Fistulas, Skin Lesions, and Atypical Wounds Flashcards
What are fistulas?
DEFINITION:
Abnormal passage or opening between 2 or more body organs or spaces
Internal fistulas–internal organ to internal organ (Ex: small bowel to bladder or bladder to vagina)
External fistulas–cutaneous involvement
Most common are enterocutaneous fistulas (involve the skin and GI tract)
Location can significantly complicate care
What are some of the causes associated with fistulas?
Surgical complications
Injury
Infection
Inflammatory diseases
- Crohn’s disease
- Ulcerative colitis
What are primary skin lesions?
Directly associated with the disease process
- Macule
- Patch
- Papulae
- Nodule
- Tumor
- Plaque
- Bullae
- Vesicle
What is a Macule?
Flat, colored lesion, less than 2 cm in diameter, not raised above the surface of the surrounding skin
A ‘freckle’ or ephelid, is a prototype pigmented macule
What is a Patch?
A large (more than 2 cm) flat lesion with a color different from the surrounding skin. This differs from a macule only in size
What is a Papule?
A small, solid lesion, less than 1 cm in diameter, raised above the surface of the surrounding skin and hence, palpable (closed comedone, or whitehead, in acne)
What is a Nodule?
A larger (1-5 cm), firm lesion raised above the surface of the surrounding skin.
What is a Tumor?
A solid, raised growth more than 5 cm in diameter
What is a Plaque?
A large (more than 1 cm), flat-topped, raised lesion, edges may either be distinct (psoriasis) or gradually blend with surrounding skin (eczematous dermatitis)
What is a Bullae?
A fluid-filled, raised, often translucent lesion more than 1 cm in diameter
What is a Vesicle?
A small, fluid-filled lesion, less than 1 cm in diameter, raised above the plane of surrounding skin. Fluid is often visible, and the lesions are often translucent
What is Lichenification?
A distinctive thickening of the epidermis that is characterized by accentuated skin fold markings
How would you assess the ABSCEs of Melanoma?
See slide #8
What are the characteristics of Necrotizing Fasciitis?
“Flesh-eating” disease
Caused by gram negative bacteria, Staph Aureus, Group A strep, and many others
Progressive, rapidly spreading inflammatory infection located in deep fascia
RISK FACTORS:
- Diabetes
- Obesity
- Renal failure
- Immunocompromised state
- Cancer
- IV drug users
What are the signs and symptoms of Necrotizing Fasciitis?
Advanced (3-4 days):
- Swelling in affected area (may have a purplish rash)
- Large dark marks with dark filled blisters
- Necrotic, bluish, white, or dark, mottled, flaky appearance
Critical:
- Drop in Bp
- Septic shock
- Coma
What are the signs and symptoms of Necrotizing Fasciitis in terms of APPEARANCE?
Initially appears red, swollen, hot, and painful (ddx: cellulitis)
Within hours skin becomes blue-gray with fluid-filled blisters
Radiography to confirm diagnosis
Patient can go into shock/multiple organ failure quickly
What are the characteristics of Necrotizing Fasciitis treatment?
Antibiotic therapy
Surgical debridement
Moist wound healing
Amputations
HBO
What is Pyoderma Gangrenosum?
Inflammatory ulcerative disease
- Unknown etiology (approximately 50% of patients show an underlying disorder: IBS, Crohn’s, ulcerative colitis)
- Painful skin ulcers
Risk factors
- Age 40-60 years, IBS, UC, RA
What is the clinical appearance of Pyoderma Gangrenosum?
Ulcer begins as a follicular pustule with rapid growth
Leads to necrosis and enlargement of the area
Irregular, jagged raised margins that are typically undermined and purple/bluish in color
What are the treatments for Pyoderma Gangrenosum?
Systemic treatment is mandatory
- Corticosteroids
- Immunosuppresive therapy (Cyclosporin A)
Standard wound care on ulcerations
- Moist wound healing environment
- Foams, alginates, hydrogels, enzymatic debridement
- No sharp debridement–could trigger PG
- Pain reduction methods
What is Karposi Sarcoma?
Cancer that develops from the cells that line lymph or blood vessels
Caused by Human Herpes Virus 8
More common in males
Onset age: 50-70 years old
In association with HIV
- May develop at any time during the course of the disease
- Increased immunosuppression = increased aggressive Karposi sarcoma
What is the clinical appearance of Karposi Sarcoma?
Red to purplish asymptomatic macules and papules and nodules
Located on skin or mucous membranes
Initially painless, can ulcerate and become painful
Starts as flat patches on one or both LEs (ankles and soles of feet)
Patches–plaques, nodules, or scaly tumors
Can occur internally–cause discomfort with breathing, swallowing, SOB
What is the treatment for Karposi Sarcoma?
Refer to dermatologist
Frozen liquid nitrogen
Radiation
Surgical excision
Intralesional chemotherapy
What are some characteristics of Herpes Zoster (Shingles)?
Caused by varicella zoster (chicken pox) virus
Primary infection–chicken pox
Remains dormant in dorsal root ganglia
Can react later in life
More common in elderly and immunosuppressed patients
Stress
Painful blistering rash
- Prior to rash developing, pain, itching, or tingling in the area where it will develop
What is the clinical appearance of shingles?
Prodromal phase–malaise, HA, photophobia
Dermatomal distribution:
- Trunk and thoracic area
- Usually 1-2 dermatomes but can be more widespread
Does not cross midline
Rash of clustered vesicles–dry and crust over (infectious until they dry and crust over)
Usually heals in 2-4 weeks
Scarring and pigmentation common
Postherpetic neuralgia
What is the treatment for shingles?
Antiviral meds–Acyclovir
Pain meds
Oatmeal bath
Cool, wet compress
Calamine lotion
NO OCCLUSIVE DRESSINGS
