EXAMINATION OF VARICOSE VEIN

Patient particulars
Name, Age, Gender
Address
Occupation
Date of admission
Date of examination.

CHIEF COMPLAINTS
 Irregular swelling of the lower limbs.
 Pain- Constant dull aching pain/Dragging pain in the lower limbs
 Ulcer ,eczema,bleeding.

HISTORY OF PRESENT ILLNESS

Pain
 Onset, Duration, Progression, Nature of pain, Radiation.
 Aggravating & reliving factors- pain gets worse while standing up for
a long time & relieved when he lies down
 More during night time
 Associated night leg cramps.

o Varicosities of veins /complications.

o H/o swelling at ankle/calf
o Itching of the leg
o Pigmentation/ Eczema
o Venous ulcers

Ulceration- (describe in all points for Ulcer)

o Pigmentation and discoloration

o Fever with calf pain
o Distention of abdomen.
o Pregnancy.
o Any condition with raised intra-abdominal pressure
o Smoking
o Diagnosed comorbidities
 o Prolonged drug intake
PAST HISTORY
H/o similar complaints in the past.
H/o Hypertension,T2DM
H/o chest Pain etc.

Treatment history

History of allergy to food and any drug.

Menstrual history (in females)
Marital and obstetric history. (In females)

FAMILY HISTORY
H/o hypertension, diabetes, tuberculosis, malignancy.
H/o similar complaints in the family (in case of malignancies)

PERSONAL HISTORY.
Vegetarian /non vegetarian
Appetite
Sleep
Bowel and bladder habits
Substance abuse-smoking, alcohol.

Summary after history.

General physical examination.

Patient is conscious, cooperative
Orientation to time, place, person.
Built Nourishment.

Vitals:
 Pulse: rate, rhythm, volume, equality, character, condition of the
arterial wall, Radio-Radial delay, radio-femoral delay, pulse deficit if
any, peripheral pulses.

 Blood pressure- right arm supine position.

 Respiratory rate, rhythm, type.
 Temperature.
Pallor, icterus, Cyanosis clubbing, edema,
Lymphadenopathy (site, size, shape, number, consistency, mobility, matted
, ulceration)

Height, Weight, BMI.

Head to toe examination Local examination.

INSPECTION
Attitude of the limb

1. Varicose vein
o Limb involved-bilateral or unilateral.
o Medial aspect or postero-lateral Site
o Extent
o Describe the course

2. Swelling- Localized or generalized

3. Skin of the Limb:

o Color change
o Texture
 Stretched & shiny
 Eczema/pigmentation (around medial malleolus)
 Ulceration (Venous ulcer- on medial aspect of lower part of
leg)
 Scar formation/healed scar
 Toes- Loss of hair, brittleness of nails
 Ischemic changes.

4. Morrissey's test- impulse on coughing at saphenous opening

5. Comment on healthy limb.

PALPATION
All the inspectory findings should be confirmed
Local rise of temperature & Tenderness
 1. Brodie-Trendlenberg test- for sapheno- femoral valve and
communicating system.
2. Tourniquet test
3. Perthes’ test
4. Modified Perthes’ test
5. Schwartz test
6. Pratt's test
7. Morrissey's cough impulse test
8. Fegan sign-to indicate the sites of perforators
9. Pitting edema/ thickening, redness or tenderness

PERCUSSION
 Schwartz test

Auscultation- for AV Fistula

 Examination of regional lymph nodes:- inguinal lymph nodes.

 Examination of other limb.

Systemic examination.
Cardiovascular system
Respiratory system
Abdomen
Central nervous system
Locomotor system

Provisional diagnosis
Differential diagnosis

Investigation
Treatment -Medical, surgery.
Follow-up.
Prognosis