Arterial + Venous ulcers and Gangrene Flashcards
Where are arterial ulcers found?
Distal: dorsum of foot and between toes
What is the appearance of arterial ulcers?
- Punched out: deeper than venous ulcer
- Well defined edges
- Pale base (grey granulation tissue)
What are signs of arterial ulcers?
- Around ulcer: Hair loss, shiny pale skin
- Calf muscle wasting
- Absent pulses
- Night pain
What is the gold standard Ix for arterial ulcers?
Duplex USS of lower limb
What other Ix are done for arterial ulcers?
- ABPI
- Percutaneous angiography
- ECG
What bloods are done for arterial ulcers?
- Fasting serum lipid
- HbA1c
- Blood glucose
- FBC
What is gangrene?
tissue necotsis, etiher wet with superimposed infection, dry of gas gangrene
What is gangrene caused by?
tissue ischaemia and infarction or physical trauma
What is gas gangrene caused by?
clostridium perfringens
What are RF for gangrene?
- Diabetes
- PVD
- Neuropathy
- Immunosuppression
- Steroid use
- Ulcers can site of gangrene
What are symptoms and signs of gangrene?
- Painful black tissue
2. Often affects extremities and areas of high pressure
What symptoms are specific to wet gangrene?
- boggy
- lots of pus
- bad smell (anaerobes)
What symptoms are specific to gas gangrene?
spreading of infection and destruction of tissues causing overlying oedema and discolouration and crepitis (gas bubbles)
What is a neuropathic ulcer associated with?
DM
What is the appearance of a venous ulcer?
- Large and shallow (sloping, less well-defined sides)
2. Other symptoms of venous insufficiency: swelling itching, aching
Where are venous ulcer’s found?
more proximal than AU (gaiter region ankle and knee)
What are signs of venous insuffieicnecy?
- Stasis eczema
- Lipodermatoscelerosis (champagne bottle) – pain redness
- Atrophie blanche – white and shiny skin and red area around outside
- Hemosiderin deposition
What is the gold standard Ix for venous ulcer?
- Duplex USS of lower limbs: Gold standard – can visualsie where blockage
What other Ix are done for venous ulcer?
- Measure SA of ulcer (monitor progression)
- ABPP
- Swab for microbiology: signs of infection
- Biopsy
When would you do biopsy in venous ulcer?
if possibility of Marjolin’s ulcer (a cancer, squamous cell carcinoma)
What is the management plan for venous ulcers?
- Graded compression stockings
- Debridement and cleaning
- Antibiotics (if infected)
- Moisturising cream
