5 - Derm - Leg ulceration - Arterial ulceration

Question 1

causes - 7

Answer 1

atherosclerosis
dm
vasculitis
cholesterol emboli
vasoplastic disease (reynauds)
trauma
circulatory collapse

Question 2

appearance

Answer 2

punched out ulcers, little/no granulation tissue, base may be dry, black or necrotic tissue, pale leg

Question 3

Sx??

Answer 3

painful, cold leg, rest pain, atrophic and hairless skin

Question 4

location and signs?

Answer 4

feet/higher up leg, usually at pressure areas

absent peripheral pulses, arterial bruits, atrophic and hairless skin

Question 5

RF’s

Answer 5

smoking, htn, chd, claudication

Question 6

ABPI - stands for? measured using? be aware of?

Answer 6

ankle brachial pressure index
measured using doppler
beware of artificially high readings in severe calcification (DM)

Question 7

ABPI values and meanings

Answer 7

> 0.8 - sig disease unlikely
0.6-0.8 - impaired healing , reduce compression
0.4-0.6 - severe, no compression, refer to surgeon
<0.4 - limb threatening ischaemia

Question 8

mgmt of arterial ulcers - 4 principles

Answer 8

conservative - clean and covered, analgesia, lifestyle

percut transluminal angioplasty

surgical bypass

chemical lumber sympathectomy (inoperable cases - improves blood flow and reduces pain)