DEF:-these are dilated tortuous veins.
SITE:-seen in lower limb commonly. other places where we can see are hemorrhoids in rectum , esophageal varices , and spermatocele
IMPORTANT HISTORY
h/o occupation:- long standing job
family history:- runs in family , involvement of FOX C-2 gene, klippel-trenaunay syndrome {portwinw stain,varicose vein, local gigantism}
h/o night cramps ,severe pain after walking :- shows deep venous thrombosis
h/o relieve of pain after lying down and raising the limb:- venous claudication {where as in arterial claudication it will aggravate the pain, in neurogenic claudication person stand and bends to relieve pain}
h/o venous ulcer at medial or lateral malleolus, dark hyper-pigmentation , eczema, lipodermatosclerosis
INSPECTION
involvement of great saphenous vein if it extends from dorsum of foot to the thigh, and short saphenous vein if it ends in politeal fossa.
morriseys cough impulse at the sapheno-femoral junction{ it lies 4 cm below and lateral to pubic tubercle, can be identified by asking the patient to flex and abduct,so that adductor longus tendon which gets inserted at pubic tubercle becomes prominent}
PALPATION
thickening of vein
TEST:-
brodie-trendlenburg test :-
empty the vein by raising the limb and tie tourniquet below s-f junction
1 ask the patient to stand up open tourniquet immediately and look for fast filling of blood column .it shows s-f incompetency
2 keep tourniquet as such, wait for 1 minute and look for filling of blood, if it gets filled it shows perforator incompetency
multiple tourniquet test:-
aim is to identify incompetent perforators
tie tourniquets at multiple levels after emptying the vein.
look for filling of blood..where perforators are incompetent vein will become dilated.it can be confirmed by double tourniquet test
modified perthes test:-
NO NEED TO EMPTY THE VEIN, tie tourniquet below s-f junction and ask the patient to walk fo3 minutes, if patient complaints pain then there is DVT, or if it shrinks then no dvt only varicosity.
schwartz test
keep one hand at s-f junction across the course of vein and with other hand tap on the vein below , feel foe the impulse.
fegans test
empty the vein and palpate across the vein , cresentic gaps may be felt it signifies perforator incompetency.
morriseys cough impulse
ask the patient to cough and feel for impulse at saphenofemoral junction ,if felt signifies s-f incompetency
AUSCULTATION
hear for bruit which signifies A-V fistula
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