1. Ulcers, Sinuses and Fistulas Flashcards
Define an ulcer.
An ulcer is a tissue defect characterised by loss of continuity of epithelium on the skin/mucous membrane due to molecular death of the tissue.
Classify Ulcers.
- Non-specific Ulcers
- Specific Ulcers
- Malignant Ulcers
State 5 types of Non-specific Ulcers.
- Traumatic Ulcers
- Arterial Ulcers
- Venous Ulcers
- Trophic (neurological) Ulcers
- Others
State 3 types of Specific Ulcers.
- Tuberculous Ulcers
- Syphilitic Ulcers
- Actinomycotic Ulcer
State 4 types of ulcers with a malignant aetiology.
- Basal Cell Carcinoma
- Squamous Cell Carcinoma
- Malignant Melanoma
- Others
State the 6 parts of an Ulcer.
- Margin
- Edge
- Floor
- Base
- Discharge
- Surrounding skin
Define the ‘Margin’ of an ulcer.
Margin is the border/transitional zone of skin around an Ulcer.
Define the ‘Edge’ of an ulcer.
Edge is the mode of union between the Margin and Floor of the Ulcer.
Define the ‘Floor’ of an ulcer.
Floor is the exposed surface of the Ulcer
State the 5 types of edges seen in an Ulcer.
SPURE
- Sloping edge \___/
- Punched out edge |___|
- Undermined edge /___\
- Raised, Rolling/Beaded edge o___o
- Raised, Everted edge _>___
When an Ulcer with a Raised, Everted edge is seen, it is most likely a ……… ?
Squamous Cell Carcinoma
When an Ulcer with a Raised, Rolling edge is seen, it is most likely a ……… ?
Basal Cell Carcinoma
When an Ulcer with a Undermined edge is seen, it is most likely a ……… ?
Decubitus Ulcer/Tuberculous Ulcer
When an Ulcer with a Punched out edge is seen, it is most likely a ……… ?
Neuropathic Ulcer
When an Ulcer with a Sloping edge is seen, it is most likely a ……… ?
Venous Ulcer
State the 3 types of discharge seen in an Ulcer.
- Serous
- Haemorrhagic (Sanguineous)
- Purulent
2 patients came to the OPD with ulcers. Both ulcers had discharge oozing out. One was Golden Yellow in colour, whereas the other was Greenish in colour. State the type of discharge seen along with it’s aetiology.
Purulent Discharge because the ulcer is infected
- Golden Yellow = Staph. aureus
- Greenish = Pseudomonas
State the 3 phases of an Ulcer.
- Spreading Phase
- Transition Phase
- Healing Phase
How does an Ulcer heal?
By restoration of the loss tissue and missing epithelium
Where do the tissue and epithelium required come from?
The missing tissue is replaced by fibrous tissue, which is made of collagen. The epithelium regenerates from the edge of the Ulcer and remaining skin appendages.
State 5 local factors that cause an ulcer to not heal.
- Infections
- Foreign bodies
- Ischaemia
- Lack of rest
- Specific diseases ex; TB, Cancer
State 7 systemic factors that cause an ulcer to not heal.
I A McDAD
- Immunocompromised state
- Anaemia
- Malnutrition (Proteins, Vit. C, Zinc)
- Co-existing diseases (Cancer, Liver/Kidney Diseases)
- Drugs (Steroids)
- Age (Old Age)
- Diabetes Mellitus
What are the 4 investigations you’d like to carry out on a patient with an Ulcer?
- Total WBC Counts (Leukocytosis)
- Differential Count (Neutrophilia)
- Bacterial Culture and Antibiotic Sensitivity Test on Pus
- Blood Sugar Levels (D.M.)
What treatment plan would you suggest for a patient with an Ulcer?
- Hospitalize the patient
- Provide bed rest
- If patient has D.M., control it w. Insulin
- Administered appropriate antibiotics
- Make sure the dressings are changed daily
- Remove the dead, necrotic tissue (slough)
- Start surgical debridement
- Apply Local antiseptics (Povidone Iodine/Silver Sulphadiazine)
- If the Ulcer is large, book an OR for ‘Split Skin Grafting’ surgery
