case presenataion on varicose veins case collected from general medicine department gandhi medical college hyderabad.

2.  NAME: Nagaraju
 AGE: 27 years
 GENDER: male
 IP NUMBER: 331071045682
 DEPARTMENT: General medicine
 WEIGHT: 65 kgs
 BLOOD GROUP TYPE: B+ve
 DATE OF ADMISSION: 24/08/2018

4.  Chief complaints: Right lower limb swelling
since 5 months associated with calf pain.
 Past medical history: NO past history of
hypertension, diabetes mellitus, tuberculosis,
asthma, epilepsy, palpitations, chest pain and
SOB
 Social history: nothing significant
 Past medication history: nothing significant

5. Personal history:
• Diet- mixed
• Bladder and bowel – regular
• Sleep – adequate
• Appetite - normal

6.  Blood pressure-130/80 mmof Hg
 Temperature- 98.6°F
 Pulse rate –80 /min
 Respiratory rate-20/min
Patient on examination is coherent and
conscious.
CVS:-S₁ S₂ + heard
R/L: BAE+

7. TEST OBSERVED RANGE NORMAL RANGE
RBC 3.79 millions/mm³ 4.5-5.5millions/mm³
WBC 7470 cells/mm³ 4000-10000cells/mm³
PLATELETS 4.28 lakh/mm³ 1.4-4.1lakhs/mm³
HB 13.6gm/dL 14-17gm/dL
MCH 27.2
MCV 84.2
MCHC 32.3

8. DIAGNOSIS:-
B/L- lower limb venous system
SFJ- incompetent
GSV-7mm at the origin dilated rest of the GSV
SSV-dilated 6mm
On evaluation long segment echogenic
thrombus noted involving v3 of SSV

9. From the subjective and objective findings it
can be evidenced that the patient is suffering
from the varicose veins.

10.  DRUG CHART:-
SNO DRUG NAME DOSE ROUTE FREQUENCY DAY
1
2 3 4
1. LMWH 40mg IM BD + + + +
2. WARFARIN 2mg oral OD + + + +
3. MONOCEF 1g IV BD + + + +
4. METROGYL 500mg IV TID + + + +
5. RANTAC 150mg oral BD + + + +
6. CHYMORAL
FORTE
50mg oral TID + + + +

11.  Exercising, watching your weight, elevating
your legs, and changing your sitting or
standing position regularly have been shown
to be helpful; these may also help treat the
discomfort you may experience.

12.  For the first 2 weeks after surgery, avoid standing for long periods.
Also avoid heavy lifting.
 Ask someone to help you for a few days after surgery.
 Keep your legs raised when you’re sitting or lying down.
 Begin a regular walking program, starting the day after surgery.
Just walk for a few minutes at first; then work up to 5 minutes at a
time. Gradually increase to 15 to 20 minutes at a time, 2 to 3 times
a day.
 Wear bandages or elastic stockings. When you are sitting, move
your feet back and forth and in circles to keep your blood moving.
 You may have some bruising in the area where the vein was
removed.

13.  Two major drug interactions were identified
in treatment
 WARFARIN AND METRONIDAZOLE:-Using
warfarin and metronidazole may cause you to bleed
more easily.You may need a dose adjustment based
on your prothrombin time.
 WARFARIN AND HEPARIN:-
Using heparin together with warfarin can cause you
to bleed more easily.You may need a dose
adjustment in addition to testing of your
prothrombin time

14.  Moderate drug interactions found is
Ranitidine and warfarin
Warfarin and ceftriaxone
In which the other drugs increases the effects
of warfarin which can cause unusual bleeding,
bruising, vomiting, blood in your urine or
stools, headache , and dizziness.