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case presentation on varicose vein

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by

Ramsha Khan

on 10 February 2016

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Transcript of case presentation on varicose vein

FAMILY HISTORY :
+VE history as his father and elder brother is suffering from varicose vein

NO OTHER SIGNIFICANT HISTORY
G.P.E
Sit calmly
Well oriented to time and place
Ambulatory , response to question and command
Not in cardio-pulmonary distress
NO any jvp raise , lymphadenopathy ,cynosis clubbing, jaundice
vitals = b.p = 130/80mmHg
pluse=82/min ,regular good
RR = 16cpm
Temp:= A/F
PERSONAL HISTORY
Thank you!
prominent veins in right leg for past 8yr
swelling at knee for past 6-7yr
pain in right leg for past 2 month
INVESTIGATION:
DOPPLER U/S
DUPLEX U/S
PHOTOPLETHYSMOGRAPHY
VENOGRAPHY
case presentation on varicose vein
by Dr. RAMSHA KHAN
IMAM, 30yr old male risksha driver by occupation married from hyd: admitted in ward 5 on 8 of feb: 2016 with cheif complain of ...
H.O.P.C
Pat: was asymptomatic 8yr back when he noticed prominent veins in right leg on medial side which gradually went on increasing and b/m more prominent on prolonged standing .
He started having swelling at right knee 6 to 7 yr back . Swelling b/m more prominent during standing and subside in lying position. He also compalin of mild continues aching sensation felt in whole leg , more in evening hours and prologed standing , relived by rest neither shifhting or radiating anywhere .
NO H/O....... itching , pigmentation ulceration , fever , constipation , night cramps , oral contraceptives
PAST HISTORY:
In pat: history of t.b is +ve
No H/O of DVT
No H/O of asthama ,allergy, hypertension
NO any previous hospital admision aur surgical histroy
Unmarried , nonveg: with normal appetite, no any addiction of alcohol or smoking
bowel habits = constipation
Review of system: no other pertinent symptoms
INSPECTION OF VEIN
SITE , EXTENT AND ANATOMICAL REALTION
BLOWS OUT
SAPHANA VERIX
COLLAPSIBILLTIY
MORRISEY'S TEST
INSPECTION OF ANKEL
ANKEL FLARE
HYPERPIGMENTATION OF SKIN DERMATITIS EDEMA
ULCER
PALPATION
WARMTH AND TENSENESS
PITS BT FEGAN'S METHOD
COUGH IMPULSE OR CRUVILHIER'S SIGN
SCHWARTZ TEST BY TAPING
TEST FOR IN COMPETENT PERFORATORS
BRODIE-TRENDELENBURG TEST
MULTIPLE-TOURNIQUET TEST
PRATT'S TEST
AUSCULTAION:
NO BRUE HEARD ( FOR ARTERIOVENOUS FISTULA)

INSPECTION
insp: of vein
insp: of ankel and foot
LYMPH NODES :
ENLARGE IN CASE OF VENOUS ULCER AND INFECTED
ABDOMEN:
SOFT NO MASS PALPABLE
OPPOSITE LIMB:
NORMAL IN THIS CASE
TRAETMENT:
CONSERVATIVE
SURGICAL
DUPLEX U/S :
INVOLVE HIGH RESOLUTIN B MODE U/S IMAGING AND DOPPLER U/S
PERFORMED IN PAT: STANDING POSITION
BLUE COLOUR SHOW NORMAL VEIN UPWARD FLOW TOWARDS HEART
RED COLOUR SHOW INCOMPETENT VEIN WITH REVERSE FLOW
INCOMPETENT VEIN , VENOUS ULCERATION, DVT CAN BE SEEEN
PHOTOPLETHYSMOGRAPHY
PROBE IS ATTACH TO SKIN TO ASSES VENOUS FILLING OF THE SURFACE OF VENULES BY LIGHT TRANSMISSION OF SKIN
VENOGRAPHY
ASCENDING = CANNULATING VIN IN FOOT , INJECT XRAY CONTRAST MEDIUM ,PROVIDE ANATOM: INFO: BUT LESS ABOUT FAILED VALVES

DESCENDING= INSERT CANNULA IN FEMORAL VEIN WHILE PAT: STANDING THUS PROVIDE INFO: ABOUT INCOMPETENT VALVE
DOPPLER U/S :
2001
2007
2013
COMPRESSION STOCKING
DIOSMIN THERAPY
ELEVATION OF LIMB
UNNA BOOTS
INJECTION SCLEROTHERAPY = causes aseptic inflam:
fibrosis leading to block
aprox: of intima leading to obliteration by endothelial damage
alters interavascula osmolarity and surface tension of plasma membrane

SURGICAL TREATMENT
LIGATION OF SOURCE OF VENOUS REFLUX USUALLY AT S-F JUNCTION
REMOVAL OF INCOMPETENT SPHENOUS TRUNKWITH BABCOCK STRIPPER
NEW TECHNIQUES
VNUS CLOSURE = involve intraluminal destruction of long and short saphenous vein using ablation cather

TRIVEX = percutaneous procedure for removing superfical veins by suction
CONSERVATIVE TREATMENT
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