A site for medical students - Practical,Theory,Osce Notes


How to examine the dilated vein ?

Examination of dilated vein 
How to know the presence of dilated and tortuous abdominal/chest wall veins ?
Method :
The patient is asked to sit with legs hanging from the bed (never examine in lying down position).
Then he / she is asked to cough or to perform the Valsalva manoeuvre. Cough makes the veins
prominent transiently while the Valsalva retains the prominence of veins so long the manoeuvre
is continued.
Proper light is necessary (patient facing the window) for demonstration.
What are the conditions associated with dilated chest wall veins ?
  • SVC obstruction is the commonest cause
  • Intrathoracic obstruction from any aetiology
  • IVC obstruction it is not uncommon
  • Severe congestive cardiac failure.
What is the difference between visible vein versus engorged vein?
Sometimes veins are visible normally in thin built persons (often in fair skinned Individuals) and is
usually present at the skin level. ie. flushed with the skin. But the engorged vein is a bit raised from the skin surface. Palpate the vein lightly by index finger and draw your Inference. Visibility of a vein does not indicate engorgement  moreover. TORTUOSITY indicate'its pathological
2.Detection of direction of blood flow 
How will you demonstrate the direction of venous flow ?
Method :
  • The veins are made prominent by the above mentioned method.
  • A tributory-free. long segment of vein (one inch or more) is selected for examination.
  • Stand on the right hand side of the patient and place the index finger of both hands side by side over the vein—the left above the right one. Now start milking the vein by movement of two index fingers in opposite direction.
  • The two ends of the bloodless vein is blocked with the pressure given by two index fingers. The left index finger is now removed and the rapidity of venous filling from above is noted. The same procedure is repeated after removal of the right index finger
  • You should notice the rapidity of venous filling from below is observed now. The rapidity of venous filling indicates the direction of blood flow.
Direction of venous blood flow
Normal direction of flow of blood in the veins over the abdomen is -
Above the umbilicus - Upwards
Below the umbilicus - Downwards
Thin veins over the subcostal margin are normal.
Venous flow in different conditions :
Normally — Away from the umbilicus (but one cannot see any venous prominence in health.
Portal hypertension — Away from the umbilicus.
IVC obstruction 
  • Above the umbilicus - Upwards and away from the umbilicus.
  • Below the umbilicus - Towards the umbilicus.
SVC obstruction — From above downwards
IVC obstruction features
Portal hypertension clinical features
SCV obstruction clinical features
  • Dilated veins seen over the abdomen and chest. 
  • Direction of flow is from above downwards.
  • Look for the direction of bloodflow above the umbilicus