Examination Ulcer Flashcards
Overall
Look Feel Move Special tests Examine regional LNs
Look: what to take into account
Number of lesions
Site
Size (surface size and depth)
Shape
Margin (junction between normal and abnormal skin)
Edge (sloping, punched out, raised, rolled)
Floor (slough, necrotic, periosteum/bone)
Discharge (quantity, consistency, colour, odour)
Surrounding skin (hyperpigmentation, oedema, erythema, stretch marks, wrinkling)
Whole limb overview
What is assoc with multiple ulcers
arterial disease
Typical site for varicose ulcers
over medial malleolus
Usually vertically oval
Ulcer shape and diagnosis
Irregular shape - malignant
Vertically oval - varicose
Venous ulcer
- Underlying condition
- Location
- Characteristic
- Skin changes
- Tx
varicose veins, Prev DVT, Obesity, Preg
Lower calf/medial malleolus
Shallow flat, margins, slough at base
Haemosiderin staining, eczematous, and itch, skin/limb oedema
Compression therapy
elevation
surgical management
Arterial ulcer
- Underlying condition
- Location
- Characteristic
- Skin changes
- Tx
Diabetes, HTN, smoking, previous vascular disease
Pressure points, toes and feet, lateral malleolus and tibial areas
punched out and deep, irregular shape, unhealthy wound bed, necrotic tissue
painful
shiny skin, reduced hair growth, cool skin, absent or weak pulses, delayed cap refill
Revascularization, anti platelet medication, manage RF
Neuropathic ulcer
- Underlying condition
- Location
- Characteristic
- Skin changes
- Tx
Diabetes, trauma
plantar aspect of foot
Deep, surrounded by callus, painless/insensate
Dry cracked insensate skin with causes
off-loading of pressure
Pressure ulcer
- Underlying condition
- Location
- Characteristic
- Skin changes
- Tx
Limited mobility
On bony prominences
Deep often macerated
Atrophic skin, loss of muscle mass.
Off-load pressure, adequate nutrition, reduce excess moisture/shearing
Feel
Check for tenderness (esp arterial)
Temperature palpation (back of hand)
Palpate the edge of ulcer for induration (hardening) - seen in chronic benign and malignant ulcers
Determine whether it bleeds on gentle touch or not (often in malignancy)
Move
Try and move base using thumb and forefinger.
Fixation to deeper structure suggests malignancy
Special tests
Palpate peripheral pulses
Examine light-touch and pressure sensation
Examine nearby joints if boney involvement
