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MET3a > Gangrene & Ulcers > Flashcards

Gangrene & Ulcers Flashcards

1
Q

Types of limb ulcers

A 
Venous Ulcer
Arterial Ulcer
Diabetic foot ulcer
Pressure sores
Marjolin's ulcer
Neuropathic ulcer
Pyoderma gangrenosum
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2
Q

Venous ulcer

A
  • due to venous HTN (2ry to chronic venous insufficiency)
  • persistent inflammation
  • rough edge
  • redness
  • blue/purple/brown blood = hemosiderin
  • lipodermatosclerorosis = subcutaneous fat inflammation (pain and constriction of soft tissue)
  • medial leg along great saphenous vein
  • above ankle
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3
Q

Arterial Ulcer

A

Reduced blood supply = ischaemia and necrosis

  • little exudate
  • painful
  • small deep lesions
  • defined border
  • necrotic base
  • cold
  • no peripheral pulse
  • gangrene areas
  • distal leg and bony prominences
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4
Q

Diabetic foot ulcer

A
  • hyperglycaemia
  • micro/macroangiopathy
  • neuropathy
  • infection
  • foot deformities
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5
Q

Pressure sores

A
  • tissue necrosis due to soft tissue compression
  • local ischaemia and moisture
  • comorbidities/elderly
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6
Q

Marjolin’s ulcer

A
  • squamous cell carcinoma
  • sites of chronic inflammation = osteomyelitis, burns
  • lower limbs
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7
Q

Neuropathic ulcer

A
  • pressure
  • plantar surface of metatarsal head + plantar surface of hallux
  • amputation in diabetic patients
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8
Q

Pyoderma Grangrenosum

A
  • associated with IBD/RA
  • at stomas sites
  • erythematous nodules with ulcerate
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9
Q

Venous hypertension

A
  • in deep venous = DVT
  • in superficial = varicose veins
  • AV fistulae
  • calf muscle pump is insufficient
  • increased pressure in distal veins of leg
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10
Q

Pathogenesis of venous ulcers

A

Venous HTN
Dysregulation of pro-inflammatory cytokines
Thrombophillia
Fibrin Cuff Theory

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11
Q

Pressure Sore Grades

A 
1 = non blanchable erythema
2 = partial thickness skin loss, superficial, involving dermis/epidermis
3 = full thickness skin loss, necrosis of subcutaneous tissue, can extend to underlying fascia
4 = destruction/necrosis/damage to muscle/bone/support structures with or without full thickness skin loss
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12
Q

RF of pressure sores

A
  • malnourishment
  • incontinence
  • lack of mobility
  • pain (decreased mobility)
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13
Q

Primary ulcer prevention

A 
Manage venous HTN
Avoid calf inactivity
Stop smoking
Lose weight
Fluid intake >8 glasses water per day
Avoid mechanical trauma
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14
Q

Secondary ulcer prevention

A 
Compression stockings
Elevate legs above heart
Self Examination
Vitamin Supplementation
Medication Review
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15
Q

Management of venous ulcers

A
  • leg elevation
  • compression
  • aspirin
  • pentoxifylline
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16
Q

Management of arterial ulcers

A
  • revascularisation
  • anti-platelets
  • RF management
17
Q

Management of neuropathic ulcers

A
  • off loading pressure
  • topical GFs
  • tissue engineered skin
18
Q

Management of pressure ulcers

A
  • off loading pressure
  • decrease excess moisture
  • decreased shear & friction
  • adequate nutrition
19
Q

Wet Gangrene

A
  • sudden pain
  • oedema
  • offensive odour
  • red/warm
  • no demarcation line
  • extends proximally
  • sudden loss of blood supply
  • necrotising fasciitis
20
Q

2 types of necrotising fasciitis

A

1) Group A Strep

2) Polymicrobial (non group A strep, E coli, Enterobacter, Klebsiella)

21
Q

Management for type 1 necrotising fasciitis

A
  • intensive support care
  • surgical debridement?
  • amputation?
  • broad spectrum antibiotics (vanco and tazocin)
22
Q

Management for type 2 necrotising fascitiis

A
  • intensive support care
  • surgical debridement
  • amputation?
  • IV AB = benpen sodium + clindamycin
23
Q

GAS gangrene

A
  • gas production in tissue
  • shock
  • large black necrotic bullae sores
  • crepitus
  • enter muscle through wound
  • Clostrium proliferate in necrotic tissue and produce gas
24
Q

Management of GAS gangrene

A
  • intensive supportive care
  • surgical debride?
  • amputation?
  • IV AB = benpen sodium and clinda
25
Q

Dry gangrene

A
  • dull chronic pain
  • claudication
  • no infection
  • ischaemia
  • cold
  • dark brown -> purple -> black
  • demarcation line
  • extends proximally
26
Q

Causes of dry gangrene

A
  • atherosclerosis
  • diabetes associated microangiopathy
  • hypercoagulable state
  • malignancy
  • venous obstruction
27
Q

Management of dry gangrene

A

IV heparin
if non viable extremity = surgical debridement/amputation
if viable extremity = thrombolytics, urokinase

28
Q

Fournier’s scrotal gangrene

A

Type 1 necrotising fasciits of perineal and genital region

- polymicrobial infection

29
Q

Management of Fournier’s scrotal gangrene

A

Type 1 necrotising fasciitis so

  • intensive supportive care
  • surgical debridement?
  • amputation?
  • broad spectrum AB? = vanco and tazocin

MET3a (38 decks)

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