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VENOUS DISEASE & CHRONIC VENOUS INSUFFICIENCY

VENOUS DISEASE & CHRONIC VENOUS INSUFFICIENCY. GEMP I Centre for Health Science Education Station 3. Station Learning Objectives. Demonstrate with a clear commentary examination of an ulcer Recognise signs & symptoms of chronic venous insufficiency

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VENOUS DISEASE & CHRONIC VENOUS INSUFFICIENCY

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  1. VENOUS DISEASE & CHRONIC VENOUS INSUFFICIENCY GEMP I Centre for Health Science Education Station 3

  2. Station Learning Objectives • Demonstrate with a clear commentary examination of an ulcer • Recognise signs & symptoms of chronic venous insufficiency • recognise other common venous disorders eg. varicosities

  3. Venous Disease • More common in lower limbs than upper limbs & • May present as • DVT • Varicose Veins • Superficial Thrombophlebitis • Chronic Venous Insufficiency & ulceration

  4. Venous Disease • Patients may complain of the following: • pain • swelling: unilateral / bilateral • discolouration: lipodermatosclerosis • ulceration

  5. Chronic Venous Insufficiency Before you are able to appreciate chronic venous insufficiency (CVI) you must understand how the valves function and the calf muscle acts as a pump aiding return of deoxygenated blood to the heart.

  6. Chronic Venous Insufficiency CVI = main late complication of deep venous thrombosis ·incomplete recanalizationof vein post DVT+ ·incompotent valves results in ·abnormally highhydrostatic pressureswhile walking or standing ·transmitted to skin via incompetentperforator veins · capillary filtration &  reabsorptionof fluids & proteins from interstitial spaces

  7. Chronic Venous Insufficiency • Clinical Features oedema dermatitis & hyperpigmentation induration ulceration pain Which of the above-mentioned features can you recognise in the following pictures ?

  8. Chronic Venous Insufficiency

  9. Chronic Venous Insufficiency • Did you recognise any of the following signs ? • Perimalleolar oedema • pigmentation • lipodermatosclerosis • eczema • ulceration

  10. Examination of Ulcers 1. HISTORY How long has it been present ? Is it painful ? Does it bleed ? Has the ulcer changed in any way ? Does the ulcer interfere with daily activities ? Does the patient have any other ulcers ? Is there a history of trauma preceding the ulcer ? Does the patient have any associated diseases ? (varicosities, hypertension, burns, collagen disease, diabetes, vascular diseases, syphilis, TB, osteomyelitis etc. Has the patient been treated previously for the ulcer ?

  11. Examination of Ulcers 1. EXAMINATION Situation Size Shape Colour Edge Tenderness Temperature Depth Floor & Base of ulcer Discharge Surrounding skin State of local tissues Local lymph nodes General exam. For associated diseases

  12. Examination of Ulcers Situation - gravitational ulcers usually occur on the lower leg above the medial malleolus Colour - rodent (basal cell carcinoma) ulcer have pearly white edges - malignant melanomatous ulcers are pigmented

  13. Examination of Ulcers Edge - sloping in healing ulcers - punched-out in syphilitic & trophic ulcers - undermined in TB or pressure sores - rolled in basal cell carcinoma - everted in squamous cell carcinoma - bluish skin on edge indicates healing Floor - syphilitic ulcers: wash-leather tissue - TB unhealthy bluish granulation tissue - ischaemic ulcers often have no granulation tissue - redness indicative of good blood supply for healing - look carefully for exposed bone, tendon & muscle

  14. Examination of Ulcers Base (area under floor) - feel for fixity to surrounding structures - feel for fibrosis which may impair local blood supply Discharge - serosanguinous - serous - bloody - purulent Surrounding Skin - eczema with gravitational ulcers - satellite nodules assoc. with malignant melanoma

  15. Other Venous Disorders Can you recognise this abnormality ? Examination of the venous system will be covered in GEMP III & IV

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