if competent superficial veins.
Hear two waves if incompetent.

Question 16

Investigations for varicose veins

Answer 16

Special tests

Ultrasound

Question 17

Varicose veins C0

Answer 17

No visible or palpable signs of venous disease

Question 18

Varicose veins C1

Answer 18

Teleangiectasies or reticular veins

Question 19

Varicose veins C2

Answer 19

Varicose veins

Question 20

Varicose veins C3

Answer 20

Oedema

Question 21

Varicose veins C4a

Answer 21

Pigmentation or eczema

Question 22

Varicose veins C4b

Answer 22

Lipodermatosclerosis or atrophie blanche

Question 23

Varicose veins C5

Answer 23

Healed venous ulcer

Question 24

Varicose veins C6

Answer 24

Active venous ulcer

Question 25

What classification of varicose veins qualifies you for treatment

Answer 25

C3 or above

Question 26

Treatment should be given to patients complaining of varicose veins that are

Answer 26

``` Bleeding Symptomatic Recurrent symptomatic Lower limb skin changes of chronic venous insufficiency Superficial venous thrombosis Venous leg ulcer ```

Question 27

First line management of varicose veins

Answer 27

Endovenous treatment

Question 28

Second line management of varicose veins

Answer 28

Ultrasound guided foam sclerotherapy

Question 29

Third line management of varicose veins

Answer 29

Open surgery

Question 30

If intervention of varicose veins in unsuitable, offer

Answer 30

Compression hosiery

Question 31

Intervention of varicose veins shouldn't be offers if

Answer 31

Deep venous system is obstructed eg DVT or pregnancy

Question 32

Endovenous treatment

Answer 32

Injury to vein wall via heat or laser resulting in fibrosis and occlusion of the vein and so ablation

Question 33

Complications of endogenous treatment

Answer 33

Skin burns Paraesthesiae Phlebitis DVT

Question 34

Foams sclerotherapy

Answer 34

Chemical foam injected into affected vein, damaged the venous walls causing fibrosis, occlusion and ablation

Question 35

Complications of foams sclerotherapy

Answer 35

Foam migration - causes potential complications of stroke, TIA or MI Thrombophlebitis Skin pigmentation

Question 36

Open surgery

Answer 36

Removal of saphenous vein

Question 37

Complications of open surgery

Answer 37

Anaesthetic risk Wound infection Damage to nearby nerves Bleeding

Question 38

Venous insufficiency causes

Answer 38

Failure of calf muscle pump Superficial venous reflux Deep venous reflux Venous obstruction

Question 39

Pathophysiology of venous insufficiency

Answer 39

Insufficiency - venous hypertension - endothelial leak - oedema - increase perfusion distance - impaired healing - inflammation - fibrinogen, tissue damage - impaired tissue perfusion

Question 40

Examination findings on chronic venous insufficiency

Answer 40

``` Oedema Telangiectasia Eczema Haemosiderin pigmentation - orange Hypopigmentation - white Lipodermatosclerosis Ulceration ```

Question 41

Features of venous ulcers

Answer 41

``` In gaiter area Granulomatous (red) base Shallow Irregular margins Exudative, oedematous Painless Pulses present ```

Question 42

Features of arterial ulcers

Answer 42

Defined borders Smaller and deeper Painful Food on anterior skin, under heel, around malleolus

Question 43

Features of neuropathic ulcers

Answer 43

Can't feel them | Found at metatarsal head, under heel, around malleolus

Question 44

Investigation of chronic venous insufficiency

Answer 44

Ankle-brachial pressure index (ABPI) - excludes arterial disease

Question 45

Treatment of chronic venous insufficiency

Answer 45

Wound care - antibiotics Elevation Compression bandaging Shockwave therapy

Question 46

Secondary causes of lymphoedema

Answer 46

Malignancy Surgery Radiotherapy Infection

Question 47

Treatment of lymphoedema

Answer 47

Elevation Drainage Compression bandaging