Clinical Symposium 10: Chronic Leg Ulcer

Question 1

Define Ulcer

Answer 1

a local defect or excavation of the surface of an organ or tissue that is produced by sloughing of inflammatory necrotic tissue

Question 2

Define Erosion?

Answer 2

loss of an area of epidermis

Question 3

What is the most common leg ulcer?

Answer 3

Venous

Question 4

Other than venous and arterial leg ulcers, give 6 other causes of leg ulcers: (7)

Answer 4

1) peripheral neuropathy

2) inflammation

3) cancer

4) vasculitis

5) infection

6) diabetes

7) trauma

Question 5

Give 3 risk factors for venous leg ulcers:

Answer 5

1) vascular incompetence

2) previous damage to the venous system (e.g. DVT, hypertension)

3) obesity and immobility (poor muscle contraction causing venous pooling)

Question 6

How do venous complications often lead to ulceration?

Answer 6

high pressures in the veins of the legs makes healing difficult after a minor injury

Question 7

Where are venous leg ulcers most commonly located?

Answer 7

medial gaiter area (mid-shin)

Question 8

Which is generally more painful - arterial or venous leg ulcers?

Answer 8

Arterial

Question 9

Describe the appearance of venous leg ulcers:

Answer 9

superficial and sloughy with ill defined boarders

Question 10

Give 5 presentations associated with chronic venous hypertension:

Answer 10

1) varicose veins

2) lipodermatosclerosis

3) venous flare

4) atrophie blanche

5) varicose eczema

Question 11

What is venous flare?

Answer 11

an allergic response to an irritant cause thin, spindly veins on the ankle and calf

Question 12

What is atrophie blanche?

Answer 12

circular whitish skin due to delayed healing

Question 13

What is the primary underlying cause of arterial leg ulcers?

Answer 13

peripheral vascular disease (plaques limiting oxygenated blood in the lower limbs)

Question 14

Give 8 risk factors for leg ulcers:

Answer 14

1) obesity

2) renal failure

3) diabetes

4) smoking

5) high blood pressure

6) history of ischaemic heart disease

7) clotting and circulation disorders

8) rheumatoid arthritis

Question 15

Where are arterial ulcers usually found?

Answer 15

lower leg and foot

Question 16

Describe the surrounding skin of an arterial ulcer:

Answer 16

dry, cool, pale and hairless

Question 17

Describe how Buerger’s sign can check for peripheral vascular disease and poor circulation in the lower limbs:

Answer 17

pallor results if a leg is raised

Question 18

What is a neuropathic ulcer?

Answer 18

An ulceration as a result of peripheral neuropathy

Question 19

What is peripheral neuropathy?

Answer 19

Weakness, numbness, and pain from nerve damage

Question 20

Where are neuropathic ulcers commonly found?

Answer 20

on the sole of the foot

Question 21

Give two causes of peripheral neuropathy:

Answer 21

1) diabetes

2) alcohol B1/B12 deficiency

Question 22

What are ‘initial pustule ulcers’?

Answer 22

pustules that form ulcers

Question 23

Describe the appearance of initial pustule ulcers:

Answer 23

dark red base with overhanging purple/ bluish boarders

Question 24

True or false: initial pustule ulcers can spread rapidly

Answer 24

true

Question 25

Describe the appearance of malignancy ulcers:

Answer 25

they have rolled edges

Question 26

True or false: pyoderma gangrenosum ulcers have no association with gangrene or pus

Answer 26

true

Question 27

What are pyoderma gangrenosum ulcers?

Answer 27

inflammatory ulcers with no cause identified but are associated with inflammatory bowel disease and rheumatoid arthritis

Question 28

Give two drugs used to treat pyoderma gangrenosum ulcers:

Answer 28

1) prednisolone

2) ciclosporin

Question 29

What is would are healed by second intention?

Answer 29

wounds with tissue loss or wounds with margins not apposed

Question 30

Describe the steps of healing by second intention: (3)

Answer 30

1) granulation tissue is laid

2) organisation follows (layering of scar tissue)

3) epithelial regeneration

Question 31

What are the 3 steps used to manage and treat leg ulcers:

Answer 31

1) treat underlying cause

2) treat the ulcer

3) treat any associated infection

Question 32

Give an example of a drug used to treat venous leg ulcers:

Answer 32

pentoxifylline

Question 33

What type of drug is pentoxifylline?

Answer 33

methylxanthine

Question 34

How does pentoxifylline treat venous ulcers?

Answer 34

it increases microvascular blood flow to enhance oxygenation of ischaemic tissue and aid healing

Question 35

What item of clothing can be worn to increase arteriole blood pressure in the legs?

Answer 35

compression stockings