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Wound Care > Fistulas, Skin Lesions, and Atypical Wounds > Flashcards

Fistulas, Skin Lesions, and Atypical Wounds Flashcards

1
Q

What are fistulas?

A

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

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2
Q

What are some of the causes associated with fistulas?

A

Surgical complications

Injury

Infection

Inflammatory diseases

  • Crohn’s disease
  • Ulcerative colitis
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3
Q

What are primary skin lesions?

A

Directly associated with the disease process

  • Macule
  • Patch
  • Papulae
  • Nodule
  • Tumor
  • Plaque
  • Bullae
  • Vesicle
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4
Q

What is a Macule?

A

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

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5
Q

What is a Patch?

A

A large (more than 2 cm) flat lesion with a color different from the surrounding skin. This differs from a macule only in size

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6
Q

What is a Papule?

A

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)

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7
Q

What is a Nodule?

A

A larger (1-5 cm), firm lesion raised above the surface of the surrounding skin.

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8
Q

What is a Tumor?

A

A solid, raised growth more than 5 cm in diameter

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9
Q

What is a Plaque?

A

A large (more than 1 cm), flat-topped, raised lesion, edges may either be distinct (psoriasis) or gradually blend with surrounding skin (eczematous dermatitis)

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10
Q

What is a Bullae?

A

A fluid-filled, raised, often translucent lesion more than 1 cm in diameter

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11
Q

What is a Vesicle?

A

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

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12
Q

What is Lichenification?

A

A distinctive thickening of the epidermis that is characterized by accentuated skin fold markings

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13
Q

How would you assess the ABSCEs of Melanoma?

A

See slide #8

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14
Q

What are the characteristics of Necrotizing Fasciitis?

A

“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
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15
Q

What are the signs and symptoms of Necrotizing Fasciitis?

A

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
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16
Q

What are the signs and symptoms of Necrotizing Fasciitis in terms of APPEARANCE?

A

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

17
Q

What are the characteristics of Necrotizing Fasciitis treatment?

A

Antibiotic therapy

Surgical debridement

Moist wound healing

Amputations

HBO

18
Q

What is Pyoderma Gangrenosum?

A

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

19
Q

What is the clinical appearance of Pyoderma Gangrenosum?

A

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

20
Q

What are the treatments for Pyoderma Gangrenosum?

A

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
21
Q

What is Karposi Sarcoma?

A

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
22
Q

What is the clinical appearance of Karposi Sarcoma?

A

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

23
Q

What is the treatment for Karposi Sarcoma?

A

Refer to dermatologist

Frozen liquid nitrogen

Radiation

Surgical excision

Intralesional chemotherapy

24
Q

What are some characteristics of Herpes Zoster (Shingles)?

A

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

25
Q

What is the clinical appearance of shingles?

A

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

26
Q

What is the treatment for shingles?

A

Antiviral meds–Acyclovir

Pain meds

Oatmeal bath

Cool, wet compress

Calamine lotion

NO OCCLUSIVE DRESSINGS

Wound Care (12 decks)

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