5 - Derm - Leg ulceration - Venous ulceration Flashcards
what is an ulcer
loss of epidermis and all/part of dermis
4 causes of ulcers
chronic venous insufficiency 70%
mixed venous/arterial 22%
chronic arterial insufficiency 6%
diabetes 15-25%
venous ulcers - caused by? Sx? features?
sustained venous htn
painless unless infected
large and superifical
venous ulcers - where?
often gaiter area (lower half of lower leg) and circumferential - commonly over medial malleolus (course of long saphenous)
Venous ulcers RFs - 9
varicose vv DVT long periods of sitting/standing htn multipartum prev surgery fractures/injury obese age
describe aetiology of venous ullceration
blood from superficial to deep vv - by calf pump, backflow prevented by valves
impaired by…
-calf pump dysfunction (NM disease)
-valve failure (DVT, thrombophlebitis)
ven htn (>2mmHg) -> impaired bl flow, build up of toxic metabolites, and local ischaemia
venous ulcers - associated features - name 4/7
granulation tissue (moist red)
lower leg oedema
brown pigment
varicose vv
venous ulcers - ass features - name 3/7
venous eczema
lipodermatosclerosis - hardening, inflam, hyperpigmentation
atrophie blanche (white with telangiectasia)
venous ulcers - 3 complications
superficial infection
cellulitis
lymphoedema
venous ulcers mgmt - investigation? what does this tell us?
ABPI - ensure no arterial disease - compression contrindicated if <0.8 as can trigger ischaemia
venous ulcers first mgmt steps - consequence?
graded compression bandaging - pressure decreases up the leg
+leg elevation
+ulcer dressing - absorb exudate
contact dermatitis is common
4 other mgmt steps to consider
ABs if infected
emollients and topical steroids for venous eczema
superficial venous surgery for underlying venous disease
skin grafting in severe ulceration
