Condition- Venous Leg Ulcers Flashcards
1
Q
What causes venous leg ulcers?
A
- Incompetent valves
- leads to venous stasis + raised venous pressures
2
Q
Where are venous ulcers often found?
A
- Superior to the medial malleolus
= “Gaiter area”
3
Q
List some risk factors for developing venous ulcers
A
- Chronic Venous Insufficiency
- DVT
- Obesity
- Immobility
- Varicose Veins
- Previous trauma/ surgery to leg
4
Q
Describe some of the features of venous leg ulcers
A
- Superior to medial malleolus
- Irregular margin
- Large
- Shallow
- Painless
- Brownish colour= due to haemosiderin deposits
- Lipodermatosclerosis= inverted champagne bottle
- Atrophic blanche
- Exudate
5
Q
List some investigations you could carry out on a patient with Venous Ulcers
A
- ABPI: exclude arterial ulcer
- If ABPI< 0.8 management is different
- Swab: to exclude infective causes
- Imaging:
- Duplex US: looks at anatomy + retrograde flow
- Doppler US: looks for reflux
6
Q
Why might you need to biopsy a venous ulcer?
A
To exclude Marjolin’s ulcer which is a SCC which forms in the middle of the ulcer
7
Q
How would you manage a patient with venous leg ulcers?
A
- Graduated Compression stockings
- must exclude diabetes, neuropathy and PVD (ABPI >0.8)
- Debridement (removal of infected tissue) and cleaning
- Abx if infected
- Steroids for surrounding dermatits
8
Q
Describe the difference in location between arterial, venous and neuropathic ulcers
A
- Arterial: distal, on dorsum of foot or over bony prominence
- Venous: superior to medial malleolus + lower calf = “gaiter’s area”- (where you’d wear gaiters)
- Neuropathic: pressure points/ under calluses
9
Q
What causes lipodermatosclerosis in people with venous ulcer? What does this look like?
A
Inverted champagne bottle shape
- Venous stasis => leukocyte recruitment and migration => cytokine release and inflammation => collagen deposition in subcutaneous fat => lipodermatosclerosis
