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Year 3 - CR > Limb Ulceration > Flashcards

Flashcards in Limb Ulceration Deck (31)
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1

What are the causes of leg ulceration

- venous hypertension
- arterial disease
- neuropathic
- neoplastic
- vasculitis
- infection
- haematological
- drugs
- other

2

What are the different types of leg ulcers

- Venous ulcers
- arterial ulcers
- neuropathic ulcers
- pressure ulcers
- diabetic ulcers
- ischeaemic ulcers

3

What causes venous ulcers

- venous ulcers are the result of sustained venous hypertension in the superficial veins due to incompetent valves in the deep perforating veins or to previous deep vein thrombosis

4

What are venous ulcers associated with

- oedema of the lower legs
- venous eczema
- brown pigmentation from haemosiderin
- varicose veins

5

What is the management of venous ulcers

- high compression bandaging and leg elevation to reduce venous hypertension
- doppler studies should be done before compression to exclude significant arterial disease
- diuretics can reduce the oedema
- antibiotics only necessary for overt bacterial infection
- opiate pain medication if required
- ulcer dressings

6

Where are arterial ulcers

- present as punched out, painful ulcers higher up on the leg or on the feet

7

What is the clinical presentation of arterial ulcers

- clinically the leg is cold and pale
- absent peripheral pulse
- arterial bruits
- loss of hair

8

What is the management of arterial ulcers

- keep the ulcer clean and covered
- adequate analgesia and vascular reconstruction if appropriate

9

What causes neuropathic ulcers

- tend to be over pressure areas of the feet such as the metatarsal heads owing to repeated trauma
- most commonly found in diabetics due to peripheral neuropathy

10

what causes arterial ulcers (ischaemic ulcers)

Arterial leg ulcers occur as a result of reduced arterial blood flow and subsequent tissue perfusion.

Three mechanisms involved in the pathophysiology :
- (a) extramural strangulation,
- (b) mural thickening or accretion
- (c) intramural restriction of blood flow

11

What causes diabetic ulcers

Diabetic ulcers are most commonly caused by: poor circulation. high blood sugar (hyperglycemia) nerve damage

12

What is the management of pressure ulcers

- bed rest with pillows and fleeces to keep pressure of bony areas and to prevent friction
- air filled cushions for patients in wheelchairs
- special pressure relieving mattresses and beds
- regular turning but avoidance of pressure on hips
- adequate nutrition
- treatment of underlying cause

13

How can you prevent ulcers

- identify at risk patients
- use of the Norton scale to identify those who are most at risk

Primary prevention
- loose weight
- compression stockings
- treat underlying cause such as varicose veins

14

if the skin ulcer is superior to the medial malleolus what type of ulcer is it likely to be

- venous ulcer

15

If the skin ulcer is around the sacrum, greater trochanter, or heel what type of ulcer is it likely to be

- pressure sore (decubitus ulcer)

16

What does an ischaemic ulcer feel like

- ulcer and surrounding tissue are cold

17

When does an ulcer become a chronic ulcer

4 weeks old

18

What does the shape of the ulcer tell you about what has caused it

- Oval, circular → cigarette burn
- Serpiginous → Klebsiella granulomatis
- Unusual shape → mycobacterial infection (eg cutaneous TB or Scrofuloderma)

19

what does the edge of the ulcer tell you about it

- Shelved/sloping = healing
- punched out = syphilis or ischaemic
- Rolled/everted = malignant

20

What does the discharge tell you about the ulcer

- watery discharge = TB
- bleeding = malignancy

21

What does associated lymphadenopathy suggest

- suggests infection or malignancy

22

What does decreased sensation around the ulcer suggest

- implies neuropathy

23

What do arterial ulcers look like and what are they common in

- punched out appearance
- full thickness defect
- common in DM
- can occur anywhere in the extremities

24

What do venous ulcers look like and where are them

- accompanied by varicose veins
- distal leg and ankle
- painful and heavily exudative
- often recurrent
- exhibit varying depths even within 1 ulcer
- can become huge

25

where and why do pressure ulcers occur

- usually occur on bony prominences
- occur because pressure obstructs superficial blood flow

26

What is Marjolin's ulcer

- Squamous cell carcinoma
- occurring at sites of chronic inflammation e.g. burns, osteomyelitis after 10-20 years
- mainly occur on the lower limb

27

where do neuropathic ulcers occur and why do they occur

- they commonly occur over plantar surface of metatarsal head and plantar surface of hallux
- plantar neuropathic ulcer is the condition that most commonly leads to amputation in diabetic patients
- due to pressure
- management includes cushioned shoes to reduce callous formation

28

What is pyoderma gangrenous associated with

- associated with inflammatory bowel disease

29

What does pyoderma gangrenosum look like and where does it occur

- can occur at stoma sites
- erythematous nodules or pustules which ulcerate

30

What investigations do you carry out of Ulcers

- note appearance
- ABPI - arterial or venous insufficiency
- biopsy - to assess for vasculitis and malignant changes