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Flashcards in Venous Disease Deck (14)
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1

What are some risk factors for varicose veins?

Family history 

Previous DVTs

2

What is thrombophlebitis?

Inflammation of a vessel wall associated with thrombosis

3

What are mechanisms of venous hypertension?

- Reflux of blood from deep to superficial veins due to valvular failure

- Obstruction

- Calf pump failure

4

What are some clinical features of venous ulcers?

Hx of venous insufficiency

Hx of previous surgery

Painful

 

Ex

- Shallow, large, irregular edge

- Moist granulating base

- Over gaiter area

- Surrounding inflammation

5

What causes lipodermatosclerosis?

Denatured subcutaneous fat and excess fibrin deposition

6

How are venous ulcers treated?

Elevation and compression

IV antibiotics

Dressing

Debridement and split skin graph

Treat underlying pathology

7

What is the difference between primary and secondary varicose veins?

Primary occur in the absence of valvular incompetence in the superficial or perforating veins

 

Secondary are associated with deep venous incompetence secondary to recanalisation of DVT

8

What are the history/examination characteristics of ischaemic ulcers?

Hx

Painful

History of claudication/vascular disease

Cardiovascular risk factors

 

Ex

Distal periphery or pretibial

Punched out, no inflammatory - surrounding is white

Little bleeding when debrided

Pale and sloughy base

9

What are the two theories proposed to explain why venous ulcers form?

White cell trapping hypothesis

Venous hypertension > Perfusion pressure is reduced > WBC (that are larger and less deformable than RBC) clog capillary and cause RBC back up > WBC activation > Proteolytic enzyme release and local inflammation

 

Fibrin cuff hypothesis

Venous hypertension causes capillary elongation and increased permeability > large molecules like fibrin extrude from vessels > Fibrin deposits in skin forming a barrier to oxygenation > ischaemia

10

What are some clinical features of a neuropathic ulcer?

Hx

- Painless

- Hx of diabetes

 

Ex

- On pressure areas

- Plantar surface of MTP joint, MM/LM, dorsal IP joints

- Distorted foot architecture

- Granulating base

11

What are some symptoms of DVTs?

Cosmetic

Pain

Swelling

Thrombophlebitis

Bleeding

Skin changes

Ulceration

12

How does varicose veins be treated?

Conservative management

Sclerotherapy

Open surgery

Endovenous laser therapy

Radiofrequency ablation

13

What are some signs of arterial insufficiency?

Atrophic nails

Venous guttering (delayed refilling after beurger's test)

+ beurger's test (lift the foot to 45 degrees and look for pallor)

Slow cap refill

Pulseless

14

What are some three main types of ulcers?

Ischaemic

Neuropathic

Venous