Chronic Venous Insufficiency and Venous Ulcers

 

Chronic Venous Insufficiency

Pigmentation (lipodermatosclerosis ulcer)

LEGS

  1. Lipodermatosclerosis
  2. Eczema
  3. Gaps (ulcers) causing white patches “atrophie blanche”
  4. Swelling (edema not in the dorsum of the foot due to subfascial fobrosis)

Venous Ulcer

Number  inspection Palpation

As inspection

LNs

Base

Mobility

Induration

lipodermatosclerosis

Extent

Tenderness

Site Gaiter or ulcer bearing area

Medial and lateral maleolai

Shape Rounded or any
Size Usually superficial
Floor Granulation tissue
Margin Pigmentation
Edge Sloping
Discharge Color – Amount – odor

Assessment of venous circulation in lower limb

 

Assessment of venous circulation in lower limb

Ask patient to stand up

Inspection

  • Site of visible veins
  • Shape of visible veins
  • Size of visible veins
  • Effect of elevation
  • Effect of dependency
  • Ankle swelling
  • Ankle ulcer
  • Skin color

Palpation

  • Trunk of long saphenous vein
  • Trunk of short saphenous vein
  • Saphenofemoral junction
  • Saphenopopliteal junction
  • Fascial defects
  • Venous ulcer
  • Texture of skin and subcutaneous tissue

Percussion

Percussion wave conduction

Auscultation

Bruit over prominent varices
Tourniquet tests
Doppler ultrasound