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
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
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
4
Q
Diabetic foot ulcer
A
- hyperglycaemia
- micro/macroangiopathy
- neuropathy
- infection
- foot deformities
5
Q
Pressure sores
A
- tissue necrosis due to soft tissue compression
- local ischaemia and moisture
- comorbidities/elderly
6
Q
Marjolin’s ulcer
A
- squamous cell carcinoma
- sites of chronic inflammation = osteomyelitis, burns
- lower limbs
7
Q
Neuropathic ulcer
A
- pressure
- plantar surface of metatarsal head + plantar surface of hallux
- amputation in diabetic patients
8
Q
Pyoderma Grangrenosum
A
- associated with IBD/RA
- at stomas sites
- erythematous nodules with ulcerate
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
10
Q
Pathogenesis of venous ulcers
A
Venous HTN
Dysregulation of pro-inflammatory cytokines
Thrombophillia
Fibrin Cuff Theory
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
12
Q
RF of pressure sores
A
- malnourishment
- incontinence
- lack of mobility
- pain (decreased mobility)
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
14
Q
Secondary ulcer prevention
A
Compression stockings Elevate legs above heart Self Examination Vitamin Supplementation Medication Review
15
Q
Management of venous ulcers
A
- leg elevation
- compression
- aspirin
- pentoxifylline
