Case Study Summary
Mrs. Rodriguez, 45, reports 2 months of intermittent mild bilateral ankle/foot swelling, worse on the right, with a heavy leg sensation and enlarged veins; she experiences occasional foot numbness and left knee ache. She works long shifts as a server. PMH includes obesity (BMI 31) and type 2 diabetes (on metformin). Exam shows normal vitals, bilateral tortuous lower extremity veins (R>L), and decreased foot sensation; otherwise unremarkable.
Probable Diagnosis and Supporting Data
Chronic venous insufficiency (CVI) is the most likely diagnosis for Mrs. Rodriguez’s symptoms. The fact that her ankle swelling gets worse after prolonged standing suggests that there may be a problem with venous blood flow (Ortega et al., 2021). The enlarged veins on her legs could indicate venous dilation and congestion. Her work as a server, which necessitates standing for extended periods and can place more strain on her lower extremities, is a significant contributing factor to the onset of this ailment (Ortega et al., 2021). Finally, her elevated BMI of 31, which indicates that she is obese, makes her more vulnerable to venous insufficiency.
Pathogenesis of the Diagnosis
The pathogenesis of CVI involves venous valves that are insufficiently effective at preventing blood from flowing backward in the lower extremities. Due to venous valvular incompetence, which causes venous dilation, elevated venous pressure, and hindered venous return, chronic venous hypertension occurs (Molnar et al., 2021). Chronic venous stasis over time causes fluid to seep from capillaries into the surrounding tissues, resulting in edema, especially in the body’s dependent parts like the feet and ankles.
Data Inconsistent with the Diagnosis
Although the evidence indicates a diagnosis of CVI, several data points are inconsistent, potentially calling for the examination of alternate hypotheses. Specifically, acute deep vein thrombosis (DVT) is characterized by leg discomfort and erythema (Ortega et al., 2021). While this hypothesis does not fully align with the symptoms claimed by Mrs. Rodriguez, DVT cannot be wholly ruled out. In order to evaluate venous blood flow and spot any deep vein thrombosis, Doppler ultrasonography can be utilized for erythema (Ortega et al., 2021). The results of this test would assist in determining whether DVT—which may coexist with CVI—is present or not.
Recommended Diagnostic Tests and Treatment
Treatment for chronic venous insufficiency typically consists of a combination of conservative actions and medical procedures. Conservative methods include lifestyle changes like losing weight, exercising frequently, elevating the legs, and avoiding extended standing or sitting (Ortega et al., 2021). Graduated compression stockings during compression therapy can help improve venous return and reduce swelling (Molnar et al., 2021). Mrs. Rodriguez’s obesity and type 2 diabetes mellitus may need further care and management since they can speed up the development of CVI.
References
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