clinical aspects of vein

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clinical aspects of vein

  1. 1. Clinical aspects of vein Presented by: ANKITA MISHRA 16
  2. 2. Clinical anatomy of vein Anatomy of the venous system of the legDEEP VEINSPOSTERIOR TIBIALANTERIOR TIBIALPERONEAL `SOLEALGASTROC NEMIUSPOPLITEALFEMORALILIACSUPERFICIAL VEINSLONG SAPHENOUS (LSV)SHORT SAPHENOUS (SSV)
  3. 3. PHYSIOLOGY OF VENOUS BLOOD FLOW VENOUS RETURN FROM LEG IS GOVERNED BY:Arterial pressureCalf musculovenous pumpGravityThoracic pumpVis a tergo of adjoining musclesValves in veins
  4. 4. MUSCULOVENOUS PUMPFoot and calf muscles act tosqueeze blood out of deepveins.One way valve allow onlyupward and inward flow.During muscle relaxationblood is drawn inward thruperforating veins.
  5. 5. VENOUS VALVULAR FUNCTIONVALVE LEAFLETS ALLOWUNIDIRECTIONAL FLOW UPWARDOR INWARD.“NONREFLUXING OF VALVES”MAJOR VALVES-OSTIAL VALVEPRETERMINAL VALVE
  6. 6. PATHOPHYSIOLOGYPrimary muscle pump failureVenous obstructionVenous valvular incompetance:1.perforator incompetence-hydrodynamic reflux2.sup.vein incompetence- hydrostatic reflux3.deep vein incompetence- isolated/2°
  7. 7. Vein DisordersVenous Thrombosis (Superficial and Deep VeinThrombosis),ThrombophlebitisChronic Venous InsufficiencyVaricose Veins
  8. 8. Chronic Venous InsufficiencyResults from obstruction of venous valves in legs orreflux of blood back through valvesVenous ulceration is serious complicationPharmacological therapy is antibiotics for infectionsDebridement to promote healingTopical Therapy may be used with cleansing anddebridement
  9. 9. Stages of chronic venous insufficiency0 - no symptoms;1 - heavy feet syndrome;2 - intermittent edema;3 - persistent edema, hyper- or hypopigmentation,lipodermatosclerosis, eczema;4 - venous ulcer.
  10. 10. CausesPrimaryTheories of Aetiology:• Weak wall theory• Congenital valvular incompetenceAggravating factors:• Female sex• High parity• Occupation requiring prolonged standing• Marked obesity• Constricting clothes• Estrogen intake• Deep venous thrombosis
  11. 11. SecondaryAnything that raises intra-abdominal pressure or raises pressure in superficial/deep venous system so…: •Pregnancy •Abdominal/pelvic mass •Ascites •obesity •constipation •thrombosis of leg veins (DVT) •AV fistula •Vena cava thrombose •Large liver cysts
  12. 12. Varicose disease Varicose disease of subcutaneous veins is their irreversibledilation and elongationoccurring due to crudepathological change of venous walls and valvular apparatus.
  13. 13. ANY RISK FACTOR INCREASED VENOUS PRESSURE DILATION OF VEIN WALLS STRECHING OF VALVES-VALVULAR INCOMPETENCE REVERSAL OF BLOOD FLOW FAILURE OF MUSCLES TO PUMP BLOODVEINS DISTEND,ELONGATE,TORTOUS,POUCHED,INELASTIC AND FRIABLE
  14. 14. Surgical InterventionINDICATED OR DONE FOR PREVENTION OR RELIEF OF EDEMA, FORRECURRENT LEG ULCERS OR PAIN OR FOR COSMETIC PURPOSESVEIN LIGATION AND STRIPPINGTHE GREAT SAPHENEOUS VEIN IS LIGATED (TIED) CLOSE TO THEFEMORAL JUNCTIONTHE VEINS ARE STRIPPED OUT THROUGH SMALL INCISIONS AT THEGROIN, ABOVE & BELOW THE KNEE AND AT THE ANKLES.STERILE DRESSING ARE PLACED OVER THE INCISIONS AND ANELASTIC BANDAGE EXTENDING FROM THE FOOT TO THE GROIN ISFIRMLY APPLIED
  15. 15. NURSING CARE AFTER VEIN LIGATION & STRIPPINGKeep pt. flat on bed for first 4 hrs. after surgery,elevate leg to promote venous return when lying or sittingMedicate 30 mins. before ambulation and assist patientKeep elastic bandage snug and intact, do not removebandageMonitor for signs of bleeding, esp. on 1st post-op dayif there is bleeding, elevate the leg, apply pressure overthe wound and notify the surgeon
  16. 16. Microscopic appearance
  17. 17. RISK FACTORS Age Gender Height left>right Heredity Pregnancy Obesity and overweight Posture
  18. 18.  25-50% of adult women  15-30% of adult men Is it an industrialized country disease?UK: 45 000 hospital admissions per year
  19. 19. Treatment complicationsMajor complications following VV surgery are relatively rare Up to 20% morbidity Infection Hematoma Pain Nerve damage Saphenous nerve (LSV surgery) Sural, peroneal nerve (SSV surgery) Lymphatic leak - Venous thrombosis - Vascular injury Recurrence
  20. 20. Deep Vein Thrombosis (DVT) DVT: Blood clot in a veinlocated deep in the muscles of the legs, thighs, pelvis orarms DVT is the result of 3principle factors 1. Reduce or stagnantblood flow in deep veins 2. Injury to the bloodvessels wall 3. Increase clottingactivity (hyper-coagulability 22 or thrombophilia)
  21. 21. Risk of DVT1. Immobilization2. Recent surgery or trauma3. The use of medication4. Inherited or acquired hypercoagulability,Note: Approximately 75-90% of DVT have at least one established risk factor : Inherited thrombophilias can be identified in 24-37% of patients 23
  22. 22. SIGN AND SYMPTOMSLeg pain or tendernessLeg swellingIncrease wormth of one leg,change in skin color (redness)Homans sign positive 24
  23. 23. Medical Management Deep vein thrombosisREQUIRES HOSPITALIZATIONBED REST W/ LEGS ELEVATED TO 15-20 DEGREES ABOVEHEART LEVEL ( KNEES SLIGHTLY FLEXED, TRUNK HORIZONTAL(HEAD MAY BE RAISED) TO PROMOTE VENOUS RETURN ANDHELP PREVENT FURTHER EMBOLI AND PREVENT EDEMAAPPLICATION OF WARM MOIST HEAT TO REDUCE PAIN,PROMOTES VENOUS RETURNELASTIC STOCKING OR BANDAGEANTICOAGULANTS, INITIALLY WITH IV HEPARIN THENCOUMADINFIBRINOLYTIC TO RESOLVE THE THROMBUSVASODILATOR IF NEEDED TO CONTROL VESSEL SPASM ANDIMPROVE CIRCULATION
  24. 24. Nursing Assessmentcharacteristic of the painonset & duration of symptomshistory of thrombophlebitis or venous disorderscolor & temp. of extremityedema of calf of thigh - use a tape measure,measure both legs for comparisonIdentify areas of tenderness and any thrombosisSURGERYif the thrombus is recurrent and extensive or ifthe pt. is at high risk for pulmonary embolismThrombectomy – incising the common femoral veinin the groin and extracting the clotsVena caval interruption – transvenous placementof a grid or umbrella filter in the vena cava to blockthe passage of emboli
  25. 25. Thrombophlebitisinflammation of the veins caused by thrombus or blood clot Factors assoc. with the devt. of Thrombophlebitis venous stasis damage to the vessel wall hypercoagulability of the blood – oral contraceptive use common to hospitalized pts. , undergone major surgery (pelvic or hip surgery), MI Pathophysiologydevelops in both the deep and superficial veins of the lower extremity deep veins – femoral, popliteal, small calf veins superficial veins – saphenous veinThrombus – form in the veins from accumulation of platelets, fibrin, WBC and RBC
  26. 26. Thrombophlebitis•Thrombosis with infammation of superfiacialveins•Occur spontaneously/due to minor trauma•Can occur durin injection of sclerosing fluidfor treatment
  27. 27. Main symptoms of thrombophlebitis Edema of the extremity The pains are localised in the gastrocnemius muscles as a rule, along the course of vascular bundles The skin of the extremity becomes cyanotic.
  28. 28. Medical Management Thrombophlebitisbed rest with legs elevated apply moist heat NSAID’s ( Non – steroidal anti-inflammatory drugs) - aspirin
  29. 29. Homans sign• Pains in gastrocnemius muscle upon dorsal flexing of the foot is characteristic of thrombophlebitis of profound veins of the extremity.
  30. 30. Classification of functional tests1. Test enable one to judge the condition of valvular apparatus Trendelenburg-Trojanovs tests Hackenbruchs 2. Test enable of insufficient perforating veins Pratts test II Scheins test Thalmanns test 3. Test enable the patency of profound veins Delbe-Pertez test (marching test) Pratt-I test
  31. 31. Trendelenburg-Trojanovs test.
  32. 32. Pratts test II.
  33. 33. Hackenbruchs test.
  34. 34. Scheins test.
  35. 35. Delbe-Pertez test (marching test)
  36. 36. Loevenbergs test
  37. 37. Thrombectomy from femoral vein
  38. 38. Edema
  39. 39. Venous ulceration
  40. 40. `Thanks to all…..
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