VARISES

dr.Gunawan Tohir SpB,MM Fak.kedokteran Muhammadiyah Palembang 2011

Structure of Arteries, Veins, and Capillaries

Figure 19.1a

Capillary Beds

Figure 19.3a

Fluid Leaves Capillary

Cells

Blood Blood Capillary

Capillaries

PRE-CAPILLARY SPHINCTER
A small muscle in front of each capillary, controls the flow of blood to individual capillaries. ARTERIOLES direct the blood flow to the specific tissue. Pre-capillary sphincters direct the blood flow to specific cells. If one cell is starving, the capillary next to it will open. The sphincter opens and closes depending on the needs of individual cells.

Capillary Beds

Figure 19.3b

Venous Disorders
Varicose Veins

Superficial Thrombophlebitis Deep Vein Thrombosis/ PE

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DrU.Gupta,Dr.N.K.Gupta

VARICOSE VEINS
Abnormally dilated, tortuous veins produced by prolonged, increased intraluminal pressure and loss of vessel wall support Main sites: superficial veins of the upper and lower leg At risk
Occupations WITH PROLONGED STANDING simple orthostatic edema >50 years old, obese Women (pregnancy) familial tendency -defective venous wall development

15% to 20% of the general population

VARICOSE VEINS

VARICOSE VEINS Morphology

Thrombosis Valvular deformities Microscopically

Thickness of the vein Dilation & hypertrophy of the smooth muscle and subintimal fibrosis Spotty calcifications media (phlebosclerosis) Elastic tissue degeneration

Varicose veins
Varicose veins are a common condition in the United States, affecting up to 15 percent of men and up to 25 percent of women. For many people, varicose veins and spider veins a common, mild and medically insignificant variation of varicose veins are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes the condition leads to more serious problems. Varicose veins may also signal a higher risk of other disorders of the circulatory system.

Risk factors
Age. Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to malfunction. Sex. Women are more likely than men are to develop the condition. Hormonal changes during pregnancy or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase the risk of varicose veins. Genetics. If other family members had varicose veins, there's a greater chance you will too. Obesity. Being overweight puts added pressure in veins. Standing for long periods of time. Prolonged immobile standing impairs venous return.

PENYEBAB
1.KETURUNAN 2.KEHAMILAN 3.HORMONAL 4.KURANG GERAK 5.TERLALU LAMA BERDIRI

Varicose Veins
Pregnancy
Increased blood volume

Pressure on veins
Relaxation effect of hormones

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Symptoms
An achy or heavy feeling in your legs, and burning, throbbing, muscle cramping and swelling in your lower legs. Prolonged sitting or standing tends to make your legs feel worse. Itching around one or more of your veins. Skin ulcers near your ankle, which represent a severe form of vascular disease and require immediate attention.

VARICOSE VEINS Clinical Course

venous stasis, congestion, edema, pain, and thrombosis Sequelae
Persistent edema Trophic changes in the skin dermatitis, ulcerations poorly healing wounds infections varicose ulcers Embolism is very rare

VARICOSE VEINS Clinical Course

Esophageal Varices
Cirrhosis of the liver and its attendant portal hypertension Massive upper gastrointestinal hemorrhage

Hemorrhoids
Hemorrhoidal plexus of veins at the anorectal junction Pregnancies Straining at stools

TIPE VARISES
1.Varises ekstremitas inferior 2.Varises gastrointestinal - v esofagus - v.gaster - V Rektoanal ....> Hemoroid 3. Varises skrotum : Varicocele 4. Varises vulva ; varises vaginae

PATOFISIOLOGI VARISES

Complications
Extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles. Ulcers are the result of long-term "water logging" of these tissues, caused by increased pressure of blood within affected veins. Brownish pigmentation usually precedes the development of an ulcer. Occasionally, veins deep within the legs become enlarged.

Treatment
Sclerotherapy. Laser surgeries. Catheter-assisted procedures (heat). Vein stripping. Ambulatory phlebectomy Endoscopic vein surgery Evidence suggests that horse chestnut seed extract may be an effective treatment for chronic venous insufficiency (CVI), a condition associated with varicose veins. Recurrence not uncommon

Varicose Veins
Management
Non Operative
Self resolving (within six weeks)

After 6 weeks
if problematic/ unacceptable
Graduated Compression Stockings Surgery

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Varicose Veins

Before Treatment
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After Treatment
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Varicose Veins

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LEG ULCER

Venous leg ulcer

Take long time to treat and heal Venous insufficiency Stasis dermatitis Stasis ulcer Over the malleolus (more medial than lateral) If not controlled they can lose extremity