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Step 7 LBM 5 Amarullah
Step 7 LBM 5 Amarullah
Kardiovaskular
Step 1
1. Varicose : abnormality dilated vessel with a tortuos source. Usually occurs
in venous system but may also occur in atrial or lymphatic vessel
2. Varicose vein: are enlarged, swollen veins that are caused by faulty valves
in the veins or weak vein walls . It is a sign because the blood flow is
abnormal
3. Tortuous: Twisted veins
4. Vericeal area: area around varicose veins
Step 2
1. Why does woman feel pain and her right leg become swollen and redness?
2. What are the cause of varicose?
Varicose veins are caused by weakened valves and veins in your legs. Normally, one-way
valves in your veins keep blood flowing from your legs up toward your heart. When these valves
do not work as they should, blood collects in your legs, and pressure builds up. The veins
become weak, large, and twisted.
Age. The risk of varicose veins increases with age. Aging causes wear and tear on the valves
in your veins that help regulate blood flow. Eventually, that wear causes the valves to allow some
blood to flow back into your veins where it collects instead of flowing up to your heart.
Sex. Women are more likely to develop the condition. Hormonal changes during pregnancy,
premenstruation or menopause may be a factor. Female hormones tend to relax vein walls.
Taking hormone replacement therapy or birth control pills may increase your risk of varicose
veins.
Family history. If other family members had varicose veins, there's a greater chance you will
too.
Step 3
1. What is the veins anatomy?
Wall: collapse
If there is injury, it will be
More elastic
It does have valves
The direction is to heart, brings CO2 except v.pulmonalis
Muscle pumps
Blood volume: when the blood volume is less than normal, to make
it adequate, its needed to be vasoconstriction (body compensation)
Injury
9. Why does woman feel pain and her right leg become swollen and
redness?
Damage of valveblood cant go upwardextravasation swelling and
redness
Sweelingnerves are pressed by the swollen parts.
Varicose veins are caused by weakened valves and veins in your legs. Normally, oneway valves in your veins keep blood flowing from your legs up toward your heart. When
these valves do not work as they should, blood collects in your legs, and pressure
builds up. The veins become weak, large, and twisted.
Age. The risk of varicose veins increases with age. Aging causes wear and tear on the
valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to
allow some blood to flow back into your veins where it collects instead of flowing up to your
heart.
Sex. Women are more likely to develop the condition. Hormonal changes during
Family history. If other family members had varicose veins, there's a greater chance you
will too.
Standing or sitting for long periods of time. Your blood doesn't flow as well if you're in
Experts are not sure why the walls of veins stretch or why the valves become faulty.
In many cases, it occurs for no clear reason.
Doppler test - this is an ultrasound scan to check the direction of blood flow in
the veins to see whether the valves are working properly. This test can also check
for blood clots or obstructions in the veins.
Color duplex ultrasound scan - this ultrasound test provides color images of the
structure of veins, which helps the doctor identify any abnormalities. This test can
also measure blood-flow speed.
Superficial varicosities are the result of high-pressure flow into a normally low-pressure system.
Varicosities carrying retrograde flow are hemodynamically harmful because they cause
recirculation of oxygen-poor, lactate-laden venous blood back into an already congested
extremity. The primary goal of treatment is the ablation of these reflux pathways with resulting
improvement of venous circulation.
In the rare setting of deep system obstruction, varicosities are hemodynamically helpful because
they provide a bypass pathway for venous return. Hemodynamically helpful varices must not be
removed or sclerosed. This condition is encountered rarely, but when it is, ablation of these
varicosities causes rapid onset of pain and swelling of the extremity, eventually followed by the
development of new varicose bypass pathways.
Sclerotherapy, laser and intense-pulsed-light therapy, radiofrequency (RF) or laser ablation, and
ambulatory phlebectomy are the modern techniques used to ablate varicosities. Numerous
reports describe success rates of greater than 90% for less invasive techniques, which are
associated with fewer complications, with comparable efficacy.[4, 5]
Inadvertent injection of concentrated sclerosants into the deep system can cause deep vein
thrombosis, pulmonary embolism, and death.
The proper use of sclerosing agents requires special training and extended study. Specific
dosing and technique recommendations for the administration of sclerosants are beyond the
scope of this article.
The most commonly used sclerosants today are polidocanol and sodium tetradecyl sulfate,
both known as detergent sclerosants because they are amphiphilic substances that are
inactive in dilute solution but are biologically active when they form micelles. These agents
are preferred because they have a low incidence of allergic reactions, produce a low
incidence of staining and other cutaneous adverse effects, and are relatively forgiving if
extravasated.[8] These are best delivered as a foam, which is made by agitating the
solutions with air to create a frothy substance.
Sodium morrhuate is an older detergent sclerosant that is made up of a mixture of saturated
and unsaturated fatty acids extracted from cod liver oil. The agent is of variable composition
and has been associated with a relatively high incidence of anaphylaxis. The incidence of
extravasation necrosis is high with this drug.
Ethanolamine oleate, a synthetic preparation of oleic acid and ethanolamine, has weak
detergent properties because its attenuated hydrophobic chain lengths make it excessively
soluble and decrease its ability to denature cell surface proteins. High concentrations of the
drug are necessary for effective sclerosis. Allergic reactions are uncommon, but reports exist
of pneumonitis, pleural effusions, and other pulmonary symptoms following the injection of
ethanolamine oleate into esophageal varices. The principal disadvantages of the drug are a
high viscosity that makes injection difficult, a tendency to cause red cell hemolysis and
hemoglobinuria, the occasional production of renal failure at high doses, the possibility of
pulmonary complications, and a relative lack of strength compared with other available
sclerosants.
Hypertonic sodium chloride solution in a 20% or 23.4% solution can be used as a sclerosing
agent. The principal advantage of the agent is the fact that it is a naturally occurring bodily
substance with no molecular toxicity, but the disadvantages of the agent make it unsuitable
except in the hands of highly skilled practitioners.
Because of dilutional effects, achieving adequate sclerosis of large vessels without
exceeding a tolerable salt load is difficult.
It can cause significant pain on injection and significant cramping after a treatment
session.
If extravasated, it almost invariably causes significant necrosis. Seeing patients with
dozens of disfiguring scars at the sites of extravasation of hypertonic sodium chloride
solution is not uncommon.
Because it causes immediate red blood cell hemolysis and rapidly disrupts vascular
endothelial continuity, it may cause marked hemosiderin staining that is not cosmetically
acceptable.
Food and Drug Administration (FDA) approval of drug labeling is an important concern for
physicians and patients in the United States. Polidocanol is the most widely used sclerosant
in the world, but the agent has not been approved by the FDA. Sotradecol, sodium
morrhuate, and ethanolamine oleate all were developed prior to the establishment of the
FDA. These agents are available in the United States as grandfathered agents. The newest
form of Sotradecol was cleared by the FDA in 2006. It is highly purified with no
contaminants.
The safety of sclerosing agents in pregnancy has not been established.
Transcutaneous pulsed dye laser and intense-pulsed-light (IPL) therapy has proven effective
for the tiniest surface vessels (eg, those found on the face), but this modality is not generally
useful as primary therapy for treatment of spider veins of the lower extremity. This is true for
several reasons.
Because of the physics of light absorption, delivering an ablative dose of thermal energy to
the vessel without damaging the overlying skin is difficult.
The degree of patient-to-patient variability of light absorption in the skin is high. Even an
experienced practitioner may inadvertently cause painful skin burns that can lead to
permanent hyperpigmentation or hypopigmentation.
For most patients, the laser pulses are significantly more painful than the 30-gauge needles
used for microsclerotherapy.
Most spider veins have associated feeding vessels that must be treated by some other
means before the tiny surface vessels are amenable to laser or IPL treatment.
Dudelzak et al report successful treatment of facial spider veins (telangiectasias) with a 980nm diode laser. No complications were reported.