L3: Ulcers, Sinuses & Fistulas (Pt 1) Flashcards
Def of Ulcer
break in the continuity of covering epithelium, either skin or mucous membrane.
Parts of Ulcer
Margin of Ulcer
- line of demarcation between ulcer and normal tissue.
- It may be regular (rounded or oval) or irregular.
Edge of Ulcer
- is the part connecting floor to the margin.
Floor of Ulcer
- It is the part which is seen.
- Floor may contain discharge, granulation tissue.
Base of Ulcer
- It is the part which is felt where ulcer rests.
- It may be bone or soft tissues
Types of Edges
Sloping Edge
It is seen in healing ulcer
Undermined Edge
- is seen in tuberculous ulcer.
- Disease process advances in deeper plane (in subcutaneous tissue) whereas epidermis (skin) proliferates inwards.
Punched Out Edge
- is seen in gummatous (syphilitic) ulcer and trophic ulcer.
- It is due to end arteritis.
Raised & Beaded Edge
- (pearly white) is seen in rodent ulcer (BCC).
- Beads are due to proliferating active cells.
Everted Edge
- (Rolled out)
- It is seen in carcinomatous ulcer due to spill of the proliferating malignant tissues over the normal skin.
Examples of Ulcers
Types of Margins
Healing Margin
three zones from inside out.
- First is red zone due to central red healthy granulation tissue.
- second is middle blue zone due to active growing epithelium.
- third is outer white zone due to well formed scar.
Inflamed Margin
It is red, irregular with inflamed surrounding skin.
Fibrosed Margin
Thick white
Classification of Ulcers
- Clinically
- Pathologically
- based on duration
Clinical Classification of Ulcers
Pathological Classification of Ulcers
Classification of Ulcers based on duration
Causes of Chronic Ulcer
Def of Sinuses
blind track lined by granulation tissue leading from an epithelial surface into the underlying tissues.
Classification of Sinuses
what are the Commonest cause of sinus in neck?
TB
Tuberculosis in Neck
Def of Fistula
abnormal communication between two hollow
viscous or between hollow viscous and body
surface.
Classification of Fistulas
- Based on Cause
- Based on Number
- Based on involvment of tissue
- Based on Type
- Based on opening
- Based on output
Classification of Fistulas based on cause
Classification of Fistulas based on number
may be single or multiple.
Classification of Fistulas based on involvment of tissues
- External: From viscus to skin
- Internal: From viscus to viscus
what are external fistulas & what are examples of it?
From viscus to skin
- Orocutaneous.
- Branchial fistula.
- Thyroglossal fistula.
- Enterocutaneous fistula.
what are internal fistulas & What are examples of it?
Internal: From viscus to viscus
- TEF
- Cholecystoduodenal fistula.
- Colovesical fistula.
- Rectovaginal fistula.
Classification of Fistulas based on type
Simple: direct track
Complicated: variable course.
Classification of Fistulas based on opening
Lateral fistula: if fistula opening is from lateral aspect of viscus.
End fistula: if fistula opening is from end of the viscus.
Classification of Fistulas based on output
In pancreatic fistula-high output …….. & low output …….
> 200 ml/day - < 200 ml/day.
what are causes of persistence of a sinus or fistula?
What are causes of a non-healed fistula?
What are surgical indications of fistular repair?
