Download MBBS Final Year Surgery Case Presentation Varicose Vein Clinical Examination Discussion and Treatment

Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Varicose Vein Clinical Examination Discussion and Treatment

Mrs.rani
50 years old female
Housewife
Residence: t.nagar
Socio economic class: lower middle

CHIEF COMPLAINTS
vDilated veins in the left leg for the past 5 years
vPain in the left leg for the past 2 years

History of presenting illness
Dilated vein in the left leg
for the past 5 years
insidious in onset
initially appeared below the knee and
gradually progressed up to thigh

Associated with PAIN:
past 2 years
insidious in onset
dull aching pain
intermittent in nature
not radiating / referred
aggravated on prolonged standing and walking
usually towards end of the day
relieved by lying down
H/O prolonged standing present

No History of :
night cramps
prolonged immobilisation
itching , hyperpigmentation , ulcer
fever
trauma
abdominal distension
loss of weight , loss of appetite
constipation
swelling of legs
Use of Oral Contraceptive Pills

Past history
No H/O similar complaints in the past
No H/O diabetes mellitus, hypertension,
tuberculosis, asthma, epilepsy
H/O sterilisation 20 years back
No H/O prolonged hospitalisation or immobilisation

Personal history
Consumes mixed diet
Normal bowel and bladder habits
Does not consume alcohol or tobacco in any form
Normal sleep

Menstural history
Age of menarche: 14 years
No H/O OCP use
Attained menopause at the age of 48 years

Family history
No significant family history

General examination
Patient examined after obtaining consent
Patient is conscious, oriented, moderately built and
nourished
Afebrile
No pallor
No icterus
No cyanosis
No clubbing
No pedal edema
No generalised lymphadenopathy

Vitals
Pulse rate: 80/min
regular, normal volume, no specific character, all
peripheral pulses are felt, no RR/RF delay, no vessel
wall thickening
Respiratory rate : 13/min
BP : 110/80 mm Hg measured in right upper arm in
sitting posture

Examination of left leg
Patient in STANDING POSITION exposing from
umbilicus to toes
INSPECTION: dilated, torturous veins seen on the
medial aspect of leg, extending from infront of
medial malleolus coursing along medial aspect of leg
upto medial aspect of lower 1/3rd thigh

Inspection
Skin :
normal in colour and texture
no edema
no scars, ulcers
no loss of hair
no brittleness of nails
cough impulse not seen

Palpation
Not warm, not tender
No thickening of skin
No pitting pedal edema

Each of the following tests are performed after
milking the veins
TRENDELENBERG TEST 1
Observation: veins fill rapidly from above
downwards
Inference: saphenofemoral in competence
TRENDELENBERG TEST 2
Observation: veins fill gradually
Inference: perforator incompitance

MULTIPLE TORNIQUET TEST
Observation: dilated veins appear between the 2nd
and 3rd torniquet
Inference: below knee perforator incompetence

FEGAN TEST
Observation: defect in the fascia felt as pit along
the course of dilated veins just below the knee

MODIFIED PERTHE TEST
(performed without emptying the veins)
Observation: dilated veins do not become
prominent and there is no pain on walking
Inference: patent deep vein

MORRISSEY'S COUGH IMPULSE TEST
Observation: cough impulse not felt on the SFJ
No lymph nodes palpable

Percussion
SCHWARTS TEST
Observation: impulse not felt at the SFJ

Auscultation
No bruit heard

Examination of peripheral arterial system
Femoral, popliteal, posterior tibial, dorsalis pedis
pulses felt equally in both lower limb
No distal neurological deficit
Examination of right lower limb: normal

Other system examination
ABDOMEN
soft
no organomegaly
no mass palpable
no free fluid

CVS: S1, S2 heard; no murmur
RS: normal vesicular breath sound heard
no added sounds
CNS: no focal neurological deficit
Spine and Cranium: normal

Diagnosis
Primary varicose veins of the left lower limb involving
the great saphenous vein with Saphenofemoral and
below knee perforator inompetence with clinical class
C(2)E(p)A(s+p)P(r )without any complication

Investigation
Routine:
CBC
BT, CT
blood grouping & typing
blood sugar, urea, serum creatinine
urine sugar, albumin
ECG
Chest X-ray

SPECIFIC
Duplex study
Ultrasound abdomen

Treatment
Saphenofemoral flush ligation with stripping of great
saphenous vein up to knee and sub-facial perforator
ligation-LEFT SIDE

This post was last modified on 08 August 2021