Cutaneous ulcers Flashcards

1
Q

How can ulcers be categorized?

A
  1. Specific/non specific
  2. Chronic or acute or acute on chronic
  3. Inflamatory or non inflammatory
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2
Q

What is an ulcer?

A

Ulcer is define as loss of continuity in the surface epithelium, underlying tissue can also be affected to varying degrees.

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3
Q

What are specific ulcers?

A

Specifc caused by a known organism these ulcers usually have well define characteristics
These are formed mainly by certain infective organism

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4
Q

What are non-specific ulcers?

A

Non specific ulcers are ulcers from various causes and present with similar features

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5
Q

What are chronic ulcers?

A

Chronic ulcers > 4-6 weeks

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6
Q

What are acute ulcers?

A

Acute ulcers are ulcers with duration of < 3-4 weeks

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7
Q

What are acute on chronic ulcers?

A

Acute on chronic ulcers continual injury on a background of chronicity

Repair and destriction occuring at the same time

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8
Q

What are some non-specific ulcers?

A
  1. Traumatic ulcers
  2. Infective ulcers
  3. Vascular ulcers
  4. Neurotrophic ulcers (e.g. diabetic foot ulcers)
  5. Ulcers of metabolic disorders
  6. Neoplastic ulcers (malignant)
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9
Q

What is an ulcer floor? What are you expected to see on an ulcer floor?

A

This that part of the ulcer visible to the eye, that is what you see

Types:
* Full of necrotic tissue,
* Slough (dissolving necrotic tissue usaully white in palely grey in colour
* Full of of pus
* Health granulation tissue –pink, moist, punctate bleeding
* Unhealthy granulation tissue pale and filled with purulent discharge
* Cobble stone appearrance or nodular- malignant transformation
* Bone or exposing artery , tendons, joint cavity submucosa etc.

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10
Q

Describe the edge of an ulcer?

A

it is the junction of the ulcer and the normal skin

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11
Q

What are types of ulcer edges?

A
  1. Sloping in non specific ulcers
  2. Raised and everted in neoplastic ulcers (malignant)
  3. Punched out syphilitic, neuropathic or pressure ulcers
  4. Undermined in tuberculous ulcers
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12
Q

What is an ulcer Base? What are types of ulcer Base?

A

What you feel on palpation, hold the edge or feeling the floor with sterile gloved hand

  • Indurated or hard: Malignant, calcifications
  • Firm
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13
Q

What are types of ulcer smell?

A
  • Malodourous fishy smell of diabetic foot gangrene
  • Smell of decaying flesh from necrotic tissue
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14
Q

Regional structures can experience

A
  • Swelling
  • Joint deformity
  • Contractures
  • Discharging sinus
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15
Q

What is ulcer discharge? What are types of ulcer discharge?

A

What fluid is emernating from the ulcer

Types:
* Serous - ulcers with surrounding edema
* Lymph – ulcers with lymphatic obstruction
* Bloodly discharge – grannulation or malignant
* Pus- infected ulcers
* Pigments- melanoma

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16
Q

What are traumatic ulcers?

A

These are non infective and non specifc ulcers arising from injuries such as avulsion, larceration, burns, irradiation

These are acute in nature and starts of as clean or contaminated depending on the cause

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17
Q

What can cause pyogenic ulcers?

A

Cellulitis, boil and carbuncle

18
Q

What are types of vascular ulcers?

A

Venous and arterial ulcer

19
Q

What is a venous ulcer? Who is most prediposed to a venous ulcer?

A

Disease of the venous drainage,
Incompetent valves leading to: venous stasis

  • venous hypertension
  • common in the lower limbs
  • Frequently there is an history of dvt
  • Ulcer is very painful
  • There is hyperpigmentation of the surrounding skin
  • Presence of varicose veins
20
Q

How do you treat venous ulcers?

A
  • Treatment is to improve venous drainage by limb elevation and bed rest
  • Elastic compression bandaging and/or compression stocking
  • Physiotherapy
  • Varicose vein ligation and venous stripping (Trendelenburg procedure)
21
Q

What are the Signs of arterial insufficiency are?

A
  • shiny often hairless skin , cyanotic and cold extremity, brittle nails and lossof nail pulp
  • The distal puslse may be absent or diminished
22
Q

What are arterial ulcers?

A
  • Caused by arterial occlusion and insufficiency: Starts as a dry gangrene patch which gradually spread proximally
  • Commonest on the distal extremity – toes and fingers
  • Common from 50 years above, in patient with diabetes, peripheral vascular disease,
  • There are very painfull, and floor is necrotic and dry
23
Q

Investigations for arterial ulcers

A

Arteriography, dupplex uss , ct angiogram

24
Q

What is the treatment for arterial ulcers?

A

Is bed rest, transluminal balloon angioplasty, arterial by pass surgery, endoarterctomy
Drugs - vasodilators

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Metabolic Ulcers
* Connective tissue disease(systemic lupus, poly arterisis nodusa) * Hemoglobinopathies * Ulcerative colitis * Treatment is addressed to cause of ulcer
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Neurotrophic Ulcers
* Ulcer arises from repeated trauma or prolong pressure on a part due to deminished or absent sensation to that part * Causes are leprosy, diabetic neuropathy, spinal cord compression and lession, peripheral nerve injury, bit b12 def . *Treatment is to address the underlying cause and prevent presure or injuries
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Neoplastic Ulcers
* Primary skin cancers * Ulcers from secondary metastasis to the skin
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Decubitus/pressure ulcers treatment
– 2 hourly turning of patients – Prevent skin maceration by keeping it dry, – Use of pressure reliefing devices, e,g air foam mattress, stryker bed,air levitation, ripple bed, other mechanical devices
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What are some examples of specific ulcers?
* Tuberculous ulcers * Buruli ulcers * Tropical ulcers * Syphilitic ulcers
31
What are tropical ulcers and what are they caused by?
ACUTE SYNERGISTIC ULCERS CAUSED BY bacteriodes fusiformis and aereobic borrellia vincenti It is common in the tropical and subtropics Caused by poor personal hygiene, malnutrition and walking bare footed It start as an acute ulcer from a minor injury, which becomes infected by the above organism
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What is a buruli ulcer and what is it caused by?
Caused by mycobacterioum ulcerans Acid fast bacillus Pre ulcerative/ulcertative lesion Preulcerative Papule,nodule, Plaque Oedematous lesion Mixed lesion Ulcerative Necrotizing: Organising, Healing Combine form
35
What is a tuberculous ulcer and what is it caused by?
Skin in areas of tuberculous abscess It is associated with sattelite sinus, matted lymph nodes and caseous discharge Bacteriology show acid fast bacilli, Chest x ray or bone radiograph may show a caseaous lesions.
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Methods in debridement include
Debridement Surgical Enzymatic Biological method Osmotic method Negative presure wound therapy Skin grafting
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Treatment of an ulcer
Bed rest/splinting Culture sensity antibiotics Analgesics Tetanus prophylaxis Regular dressing changes Use of desloughing agents/dressing material Serial debridement/sloughectomy
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What are the Investigations of an ulcer?
Investigation General /specifc Bacteriolgic studies Plain radiographs- Dupplex doppler scan, arteriograph Chest x rays Ulcer edge bopsy Others
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