Nutritional changes of lower extremity skin

Introduction The nutritional changes of the lower extremities skin is one of the symptoms of primary deep venous valve insufficiency of the lower extremities. It occurs mostly in long-term physical labor or standing workers, and has a high incidence among farmers, barbers, athletes, surgeons and the like.

Cause

Reduce venous pressure in valve insufficiency, including elevation of the affected limb, proper activity, application of elastic bandages, etc. Primary nutritional deficiencies refer to the lack of adequate intake, either insufficient intake of individual nutrients or insufficient intake of several nutrients. Common causes of inadequate nutrient intake are food shortages caused by social and economic factors such as war, famine, and poverty. Second, bad eating habits, such as partial eclipse, eating or picky eaters, make certain foods inadequate or lacking. The lack of nutrition; the third is unreasonable cooking and processing, resulting in the destruction and loss of nutrients in the food, although the amount of food intake is quite large, but some nutrients are insufficient. For long-term consumption of fine white rice noodles, rice and other diseases are prone to beriberi; vegetables are cut and washed first, excessive heating or boiled can cause a lot of vitamin C damage and loss.

an examination

Related inspection

Body function and nutrition

Symptoms and signs

Simple varicose veins of the lower extremities are more common with saphenous veins. Separate small saphenous veins are rare; more common in the left lower limbs, but bilateral lower extremities can be followed. The main clinical manifestations are the expansion, elongation and distortion of the superficial veins of the lower extremities. If the disease progresses, when the venous valve is destroyed, there may be mild swelling of the ankle and skin nutrient changes in the foot, including skin atrophy, desquamation, itching, hyperpigmentation, induration of the skin and subcutaneous tissue, eczema and ulceration. .

Diagnostic examination

According to the clinical manifestations of varicose veins of the lower extremities, the diagnosis is not difficult. The following examinations provide further insight into superficial venous valve function, deep venous return of the lower extremities, and traffic venous valve function:

1 large saphenous vein valve function test: the patient is supine, the lower limbs are raised, the vein is evacuated, the tourniquet is tied at the root of the thigh, the saphenous vein is pressed, and then the patient is stood, and the tourniquet is released within 10 seconds. The upper and lower veins are filled in the opposite direction, suggesting that the valve is insufficiency. Applying the same principle, a tourniquet can be placed on the socket to detect the function of the small saphenous vein valve. If the vein under the tourniquet is filled within 30 seconds before the tourniquet is released, there is a venous valve insufficiency.

2 deep vein patency test: use the tourniquet to block the trunk of the superficial vein of the thigh, and the paralyzed patient kicked the leg vigorously or squats for more than 10 times. At this time, due to the contraction of the calf muscle pump, the venous blood is forced to flow back to the deep vein, and the varicose vein is evacuated. If the superficial varicose veins are more obvious after the activity, the strength is increased, and even the pain is painful, indicating that the deep veins are not smooth.

3 traffic venous valve function test: the patient lying on his back, raising the lower limbs, and stopping the tourniquet at the base of the thigh. Then, from the toe up to the nest, wrap the first strong bandage, and then the lower end of the hemostasis, and tie the second elastic bandage. Let the patient stand and untie the first strong bandage while continuing to entangle the second elastic bandage. If the varicose vein appears in the gap between the two bandages, it means that there is dysfunction. Traffic veins. Other tests: such as ultrasound Doppler, plethysmography, lower extremity venous pressure measurement and venography, can more accurately determine the nature of the lesion.

The diagnosis of simple varicose veins of the lower extremities must be ruled out by following the following diseases:

1 primary deep venous insufficiency of the lower extremity: various symptoms are relatively serious. When the lower extremity superficial vein pressure test, the pressure drop rate after standing activity is reduced, generally within 20% to 25%. The most reliable method of examination is venography of the lower extremities, which can observe special signs of deep venous insufficiency.

2 lower extremity deep vein thrombosis after the syndrome: in the early stage of deep venous blood colitis, superficial vein dilation is a compensatory performance, accompanied by significant swelling of the limbs. During the recanalization of deep vein thrombosis, due to the destruction of the valve, venous blood reflux and elevated venous pressure lead to superficial varices, accompanied by swelling of the limb after the activity. If there is still difficulty in differential diagnosis, venography of the lower extremity should be performed.

3 arteriovenous fistula: the temperature of the skin of the affected limb of the arteriovenous fistula is elevated, local sputum and tremor or vascular murmur may be localized, the superficial venous pressure is significantly increased, and the oxygen content of the venous blood is increased. In congenital arteriovenous fistula, the affected limb is often longer and thicker than the healthy limb.

Differential diagnosis

Differential diagnosis of skin nutrient changes in lower limbs:

1. Deep vein thrombosis syndrome: patients have more than surgery, trauma or long-term bed rest after pregnancy, a history of thrombosis. In the early stage, thrombotic obstructive lesions were the main cause, and in the later stage, the thrombus was recanalized, and the venous valve was destroyed, which was manifested as reflux disease. The patient presented with a wide range of uniform swelling of the lower extremities, accompanied by tenderness in the gastrocnemius and the trigone. In severe cases, the arterial system was involved, and the dorsal artery and posterior tibial artery were weakened, and the femoral bruises disappeared. Sometimes it is difficult to identify with PDVI in the later stage of the disease, and venography can help to determine the diagnosis.

2. Simple lower extremity superficial varicose veins: The clinical symptoms are mild, which is characterized by the heavy feeling of lower limbs and fatigue, and the superficial venous system is distorted and expanded. Later in the lesion, when the traffic valvular membrane is damaged, there may be nutritional changes in the foot boot area, such as skin desquamation, pigmentation, eczema and ulcer formation. There is generally no severe swelling and severe bulging pain. The venous angiography shows that the deep venous system is completely normal.

3. Klippel-Trénaunay syndrome: It is a congenital venous malformation, which is rare in clinical practice. Patients have typical triad disorders: thickening of the limbs, superficial varices, and vasospasm of the skin. It is generally difficult to identify.

4. Limb lymphedema: It is caused by lymphatic vessel damage or other causes of lymphatic vessel and lymph node defects, resulting in lymphatic retention. At the beginning of the lesion, it is located in the depression below the knee joint. Afterwards, the skin becomes rougher and thicker, and becomes harder and clumpy. It is easy to be associated with erysipelas infection. Lymphangiography is helpful for differential diagnosis.

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