Flashcards in Week 226 - Varicose Veins Deck (25)
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Week 226 - Varicose Veins: What are the three main types of oedema?
• Lymphoedema
• Lymphovenous oedema
• Dependency oedema
2
Week 226 - Varicose Veins: In terms of capillary filtration what occurs during lymphoedema, lymphovenous oedema and dependency oedema?
• Lymphoedema - Normal capillary filtration.
• Lymphovenous filtration - Increased
• Dependency oedema - Increased
3
Week 226 - Varicose Veins: What is dependency oedema?
Oedema caused by immobile limbs resulting in reduced venous return.
4
Week 226 - Varicose Veins: What is lymphoedema?
• Caused by inadequate drainage.
• There is normal capillary filtration.
• An increase in protein concentration.
5
Week 226 - Varicose Veins: What is lipoedema?
• Symmetrical fatty deposits, bilaterally.
• Possible due to disturbed venous function.
6
Week 226 - Varicose Veins: Which three types of chronic oedema lead to lymphatic overload/failure?
• Lymphovenous oedema
• Dependency Oedema
• Lipoedema
7
Week 226 - Varicose Veins: What is the definition of chronic oedema?
Persistent (>3 months) swelling due to excess accumulation of fluid in the tissues.
8
Week 226 - Varicose Veins: What are the signs and symptoms of lymphovenous oedema?
• Subcutaneous tissues are generally soft and pitting.
• Swelling reduces with elevation.
• Skin and tissue changes occur over time.
• Patients often complain of discomfort and restlessness.
• Rarely affects areas other than the lower limb.
9
Week 226 - Varicose Veins: What skin changes can occur with lymphovenous oedema?
• Haemosiderin staining
• Ulceration
• Varicose eczema
• Lipodermatosclerosis
• Varicose veins + telangiectasia
10
Week 226 - Varicose Veins: Dependency oedema is usually present in those with immobile limbs, which conditions can exacerbate it?
• Arthritis
• Chronic respiratory/cardiac problems.
• Age
• Advanced cancer, cardiac or renal failure.
11
Week 226 - Varicose Veins: What are the signs of dependency oedema?
• Skin is usually translucent and shiny in appearance.
• Subcutaneous are very soft and pit.
• Can lead to lymphorrhoea.
• Generally responds well to elevation.
12
Week 226 - Varicose Veins: What is the incidence of lymphoedema?
2 per 1000
13
Week 226 - Varicose Veins: What are the primary types of lymphoedema?
• Congenital - Aplasia, Hypoplasia, Hyperplasia, Valvular incompetence.
• Hereditary - Milroy's Disease, Sex linked, Dominant trait.
14
Week 226 - Varicose Veins: What are the secondary causes of lymphoedema?
• Parasitic infection.
• Obstruction/obliteration of vessels (Due to surgery, tumour, radiotherapy)
• Trauma
• Infection
• Venous disease
• Immobility
15
Week 226 - Varicose Veins: What are the complications of chronic oedema?
• Dry/flaky skin
• Eczema
• Contact dermatitis
• Fungal infections
• Hyperkeratosis
• Papillomatosis
• Lymphangiomata
• Lymphorrhoea
• Ulceration
• Folliculitis
• Fibrosis
• Cellulitis
16
Week 226 - Varicose Veins: What is Papillomatosis?
A possible complication of chronic oedema.
Wart like raised areas of skin due to hyperplasia and enlargement of contiguous dermal papillae.
17
Week 226 - Varicose Veins: What is Lymphangiomata?
A benign tumour formed of dilated and newly created lymph vessels, a possible complication of lymphoedema.
18
Week 226 - Varicose Veins: What is the first line treatment for cellulitis?
• Amoxicillin 500mg TDS +/- Flucloxacillin
(Erythromycin if penicillin allergy).
19
Week 226 - Varicose Veins: What is the management/treatment of lymphoedema?
• Multilayer lymphoedema bandaging.
• Skin care
• Exercises
• Compression garments
• Self-massage
• Patient education including weight management.
20
Week 226 - Varicose Veins: What type of bandage should be used for management of lymphoedema (Long-stretch or short-stretch)? What is the advantages?
• Short-stretch
• Doesn't create champagne shape or cause distortion of forefoot and toes.
• Promotes tissue healing.
21
Week 226 - Varicose Veins: What are the five treatment options for varicose veins?
1) Surgery
2) Radiofrequency ablation (RFA)
3) Endo venous laser treatment (EVLT)
4) Foam sclerotherapy
5) Compression
22
Week 226 - Varicose Veins: What are the characteristics of a typical venous leg ulcer?
• Large, shallow, painless.
• Tend to appear around the medial and lateral malleoli.
23
Week 226 - Varicose Veins: What is the broad pathology behind the development of venous ulcers?
• Incompetent valves in the veins of the legs lead to blood being pushed into the superficial veins.
• This causes oedema, which can lead to venous eczema and ulceration.
24
Week 226 - Varicose Veins: What are the characteristics of a typical arterial ulcer?
• Often distal, found on the toes or the dorsum of the foot.
• Deeper and more painful than venous ulcers.
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