Arterial Ulcers

Question 1

def

Answer 1

an ulcer is an open sore on an external or internal surface of the body caused by a break in the skin or mucous membrane which fails to heal
an arterial or ischaemic ulcer

Question 2

aetiology

Answer 2

1 poor perfusion causes an area to be deprived of oxygen
2 these tissues undergo necrosis
3 the area forms an open wound

Question 3

risk factors

Answer 3

1 PAD + CAD
2 diabetes
3 atherosclerosis
4 HTN
5 renal failure

Question 4

epi

Answer 4

common in people with PAD

common in diabetics

Question 5

why are diabetics at increased risk of arterial ulcers

Answer 5

1 decreased blood flow due to thinning of arteries

2 lack of sensation due to diabetic neuropathy means small cuts go unnoticed and become infected

Question 6

history + examination

Answer 6

1 lateral surface of ankle + dorsum of foot
2 acute - irregular edges
3 ulcer base is grey
4 pain worse when supine, pain better when standing or hanging leg off bed
5 features of chronic ischaemia
-hairlessness
-absent pulses

Question 7

investigations

Answer 7

1 history
2 vascular exam
3 bloods
-glucose
-FBC
4 swabs for infection
5 hand held doppler for checking pulses accurately (ABPI)

Question 8

what is ABPI

Answer 8

ankle-brachial pressure index
between 0.5-0.7 suggests arterial disease
less than 0.5 suggests arterial ulcers