29. Leg Ulcer Flashcards
What are 5 differentials for leg ulcers?
Venous ulcer (~70%) Mixed arterial/ venous ulcer Arterial ulcer Pressure ulcer Neuropathic ulcer
What would you want to know about the history of a leg ulcer?
Is the ulcer painful?
How long has it been there?
What are associated symptoms for venous ulcers due to chronic venous insufficiency?
Varicose veins
Eczema
Discolouration of surrounding skin
Ankle oedema
What are 7 associated symptoms of arterial ulcers?
Claudication Night pain Rest pain Cold extremities Angina SOB Stroke/ TIA Hx
What are associated symptoms of neuropathic ulcers?
Sensory loss
Unsteady gait
Secondary infection (if anaerobes= foul smell)
What are 7 venous ulcers risk factors?
Varicose veins Immobility (reduced drainage) Malnourishment (reduced healing) Recurrent DVTs Pelvic mass compressing iliac veins Arteriovenous malformations (increased venous pressure) Joint replacements
What are risk factors of arterial ulcers?
Atherosclerosis RFs: smoking diabetes HTN FH atherosclerotic disease CAD CVD PAD
What are risk factors of neuropathic ulcers?
Diabetes mellitus
Alcohol misuse
How quickly can pressure ulcers develop? What are risk factors of pressure ulcers?
Within hours of constant pressure on one area:
Bedridden patients
Immobility
Splints/ plaster casts
Where are the different types of leg ulcers usually found?
Venous: gaiter of legs, just above medial malleolus
Arterial: between toes, where arterial blood supply is worst + frequently compressed ball of foot, lateral malleolus
Neuropathic: beneath metatarsals
Pressure: bony prominences- heel, malleoli
What are characteristics of the different types of ulcers?
Venous: shallow, wet + with irregular borders that look white + fragile
Arterial: deep, punched out + dry, elliptical
Neuropathic + pressure: thick, keratinized, raised edges
Pyoderma gangrenosum: dark blue/ purple halo
What are associated signs of the different types of ulcers?
Venous: oedema, extravasation, scarring, ankle flare
Arterial: cold pale limbs, poor capillary refill, venous guttering, absent or weak pulses, atrophic skin changes
Neuropathic: vibration + proprioception loss, glove + stocking peripheral sensory neuropathy, foot deformities
What are investigations for a venous ulcer?
Bloods: FBC, lipids, raised inflammatory markers Capillary glucose Urinanalysis- if vasculitis suspected Venous duplex ultrasound Ankle-brachial pressure index (ABPI) Swabbing Biopsy
How do you manage venous ulcers?
Adequate nutrition Encourage mobilisation Leg elevation Compression bandages Stockings to prevent recurrence Varicose vein surgery
How does pain vary in the most common ulcers?
Venous: less painful when elevated
Arterial: more painful when elevated
Neuropathic: caused by loss of sensation + therefore not painful
Pressure: caused by prolonged pressure on the affected site, tend to be very tender
