Venous Disorders

·         Varicosity = varix = elongated, tortuous, dilation of a vessel.  This can occur in the veins, arteries or capillaries.  Here, we will be discussing venous varicosities, b/c we are looking specifically at the veins!!!

·         Common locations include the superficial veins of the upper & lower legs, the anorectal venous plexus & the esophagus.

o        Legs:

·         most common location

·         persons younger than 50 yrs old, obese and pregnant women

·         With this prolonged increase of pressure, your venous valves become incompetent à leads to stasis of the blood à congestion & edema à thrombosis à stasis dermatitis or varicose ulcers

o        Anorectal venous plexus = hemorrhoids

·         The picture presented looked like “moles underground” making a “lumpy bumpy appearance of the rectal mucosa.

·         Angiography shows the inferior mesenteric vein that ends with a ball of varicose veins at the bottom!

o        Esophagus

·         This is often seen in cases of portal hypertension, that is usually due to cirrhosis of the liver (i.e. alcoholics).

·         If these veins rupture, they can cause fatal hematemesis (vomiting of blood) – this is in about 50% of patients that have esophageal varices due to alcoholic disease.
 

 Do you have to worry about thrombus formation that may dislodge to cause some obstruction somewhere, like the lungs?  In the deep veins of the leg, YES, but this is NOT true in the case of esophageal varicosities.
 

Lastly, there was a picture of caput medusa – which is when veins within the skin usually around the umbilicus that can develop anastomoses in conditions such as portal hypertension, like with alcoholic cirrhosis of the liver. 

It looks like a bunch of worms crawling underneath the skin.  This presents clinically with edema and ascites, and hepatomegaly and caput medusa. This is not painful, and not really curable b/c its do to portal hypertension which is major damage of the kidney, but caput medusa is a good clinical sign to find portal hypertension.

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