A 38-year-old woman presented 6 months postpartum from the birth 

of her third child with pruritic

bluish veins and a burning sensation behind her knees. She was embarrassed to wear skirts and dresses.
On physical examination, she was obese and had prominent reticular veins behind her knees and along
her lateral lower thighs.

WORKING IMPRESSION:

Prominent reticular veins in the left popliteal fossa

Can easily recognize because popliteal fossa a diamond-shaped space behind the knee joint.

3 slide

Varicose veins, also known as varicoses or varicosities

When your veins become enlarged, dilated, and overfilled with blood. Varicose veins typically appear
swollen and raised, and have a bluish-purple or red color.

Varicose veins most commonly affect the veins in the legs. That's because standing and walking
increases the pressure in the veins of the lower body.

Causes - Weak or damaged valves can lead to varicose veins.

-Inside your veins are tiny one-way valves that open to let the blood through, and then close to prevent
it flowing backwards.
-Sometimes the walls of the veins become stretched and lose their elasticity, causing the valves to
weaken.
-If the valves do not function properly, this can cause the blood to leak and flow backwards. If this
happens, the blood collects in your veins, which become swollen and enlarged.
The reasons why the walls of the veins stretch and the valves in your veins weaken are not fully
understood. Some people develop the condition for no obvious or apparent reason.

4 slide-Symptoms

Signs of varicose veins include:

 Veins that are dark purple or blue

 Veins that appears twisted and bulging, often appearing like cords on the legs
 Heavy feeling in the legs
 Burning, throbbing, muscle cramping and swelling in the lower legs
 Worsened pain after sitting or standing for a long time
 Itching around one or more of the veins

5 slide- Pathophysiology

Non- modifiable Risk

Factors: Modifiable Risk Factors:
Age Pregnancy
Gender (Female) Obesity
Family History

Venous hypertension

Venous valvular incompetence

Structural changes in the vein wall

 Inflammation

Alterations in shear stress

Non- modifiable Risk

 Age- Aging causes wear and tear on the valves in the veins that help control blood flow.
Eventually, that wear causes the valves to allow some blood to flow back into the veins, where it
collects. The majority of people who develop varicose veins are between 40 and 80.
 Gender- Women are more likely to develop the condition. Hormonal changes before a
menstrual period or during pregnancy or menopause might be a factor because female
hormones tend to relax vein walls. Hormone treatments, such as birth control pills, might
increase the risk of varicose veins.
 Family history- If other family members had varicose veins, there's a greater chance you will
too.

Modifiable Risk Factors:

 Obesity- Being overweight puts added pressure on veins.

 Pregnancy- During pregnancy, the blood volume in the body increases. This change supports the
growing baby but can also enlarge the veins in the legs.

1. Venous hypertension- High blood pressure in the leg veins over a long time, due to sitting or standing
for prolonged periods. And lack of exercise. It is more common among those who are obese, pregnant,
or who have a family history of the problem.

Venous hypertension is caused by reflux attributable to venous valvular incompetence, venous outflow
obstruction, or calf-muscle pump failure.Venous reflux may occur in either or both the superficial or
deep venous system and results in venous hypertension below the area of venous valvular
incompetence.

2. Valvular incompetence may result from deformation, tearing, thinning, and adhesion of the valve
leaflets.

3. Structural changes in the vein wall contribute to pathological weakening and resultant dilation.

4. The vein becomes inflamed because there's blood clotting inside it or the vein walls are damaged.

5. Decreases in shear stress promote inflammatory and prothrombotic changes that may further
contribute to loss of structural and functional integrity of the vein wall and valve leaflets.

6- Management for pregnant since our patient is pregnant

 Avoid sitting or standing in the same position for long periods of time. Make sure to take breaks
to change your position.
 Avoid wearing high heels. It is better to wear lower-heel or flat shoes as this works your calf
muscles, fostering healthy circulation.
 Get regular exercise. Talk with your doctor to confirm if it is safe for you to exercise during
pregnancy.
 Wear maternity support hosiery. These put pressure on the legs, stimulating blood flow up the
leg towards the heart. However, avoid wearing tight hose that cut off circulation.
 Avoid crossing your legs while sitting.
 Elevate your legs periodically to improve circulation.
 Sleep on your left side. This will help relieve pressure on the inferior vena cava.
 Reduce sodium intake to minimize swelling of the veins.
 Drink plenty of water and eat enough fiber to prevent constipation.