casecontrol
Forum Newbie
Topics: 3
Posts: 10
|
A 55 y/o man presented with a hx of tiredness, aching, tingling and cramps in his left leg. These symptoms got progressively worse toward the end of the day, but elevating the leg relieved them. The problem has gotten worse over the last several weeks, he is now unable to walk a city block without extreme pain, which lingers even after he sits down and rests for 5 minutes. Over the counter analgesics have given temporary relief. The patient notices the foot swollen at the end of the day. Physical examination revealed soft tissue swelling of the left ankle. A reddish brown discoloration of the skin was noted behind the medial malleolus of the left ankle, together with a small ulceration in the center. No calf tenderness, but some areas of venous dilation were seen. No abnormalities noted in the right leg. Pulses were normal and equal in both extremities. What is the condition?
a. superficial thrombophlebitis
b. embolic disease
c. arterial insufficiency
d. immune vasculitis
e. deep venous insufficiency
|
| yukti_5
Forum Junior
Topics: 2
Posts: 67
|
C
|
| kpmle2
Forum Guru
Topics: 95
Posts: 512
|
e. deep venous insufficiency---venous stasis ulcers.
|
| casecontrol
Forum Newbie
Topics: 3
Posts: 10
|
Answer is e. The explanation as kpmle2 stated is stasis dermatitis. Venous blood from the skin and superficial tissues that lie external to the deep fascia of the leg drains, via communicating veins, into the deep veins of the calf and is then returned to the right atrium. When calf muscles contract, valves prevent retrograde flow into the superficial system. Incompetence of valves leads to retrograde flow, increased venous pressure in the dorsal vein of the foot, causing skin changes. Also the increased venous pressure causes capillary leakage which causes blood and fibrin deposition in surrounding tissues. Breakdown of blood into hemosiderin leads to pigmentation of the skin, while fibrin deposition around capillaries forms a barrier. Ischemia predisposes to ulceration of the skin. Retrograde blood flow causes varicosities as well.
Not c because although arterial insufficiency can coexist with varicose veins, these patients have pulselessness and may have calf claudication. The patient in the question does not during the physical examination.
|
| docnit
Forum Senior
Topics: 8
Posts: 193
|
yes..i agree with the answer
but arterial insufficiency doesnt necessarily cause pulselessness though.
|
| yukti_5
Forum Junior
Topics: 2
Posts: 67
|
Thankyou casecontrol.
hmm but i was thinking it looks like he has claudication progressing to rest pain. Also absent pulses isnt necessary.
But i got a little confused .It is the description of a venous ulcer so i agree with the answer.
|
| casecontrol
Forum Newbie
Topics: 3
Posts: 10
|
Yutki I agree with you, pulselessness does not always occur with arterial insufficiency. The question is kind of tricky, but if it was arterial insufficiency then the question would have probably focused more on atherosclerosis. But the question points out more towards deep venous insufficiency with the stasis dermatitis and the venous ulcers which typically occur in the perimalleolar area of the leg. Thanks for the input.
|
| chemamr
Forum Hero
Topics: 703
Posts: 4,488
|
agree with E
|
|
| |
| | | | | | | | |
Similar forum topics