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Case • A 28-year-old women was seen by her family physician for routine pregnancy check-up at 36 weeks gestational age. Neither the patient nor the physician had any concern about the pregnancy. However patient did complain of the unilateral swelling of her left leg, which has gradually increased over the previous 2 days. Furthermore, evening before her visit she developed some sharp chest pain, which was exacerbated by deep breaths.
LEG Part of the lower limb between the knee joint and ankle joint Major structures pass through Proximal------popliteal fossa Distal------------Tarsal tunnel
Leg Bony Framework
Leg Compartments • Muscles in the anterior compartment of leg dorsiflex the ankle, extend the toes, and invert the foot. • Muscles in the posterior compartment plantarflex the ankle, flex the toes, and invert the foot. • Muscles in the lateral compartment evert the foot. • Major nerves and vessels supply or pass through each compartment.
Superficial group of muscles in the posterior compartment of leg
Common conditions affecting the Leg Peripheral neuropathy (particularly associated with diabetes mellitus) Lumbar nerve root lesions (associated with pathology of the intervertebral discs) Fibular nerve palsy
The deep and superficial veins of the legs • The veins of the legs are divided into two systems • the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and • the superficial veins (which run in the layer of fat just beneath the skin). • The superficial veins are the ones that you can see (for example, on your foot or around the ankle) and they are the ones that can become varicose.
VENOUS SYSTEM (LOWER LIMB) I- Superficial System: (Superficial to deep Fascia). 1- Long saphenous vein: start 1cm above and anterior to the medial malleolus and pass through the antero-medial aspect of the leg and thigh to open into the femoral vein through the saphenous opening. 2- Short saphenous vein: start above the ankle joint in the post. aspect of the leg midway between lateral malleolus and tendoachilis & end in the popliteal vein with variable course.
II. Deep system: Veins in the soleus muscle Ant. & post. tibial veins in the leg form the popliteal vein which is the major tributary to the femoral vein.The deep system lies deep to deep fascia.
III- Communicating system:Perforating veins communicating between sup & deep systems:1- At Saphenofemoral junction.2- At the middle of the thigh.3- Just above the knee.4- Just below the knee.5- Just above the ankle.
DEFINITION • Deep vein thrombosis (DVT) is a medical condition in which blood clots form within the large veins of the body, such as the calves and thighs, or also sometimes in the pelvis, chest, or arms. • These blood clots impede the circulation of blood and nutrients to the limbs, as well as to various organs and body systems. Such clots may become very dangerous if they break off because they can travel to another part of the body such as the lungs, brain, or heart and block circulation to that organ. • This may result in severe tissue damage and create a life-threatening situation if the clot is left untreated.
Causes of DVT • age - as people over 40 are at greater risk of DVT • a past history of DVT • a family history of DVT • an inherited condition that makes the blood more likely to clot than usual1 • immobility • obesity • recent surgery or an injury, especially to the hips or knees • Pregnancy, having recently had a baby • having cancer and its treatments • taking a contraceptive pill that contains estrogen - but most modern pills contain a low-dose, which increases the risk by an amount that is acceptable for most women • hormone replacement therapy (HRT) - but for many women, the other benefits outweigh the increase in risk of DVT • treatment for other circulation or heart problems
TREATMENT • Compression • Elevation • Immobilization • Anticoagulation
Definition • The term ’varicose vein’ refers to veins that are abnormally large and tortuous. This term applies to both the large protruding veins within the superficial subcutaneous fascia and the smaller ”spider veins” that occur just beneath the epidermis
Sex • Among the general population in the Western World, about 20 to 30 per cent of women have varicose veins. • Age • More people develop varicose veins as they get older – at least up to the age of about 60. • Heredity • It is not unusual for varicose veins to ‘run in the family’ to some extent, but there is no well-proven genetic basis for varicose veins.
Height and weight • Pregnancy • Diet and bowel habit • Occupation and posture
What trouble do varicose veins usually cause?(Signs and Symptoms)
Cosmetic embarrassment • This is by far the most common problem that varicose veins cause, and is perfectly understandable in a society that makes women want to have nice looking legs.
Ankle swelling • Varicose veins can cause ankle swelling in a few people, as the pressure in the veins causes fluid to be squeezed out into the tissues as they stand, sit with their feet on the ground or walk about. The swelling goes away after a night in bed.
