VARICOSE VEINS EDITED for 2023 cohort.pptx

Powerpoint

1. VERICOSE VEINS 2023 COHORT MSG 2 PRESENTER: D. KAMALIZENI

2. LEARNING OUTCOMES Define varicose veins Mention types of varicose veins Explain pathophysiology of varicose veins Outline diagnostic procedures of varicose veins Explain conservative management of varicose veins

3. LEARNING OUTCOMES continues.., Describe surgical management of varicose veins Explain the following: - pre-operative care - post-operative care Outline preventive measures of varicose veins List complications of varicose veins

4. Overview of anatomy & physiology of Venous System of lower limb Venous System of the lower limb consists of the following: Superficial system of veins: lies outside the deep fascia (carry 10% blood) and perforating veins which pass through the deep fascia joining the superficial to the deep system of veins Deep system of veins: lies below the deep fascia Valves in the veins: Valves present in superficial veins prevent flow of blood from proximal to distal and from deep to superficial

5. Overview of anatomy & physiology of Venous System of lower limb ct … Valves can resist pressure up to 300 mm of Hg Factors Helping in Venous return: Negative pressure in thorax during inspiration is -6 mm, calf muscle pump. Normal venous pressure in relaxed state is 20mm of Hg, however, it rises to 80-100 mm of Hg during muscle contraction Visa tergo : refers to arterial pressure transmitted to venous side through capillary bed Venae commitants : T hese are Competent valves which lie by the side of artery, they are helped by arterial pulsation to propel blood

6. DEFINITION Varicose veins are dilated, elongated, tortuous (twisting) and palpable superficial veins as a result of venous hypertension INCIDENCE More common in males in India, however in Africa they are common in females than males. Left lower limb more commonly involved. The long saphenous system is affected in 2 thirds of cases

7. Typ es of varicose veins Primary ( idiopathic): More common in women with strong family history of varicose veins. They occur in lower extremities Secondary to previous DVT: Other identifiable obstruction may occur in esophagus, haemorrhoids , arterivenous malformation Etiology: Long hours of standing, which increase hydrostatic pressure of gravity Risk factors F amily history Pregnancy Ageing Deep vein thrombosis Oral contraceptives O besity

8. Pathophysiology When veins are enlarged, valves are stretched and become incompetent. This leads to back flow of venous blood. This increases distention of veins due to too much blood volume contained in it since veins are not designed to carry out large volumes of blood CLINICAL MANIFESTATION Cosmetically disfigurement Dull aches, muscle cramps Increased muscle fatigue in the lower legs Ankle edema and a feeling of heaviness of the legs Nocturnal cramps

9. DIAGNOSIS PROCEDURES History taking P hysical examination Duplex ultrasonography Venography for both Ascending and descending veins

10. CONSERVATIVE MANAGEMENT Avoiding prolonged standing Crepe bandaging and elastic stockings warn from toe to thigh, which causes decreased edema, venous volume, reflux and increases venous return. Limb elevation above the level of heart while lying down and Wearing slightly tight special elastic socks Sclerotherapy: Under Ultrasound guidance a chemical is injected into the vein, this chemical irritates the venous endothelium and produce localized phlebitis and fibrosis, thereby obliterating the lumen of the vein ( hypertonic sodium chloride solution, Sodium morrhuate , Ethanolamine oleate or Polidocanol)

11. SURGICAL MANAGEMENT High end ligation and stripping: entire vein is ligated, dissected and all its tributaries removed Laser fiber: it produces heat that destroys the vascular endothelium

12. PRE OPERATIVE CARE General preoperative care applies Specific pre-operative care Explain to the paint importance of total: - bed rest for the first 24 hours, there after the patient begins walking every 2 hours for 5 to 10 minutes - avoiding sitting and standing for too long

13. Post- operative care General post-operative care applies Specific post-operative care F oot of the bed should be elevated, Standing still and sitting are discouraged Usually, the patient may shower after the first 24 hours. The patient is instructed to dry the incision well with a clean towel using a patting technique rather than rubbing If the patient underwent sclerotherapy, a burning sensation in the injected leg may be experienced for 1 or 2 days therefore, mild analgesics may be used ( eg , paracetamol or ibuprofen )

14. Prevention Exercise W eight : reduces pressure on the veins. Avoid too much salt in in diet Choose proper foot wear Av oid tight clothing Elevate legs when anticipating prolonged sitting Avoid long periods of sitting or standing  

15. Complications Bleeding: twisted veins if over distended may rupture leading to excessive bleeding, shock and anaemia Cosmetically disfiguring

16. Reference Bruna textbook of Medical-Surgical Nursing (electronic book) Barry A, Goldsworthy S & Gooridge D. (2014). Medical Surgical Nursing in Canada; Assessment and Management of Clinical Problems. Canada. 3rd Edition