VARICOSE VEINS CASE history and examination

Varicose veins

1. -BY SIDDALINGESH H VARICOSE VEINS CASE

2. Name: Mr. Satishkumar Age: 43 years Sex: Male Occupation: Teacher Address: Kengeri Socio-economic status: Upper middle class (According to Modified BG Prasad’s Classification PATIENT PARTICULARS

3. Multiple swellings in the right lower limb since 3 years Pain in the right lower limb since 1 year Blackish discoloration of skin over right ankle since 3 months CHIEF COMPLAINTS

4. Patient was apparently well 3 years back, then he noticed multiple swelling on inner aspect of right lower limb. They were insidious in onset, measuring about 1x1cm and has progressed to 3x3cm currently. They increase in size on prolonged standing and decrease on lying down Patient also complaints of dull aching pain since 1 year in the right calf which aggravates on prolonged standing and walking, relieves on lying down. It also increases in evening. HISTORY OF PRESENTING ILLNESS

5. The patient also noticed blackish discoloration of skin over the right ankle 3 months back, which was insidious in onset, gradually progressive and not associated with any swelling No history of wound, bleeding in the lower limb No history of diffuse swelling of the leg No history of mass per abdomen, constipation No history of trauma, prolonged immobilization of limb No history of previous surgery for varicose veins

6. No history of similar complaints in thr past No history of diabetes, hypertension, asthma , TB PAST HISTORY

7. He has been using compression stockings for 3 years TREATMENT HISTORY

8. No history of similar complaints in the family FAMILY HISTORY

9. Diet: Mixed Appetite: Normal Sleep: Undisturbed Bowel and bladder: regular No addictive habits PERSONAL HISTORY

10. A 43 year old male patient, teacher by occupation, presented with complaints of multiple swellings on his right lower limb since 3 years which were insidious in onset, gradually progressive, increased in size on prolonged standing and walking, decreased on lying down. Patient also gives history of dull aching pain since 1 year and blackish discoloration of skin over right ankle 3 months back Probable diagnosis: VARICOSE VEINS SUMMARY

11. A middle aged male patient, moderately built and nourished, conscious and cooperative and well oriented to time place and person No pallor, icterus , cyanosis, clubbing, edema No generalized lymphadenopathy Height: 170cm, weight: 90kg, BMI: 31kg/m 2 Vitals: Pulse: 75 bpm , regular rhythm, good volume, normal character BP: 122/80mmHg, left arm in sitting position Respiratory rate: 15 cycles/minute Temp: 37.5°C GENERAL PHYSICAL EXAMINATION

12. Consent was taken from the patient Patient was examined in standing and lying position with adequate exposure of complete lower limb from umbilicus to toes LOCAL EXAMINATION

13. Examined in standing position Localized multiple dilated veins present on his right lower limb: lower 1/3 rd of medial aspect of thigh, medial aspect of leg, just below the knee and in front of medial malleolus Blackish discoloration of the skin over the right ankle The skin is not stretched and not shiny, no eczema No ulcer, scar, scratch marks, loss of hair The other limb appears to be normal INSPECTION

14. The largest swelling is present approximately 3cm from medial malleolus measuring about 3x10cm Colour: Blackish Shape: Irregular Surface: Smooth Border: well defined

15. No local rise in temperatue over the dilated veins No tenderness No thickening of skin No pitting edema Brodie Trendenburg Test: Test 1: Saphenofemoral incompetence present Test 2: Perforator incompetence present Tourniquet Test: Incompetence above knee, below knee and lower leg perforators PALPATION

16. Fegan’s Test: depression felt at above knee, below knee and lower leg perforators Schwartz test: impuulse felt at the sphenous opening Morrisey’s cough impulse: Expansile cough impulse felt Test for DVT: Modified Perthes test: Varicosities shrink

17. RS: Normal vesicular breath sounds heard, no added sounds CVS: S 1 and S 2 heard, no murmur Per Abdomen: Soft, non tender, no organomegaly CNS: Sensory and motor functions intact, no other neurological defects SYSTEMIC EXAMINATION

18. Varicose veins in right lower limb of primary etiology involving great saphenous vein with saphenofemoral incompetence and above knee, below knee and lower leg perforator incompetence C 4a E p A s P r PROVISIONAL DIAGNOSIS

19. Duplex USG Other tests: CBC RBS RFT LFT ECG USG (to check for any abdominal compression) MANAGEMENT-INVESTIGATIONS

20. Saphenofemoral flush ligation, stripping of great saphenous vein up to the upper calf and ligation of above knee, below knee and lower leg perforators TREATMENT