Arterial + Venous ulcers and Gangrene

Question 1

Where are arterial ulcers found?

Answer 1

Distal: dorsum of foot and between toes

Question 2

What is the appearance of arterial ulcers?

Answer 2

1. Punched out: deeper than venous ulcer
2. Well defined edges
3. Pale base (grey granulation tissue)

Question 3

What are signs of arterial ulcers?

Answer 3

1. Around ulcer: Hair loss, shiny pale skin
2. Calf muscle wasting
3. Absent pulses
4. Night pain

Question 4

What is the gold standard Ix for arterial ulcers?

Answer 4

Duplex USS of lower limb

Question 5

What other Ix are done for arterial ulcers?

Answer 5

1. ABPI
2. Percutaneous angiography
3. ECG

Question 6

What bloods are done for arterial ulcers?

Answer 6

1. Fasting serum lipid
2. HbA1c
3. Blood glucose
4. FBC

Question 7

What is gangrene?

Answer 7

tissue necotsis, etiher wet with superimposed infection, dry of gas gangrene

Question 8

What is gangrene caused by?

Answer 8

tissue ischaemia and infarction or physical trauma

Question 9

What is gas gangrene caused by?

Answer 9

clostridium perfringens

Question 10

What are RF for gangrene?

Answer 10

1. Diabetes
2. PVD
3. Neuropathy
4. Immunosuppression
5. Steroid use
6. Ulcers can site of gangrene

Question 11

What are symptoms and signs of gangrene?

Answer 11

1. Painful black tissue

2. Often affects extremities and areas of high pressure

Question 12

What symptoms are specific to wet gangrene?

Answer 12

1. boggy
2. lots of pus
3. bad smell (anaerobes)

Question 13

What symptoms are specific to gas gangrene?

Answer 13

spreading of infection and destruction of tissues causing overlying oedema and discolouration and crepitis (gas bubbles)

Question 14

What is a neuropathic ulcer associated with?

Answer 14

DM

Question 15

What is the appearance of a venous ulcer?

Answer 15

1. Large and shallow (sloping, less well-defined sides)

2. Other symptoms of venous insufficiency: swelling itching, aching

Question 16

Where are venous ulcer’s found?

Answer 16

more proximal than AU (gaiter region ankle and knee)

Question 17

What are signs of venous insuffieicnecy?

Answer 17

1. Stasis eczema
2. Lipodermatoscelerosis (champagne bottle) – pain redness
3. Atrophie blanche – white and shiny skin and red area around outside
4. Hemosiderin deposition

Question 18

What is the gold standard Ix for venous ulcer?

Answer 18

1. Duplex USS of lower limbs: Gold standard – can visualsie where blockage

Question 19

What other Ix are done for venous ulcer?

Answer 19

1. Measure SA of ulcer (monitor progression)
2. ABPP
3. Swab for microbiology: signs of infection
4. Biopsy

Question 20

When would you do biopsy in venous ulcer?

Answer 20

if possibility of Marjolin’s ulcer (a cancer, squamous cell carcinoma)

Question 21

What is the management plan for venous ulcers?

Answer 21

1. Graded compression stockings
2. Debridement and cleaning
3. Antibiotics (if infected)
4. Moisturising cream