Know how to examine the peripheral venous system including Present Complaints, General and Physical examinations, in the cardiovascular system.
Examination of the Peripheral Venous System
1. What are the symptoms, a patient can present with ?
The patient can present with Pain, Limb Swelling, Superficial venous thrombosis and Skin changes.
I. If a patient presents with normal pain :
Patients having uncomplicated varicose veins, sometimes presents with leg discomfort, itching and a feeling like swelling.
II. If a patient presents with Swelling of the limbs :
Swelling or a sense of swelling, even if there are no visible indications, might be a symptom of venous illness in the lower limbs.
III. Blood clots in superficial vein :
Recurrent superficial venous thrombophlebitis, especially that affecting different areas sequentially and non-varicose veins, may be associated with underlying malignancy
IV. Dermatological changes :
Chronic venous insufficiency is often associated with bluish discoloration of the distal extremity.
- haemosiderin deposition
- Ulcerated Skin
2. What are the Physical Examinations to be done with such kind of patients ?
- We should inspect the colour changes of the skin, swelling of veins and superficial venous dilatation with tortuosity.
- Feeling any temperature difference if present.
- Lokking for Pitting oedema – This occurs when excessive body fluids starts to builds up in the body, and when the swollen area of the oedema is pressurised, then a ‘Pit’ will remain.
- If we see the leg is grossly swollen, then we have to press at the higher level to confirm that how much the oedema extends.
- Checking the Jugular Venous Pressure.
3. What are investigations should we do?
We mainly do the Torniquet test and Brodie-Trendelenburg tests to asses for Saphenofemoral valve incompetence(This occurs when the valve of the vein is defective and unable to send the whole blood back the venous blood to the heart.).
I. Torniquet Test :
The tourniquet test is now included in the updated WHO dengue case criteria. The test is a capillary fragility marker that can be used to distinguish patients with acute gastroenteritis from those with dengue fever, for example. Even if a tourniquet test has been performed previously, it should be redone if the results are negative.
It used to be negative.
There are no signs of bleeding.
Performing a Tourniquet Test
- Take the patient’s blood pressure and write it down, such as 100/70.
- Inflate the cuff halfway between SBP and DBP and keep it there for a few minutes. 85 mm Hg = (100 + 70) 2
- Reduce the volume and wait two minutes.
- Count the petechiae in the area below the antecubital fossa.
The tourniquet test is now included in the updated WHO dengue case criteria. The test is a capillary fragility marker that can be used to distinguish patients with acute gastroenteritis from those with dengue fever, for example. Even if a tourniquet test has been performed earlier, it should be repeated.
- A positive test is defined as having 10 or more petechiae per square inch.
II. Brodie-Trendelenburg Tests :
The suspected leg is lifted to allow gravity to empty the veins. A tourniquet is wrapped around the upper thigh, tight enough to constrict the saphenous vein. The blood flow through the femoral vein is not obstructed. The person is then instructed to stand and the degree of saphenous vein filling is measured.