leg ulcer

Question 1

what is venous ulcer? what is arterial ulcer?

Answer 1

venous ulcer = due to venous blood stasis

arterial ulcer = due to insufficient blood supply from PVD

Question 2

what is pathophysiology for venous ulcer?

Answer 2

elevated pressure in legs (obesity restricts venous return to more pressure in legs) - veins dilate & incompetent - pressure makes RBCs leak into nearby tissues - ulcer

Question 3

what is clinical presentation of venous ulcer?

Answer 3

= ulcers shallow, exudative & warm

• ankle swelling
• varicose veins
• haemosiderin deposition
• venous eczema
• lipodermatosclerosis

Question 4

what is clinical presentation of arterial ulcer?

Answer 4

ulcer = punched out appearance

• cold, white, shiny
• pain at night
• peripheral pulses absent

Question 5

what are investigations for ulcers?

Answer 5

• assess ulcer
• ABPI
• wound swab (if signs infection)
• duplex scan

Question 6

what is treatment of ulcers?

Answer 6

arterial = manage risk factors, treat w statins & antiplatelet

venous = control pain, compression bandage, leg elevation. surgical debridement

Question 7

what is advanced venous disease called?

Answer 7

lipodermatosclerosis = when part of leg like balloons up - inverted champagne bottle look

Question 8

what is presentation of vasculitic leg ulcer?

Answer 8

• painful, sudden onset, purpuric rash/pustules & necrotic

Question 9

what is ABPI?

Answer 9

ankle brachial pressure index = measure systolic pressure of brachial artery & dorsalis pedis

1 = normal
<0.8 = arterial
>1.5 = calcification

Question 10

what is described as thickened woody skin?

Answer 10

woody tethered skin affecting lower leg →lipodermatosclerosis = hardening of fat on lower limbs

(advanced stage of venous)

Question 11

what is most common site of venous ulceration?

Answer 11

medial malleolus