Chronic Leg Ulcer Flashcards
What is the definition of an ulcer?
A break in the continuity of an epithelium.
What is a leg ulcer?
A break/discontinuity of the squamous epithelium of the skin around the ankle or feet.
What is the typical duration of a chronic leg ulcer?
Usually lasts > 6 weeks with no tendency to heal in 3 months.
What is the prevalence of chronic leg ulcers?
3 per 1000 & increases with age.
Which age group is most affected by chronic leg ulcers?
Those over the age of 60 years.
What percentage of chronic leg ulcers are vascular in etiology?
76% (most common cause).
What are the two main types of vascular leg ulcers?
Arterial (atherosclerosis, Raynaudโs disease, vasculitis - 22%) and Venous (venous insufficiency, varicose veins - 75% common).
What is the most common type of vascular leg ulcer?
Venous ulcers (75% of vascular ulcers).
Name four causes of traumatic leg ulcers.
Thermal burns, radiation, bites, and severe trauma with tissue disruption.
List three neoplastic causes of chronic leg ulcers.
Squamous cell carcinoma, melanoma, and Kaposi sarcoma.
What percentage of chronic leg ulcers are neuropathic in origin?
0.05
What are two common causes of neuropathic leg ulcers?
Alcoholism and diabetes (peripheral neuropathy).
Which infectious causes can lead to chronic leg ulcers?
Osteomyelitis, tuberculosis, syphilis, and fungal disease.
Name four systemic/metabolic conditions associated with chronic leg ulcers.
Diabetes mellitus, sickle cell disease, ulcerative colitis, and rheumatoid arthritis.
What are the typical clinical features of a chronic leg ulcer?
Pain, swollen leg, burning sensation or itching, and discharge/bleeding.
What are the important aspects to assess during examination of a leg ulcer?
Site, size, shape, edge/floor, tenderness, discharge, relationship to underlying structures, and conditions of adjacent tissues.
What are the possible edge characteristics of an ulcer?
Sloping, rolled, punched out, undermined, and everted.
Where are venous ulcers typically located?
Usually found at the lower part of the leg just above the ankle.
What is the characteristic appearance of a venous ulcer?
Red in color, may be covered with yellow fibrous tissue. It may have yellow or green discharge if infected.
What are the border characteristics of a venous ulcer?
Usually irregular, often discolored & swollen.
What is the typical edge appearance of a venous ulcer?
Usually sloping.
What is Homansโ sign and what does it indicate?
Pain in the calf or popliteal region when the foot is dorsiflexed & the knee is extended; indicates possible deep vein thrombosis.
What diagnostic tests are used for venous ulcers?
Trendelenburgโs test, Doppler USS, and venography.
Where are ischemic/arterial ulcers typically located?
On feet, often heels, top of toes or between toes.
What is the typical appearance of an ischemic/arterial ulcer?
Has yellowish, brown, grey or black color.
What is the characteristic edge of an ischemic/arterial ulcer?
Punched out.
What diagnostic tests are used for ischemic/arterial ulcers?
Slow capillary refill time, weak or absent peripheral pulsation, Doppler USS, and angiography.
What are the causes of neuropathic ulcers?
Spinal cord lesions, peripheral nerve lesions (CMT, leprosy, nerve injury).
What is distinctive about the pain associated with neuropathic ulcers?
They are typically painless, while surrounding tissue may have pain.
What is a unique characteristic of pressure ulcers mentioned in the notes?
They are usually found around bony prominences.
