LOCAL EXAMINATION OF A CELLULITIC LEG/VARICOSE LEG TO WRITE IN OPD FILE SIMPLE
Reading File
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Reading File
Finding Sources
Reading File
Finding Sources
I now have solid textbook content. Let me compile the complete OPD examination proforma.
LOCAL EXAMINATION - CELLULITIC / VARICOSE LEG
(OPD File Format)
PART A: INSPECTION
1. Skin Color / Surface Changes
- Erythema - present / absent
- Extent: well-demarcated / poorly-demarcated, spreading border - yes / no
- Hyperpigmentation (hemosiderin deposition) - present / absent - location: ___
- Site: gaiter distribution / medial malleolus / diffuse
- Lipodermatosclerosis - present / absent (brawny, fibrotic, thickened skin)
- Atrophie blanche (pale area around medial malleolus) - present / absent
- Corona phlebectatica (tiny telangiectasias at medial malleolus / dorsum of foot) - present / absent
- Stasis dermatitis / eczematous changes - present / absent
2. Swelling / Edema
- Present / absent
- Brawny edema - yes / no
- "Champagne bottle leg" deformity - present / absent
- Distribution: ankle / calf / entire leg
3. Varicosities
- Telangiectasias (spider veins, <1 mm) - present / absent
- Reticular veins (1-3 mm, subdermal) - present / absent
- Varicose veins (>3 mm, subcutaneous, tortuous, dilated) - present / absent
- Distribution: medial thigh (GSV territory) / posterior-lateral calf (SSV territory) / other: ___
- Visible GSV trunk along medial thigh / calf - present / absent
- Visible SSV trunk along posterior calf - present / absent
4. Ulcer (if present)
- Present / absent
- Site: medial malleolus (venous) / elsewhere: ___
- Shape: ___
- Size: ___ cm x ___ cm
- Base: sloughy / granulating / necrotic
- Edge: sloping / punched out / undermined
- Floor: ___
- Discharge: present / absent - type: serous / seropurulent / purulent
5. Skin Integrity / Breaks
- Intact / breach / crusting / weeping
- Portal of entry for cellulitis - present / absent (describe site: ___)
PART B: PALPATION
6. Temperature
- Warmth over affected area - present / absent
- Localized / diffuse
- Increased compared to opposite limb - yes / no
7. Tenderness
- Tenderness on palpation - present / absent
- Severity: mild / moderate / severe
- Area of maximum tenderness: ___
8. Edema
- Pitting / non-pitting (brawny = non-pitting in lipodermatosclerosis)
- Grade: 1+ / 2+ / 3+ / 4+
- Extent: below ankle / up to mid-calf / up to knee
9. Varicose Veins on Palpation
- Palpable, tortuous, compressible veins along GSV / SSV distribution - present / absent
- Fascial defect / blow-out at perforator site - present / absent
- Thrill on cough / Saphena varix at groin - present / absent
10. Venous Tests (bedside)
- Tourniquet (modified Trendelenburg) test: saphenofemoral incompetence - positive / negative
- Perthe's test (for deep vein patency): positive / negative
- Cough impulse at SFJ (Saphena varix) - present / absent
- Doppler (handheld CW) over SFJ / SPJ with distal augmentation: reflux - present / absent
11. Pulses (Arterial - mandatory before any compression)
- Femoral pulse - palpable / not palpable
- Popliteal pulse - palpable / not palpable
- Dorsalis pedis - palpable / not palpable
- Posterior tibial - palpable / not palpable
- ABPI (if ulcer present): ___
12. Lymph Nodes
- Inguinal lymphadenopathy - present / absent
- Tender (reactive) / non-tender
13. Skin / Subcutaneous Tissue
- Fibrosis / induration in lower calf - present / absent
- Ankle mobility (Achilles tendon fibrosis in advanced lipodermatosclerosis) - normal / restricted
PART C: SUMMARY BOX (tick as applicable)
| Feature | Present | Absent |
|---|---|---|
| Erythema | ||
| Warmth | ||
| Swelling / edema | ||
| Tenderness | ||
| Hyperpigmentation | ||
| Lipodermatosclerosis | ||
| Varicose veins | ||
| Ulcer | ||
| Lymphadenopathy | ||
| Arterial pulses intact |
PART D: CEAP CLINICAL CLASSIFICATION (for varicose leg)
| Class | Finding | Tick |
|---|---|---|
| C0 | No visible / palpable signs | |
| C1 | Telangiectasias / reticular veins | |
| C2 | Varicose veins (>3 mm) | |
| C3 | Edema | |
| C4a | Pigmentation / eczema | |
| C4b | Lipodermatosclerosis / atrophie blanche | |
| C5 | Healed ulcer | |
| C6 | Active ulcer |
Symptom status: S (symptomatic) / A (asymptomatic)
QUICK REFERENCE - DISTINGUISHING CELLULITIS vs. VENOUS INSUFFICIENCY CHANGES
| Feature | Cellulitis | Venous Insufficiency |
|---|---|---|
| Erythema | Acute, spreading, poorly demarcated | Chronic, brownish, fixed (hemosiderin) |
| Warmth | Marked | Mild |
| Tenderness | Marked | Mild to moderate |
| Onset | Acute | Chronic / gradual |
| Fever / systemic | Common | Absent |
| Portal of entry | Often identifiable | Usually absent |
| Skin texture | Taut, shiny acutely | Fibrotic, brawny chronically |
| Ulcer | Absent (usually) | Medial malleolar (venous stasis) |
Sources: Sabiston Textbook of Surgery, 21e (Physical Examination - Varicose Veins, pp. 2403-2404); Tintinalli's Emergency Medicine (Cellulitis); Dermatology 2-Volume Set 5e (Cellulitis)
SIMPLE TO WRITE IN OPD FILE
LOCAL EXAMINATION — CELLULITIC / VARICOSE LEG
(Simple OPD Format)
INSPECTION
- Limb: Right / Left leg
- Swelling: Present / Absent — Pitting / Non-pitting
- Skin color: Erythema / Hyperpigmentation / Normal
- Erythema: Well-demarcated / Poorly-demarcated — Spreading / Localised
- Varicose veins: Present / Absent — Medial / Lateral / Posterior
- Skin changes: Lipodermatosclerosis / Eczema / Stasis dermatitis / Nil
- Ulcer: Present / Absent
- If present → Site: ___ Size: ___ cm Base: ___ Edge: ___
- Portal of entry (cellulitis): Present / Absent — Site: ___
PALPATION
- Warmth: Present / Absent
- Tenderness: Present / Absent — Mild / Moderate / Severe
- Edema: Pitting / Non-pitting — Grade: 1+ / 2+ / 3+
- Varicose veins: Palpable / Not palpable — Compressible / Firm
- Skin / subcutaneous tissue: Soft / Indurated / Fibrotic
- Inguinal lymph nodes: Enlarged / Not enlarged — Tender / Non-tender
PULSES (mandatory)
| Pulse | Right | Left |
|---|---|---|
| Femoral | + / - | + / - |
| Popliteal | + / - | + / - |
| Dorsalis pedis | + / - | + / - |
| Posterior tibial | + / - | + / - |
BEDSIDE TESTS
- Tourniquet test (Trendelenburg): Positive / Negative (SFJ incompetence)
- Cough impulse at groin (Saphena varix): Present / Absent
- Perthes test: Positive / Negative (deep vein patency)
- Handheld Doppler (SFJ/SPJ): Reflux Present / Absent
CEAP CLASS (tick one)
C0 / C1 / C2 / C3 / C4a / C4b / C5 / C6 — S / A
IMPRESSION
- Cellulitis — Acute / Resolving
- Varicose veins with CVI
- Varicose veins + superadded cellulitis
- Venous ulcer
This is a shared conversation. Sign in to Orris to start your own chat.