Swollen Leg accompanied with redness and pain Step 1 Vericose : a condition that are vein in lower leg

getting larger because its vasodilatation, With the vein getting longger than before and tortous Step 2 1. Why the leg getting swollen , redness and pain ? 2. Why the appearance was tortous? 3. What the relation between vericose with the womans second pregnancy? 4. Why the womans get profuse bleeding on the affected limb ? 5. What the relation between vericose and blood pressure? 6. What the relation between vericose and right leg was brownish ? 7. What is the patofisiology of vericose ? 8. DD of scenario 9. Why the vericose vein only appear on the right leg ? 10. What is corelation between obese woman with vericose vein ? Step 3 1. Why the leg getting swollen , redness and pain ? Swollen : the vein larger because their get vasodilatation Redness : the vein bring many of blood,so it look red In superficial Different source : happen because transudation from kapiler , because the pressure of vein can bloced(dari kapiler ke vena), so eritrosit in kapiler will out from IV to IS, Pain :the larger vein pressure the nervus ; if the bood much in tissue can (ganggu) difusi O2, anaerob-> penumpukan laktat acid 2. Why the appearance was tortous? Insuficiency katup vena, so aliran vena dari bawah banyak tertumpuk 3. What the relation between vericose with the womans second pregnancy? During pregnancy , increase esterogen so the vein will vasodilatasi, and progesteron insuficien vein valve so will increase vein capacity, - Increase BB, so katup mena mendapat tekanan berlebih, fungsinya berkurang - Saat terlentang, tekanan di abdomen meningkat, jadi tekanan di ekstrimitas bawah harus meningkat juga lbh dari tekanan di abdomen - Distensi vena, sedangkan katup vena tetap, jadi katup tidak dapat menutup dengan sempurna - The blood in abdomen will press an then will be blocked distal vein v. Femoralis juga tertekan

4. Why the womans get profuse bleeding on the affected limb ? Karena tekanan hidrostatik di vena meningkat, jadi tekanan di kapiler juga meningkat karena darah dari kapiler ke vena terhambat, sehingga kapiler pecah. 5. What the relation between varicose and blood pressure? pressure of blood in circulation increase, so the vascular will vasodilatation , and the blood pressure decrease and the vein capacity will be incerased, and the blood will fill the vein , until full , and blood pressure will increased again 6. What the relation between varicose and right leg was brownish ? Because transudation plasma from kapiler and eritrosit will out from IV to IS, (siti)Transudation in IS can bloced difusi O2 and metabolism output, and if inflamasion continuesly it will make thrombus, - Hiperpigmentation. Increased in melanin pigmen. 7. What is the etiology & patofisiology of varicose vein? Etiology : increased elasticity of vascular vein and the vein cant to flow the blood into cor, there are destructive from vein valves If Increased pressure in profunda vein (increased abdominal vein), the blood flow back into perforate vein into superficial vein, it can make blockage in superficial vein, so accumulation in superficial vein is vasodilatation.. If valve vein destruction, the function of valve doesnt well, so the blood flow into the heart will be blocked. There is obstruction in vascular vein , can dilated tortous vein

Patofifiology : decreased elasticity, decrease vein valve they make pump in vein cant work. So it make the blood pressure increase in under extremities and pressure in capillary increase too, and there are transudation into Interstitial tissue, and can make swollen 8. DD of scenario Clinical Stage of vericose vein 1: symptom are appear as redness, swollen and pain ; transudation 2: Vein are vasodilated 3: vericose seems clearly, 4: symtom with in complication like brownis colour , ulseration -thrombo phlebitis : The thrombus in vein vasculer, and have inflamatin. Karakteristik : feel like burn, eritematosa, hard when palpated, increase termperature,

Different patofisiology of Vericose vs thrombo phlebitis Vericose : in lower extremitas Thomboplebitis :superficial :decreased blood flow in vascular vein can make thrombus in angle in valve vein, and can be insuficiency of valve Patogenesis : trias virchow - Stasis blood flow - Jejas endotel break of vein wall, - Hipercoagulasi Relation between vericose and thrombo phlebitis 9. Why the vericose vein only appear on the right leg ? Maybe in scenario physical exam just only in right leg, but predileksi on vericose can found in both of lower extremitas Differences of topografi vein ? 10. What is corelation between obese woman with vericose vein ? Obese can make valve of vein have high pressure , so the function of valve vein had decreased,

Step 4 Pregnancy, obese, etc

Increased hidrostatic pressure on the vein

Capillary pressure increased

vein vasodilatation

Transudate plasma

insuficiency valve vein

Capillary broken

blood gravitasi kebawah

Transudate eritrosit IV to IS

longer vein and tortous

Vericose vein

Management of thrombophlebitis Managemet of thrombophlebitis The purpose of medical treatment is to prevent progression and tromboplebitis thrombus and rupture risk. Anticoagulation therapy can achieve both objectives. Heparin that is given for 10-12 days with intermittent IV infusion or continuous infusion may prevent the development of blood clots and growth of new clots. Dose treatment arranged by monitoring the partial thromboplastin time or PTT.4-7 days before treatment hepatin IV ended, patients started on anti-coagulants given oral.pasien received anticoagulants can be given 3 months or more for long-term prevention. Unlike heparin in 50% of patients with thrombolytic therapy causing clots dissolve decompose. Thrombolytic therapy given within the first 3 days. Following acute occlusion, with the provision of streptokinase, plasminogen activator mokinase or tissue types. Excess treatment is still intact venous valve syndrome and reduces the incidence of post-flebotik and chronic venous insufficiency.

http://www.mayoclinic.com/health/thrombophlebitis/DS00223/DSECTION=complica tions Prognosis ?

Phlebitis Prognosis

Superficial phlebitis is rarely serious and usually responds to pain control, elevation, and warm compresses. Deep vein thromboembolism is potentially life-threatening if not treated, pulmonary embolism is a potential complication. It is important to find out why the DVT occurred and minimize the risk factors for a future occurrence. DVT can damage the internal structure of the vein leading to the complication of a post-phlebitic leg with chronic leg swelling and pain.

http://www.emedicinehealth.com/phlebitis/page3_em.htm#phl ebitis_symptoms

Complication If thrombophlebitis is in a vein just under your skin (superficial vein), complications are rare. However, if the clot occurs in a deep vein you may develop a serious medical condition known as deep vein thrombosis. If that happens, the risk of serious complications is greater. Complications may include:

Pulmonary embolism. If part of a deep vein clot becomes dislodged, it may travel to your lungs, where it can block an artery (embolism) and cause a potentially life-threatening situation.

Heart attack or stroke. If you have certain types of congenital heart defects that have caused a hole in your heart such as a patent foramen ovale (PFO), an atrial septal defect or a ventricular septal defect a clot traveling through your bloodstream can enter your coronary arteries or brain and cause a heart attack or stroke.

http://www.emedicinehealth.com/phlebitis/page3_em.htm#phl ebitis_symptoms

Risk Factor of varicous veins ?

Heredity One of the most important factors. If your parents and grandparents had the problem, you are at increased risk. Gender

Women have a higher incidence of varicose vein disease due in part to female hormones and their effect on the vein walls.

Pregnancy

Blood volume increases during pregnancy and hormonal effects contribute to vein enlargement.

Age

The tissues of our vein walls lose elasticity as we age causing the valve system to fail. The following additional factors, while not directly causing varicose veins, may speed up the development of this disease and make the veins worse.

Prolonged Standing

Occupations that involve standing for a long period of time cause increased volume and pressure of blood in the lower limbs due to the effects of gravity.

Obesity

Increases in weight often increase abdominal pressure which may worsen vein problems.

Hormone Levels
Physical Trauma

Treatments like birth control pills and post-menopausal hormone replacement may cause the same hormonal effect as pregnancy.

Injury to the lower limbs can damage underlying blood vessels and add to the problem.

http://www.viavascular.com/varicose-veins/about-varicose-veins.php

Why varicose veins occurred on second pregnancy ? While you are pregnant, your body undergoes a great deal of changes. Your hormone levels change and result in changes in your body. One of these changes is that you often have an increased amount of progesterone. This can cause the blood vessels to relax, leading to varicose veins. Sometimes, if the blood vessels relax, the two halves

of the valves in the veins will separate just a small amount, and won't meet back up to block the back-flow of blood. Source : http://www.womens-health.co.uk/varicose-veins-and-pregnancy.html

Trias virchow :

Derajat ?
Berdasarkan berat ringannya penyakit dan keluhan, varises terbagi menjadi 4 stadium, yakni: Stadium I : Pada stadium ini keluhan biasanya tidak spesifik. Pada umumnya ditandai dengan keluhan tungkai, diantaranya: gatal, rasa terbakar, rasa kemeng, kaki mudah capek, kesemutan (gringgingen), rasa pegal. Stadium II: Pada stadium ini ditandai dengan warna kebiruan yang lebih nyata pada pembuluh darah vena (fleboekstasia). Stadium III: Pembuluh darah vena nampak melebar dan berkelok-kelok. Keluhan pada tungkai makin nyata dan makin kerap dialami. Stadium IV: Pada stadium ini ditandai dengan timbulnya berbagai penyulit (komplikasi), antara lain: dermatitis, tromboplebitis, selulitis, luka (ulkus), perdarahan varises, dan gangguan pembuluh darah vena lainnya.