Leg ulcers Flashcards
Which sex are more likely to develop leg ulcers?
women
What are the different types of ulcers?
- Arterial
- Venous
- Neuropathic/diabetic
- Pressure sores
- Mixed
What are the risk factors for arterial ulcers?
coronary heart disease stroke/TIA diabetes peripheral arterial disease obesity immobility
What are the risk factors for venous ulcers?
varicose veins
previous injury
previous DVT, phlebitis
FHx venous disease
What is the distribution of venous ulcers?
lower calf/ankle
Are venous ulcers painful?
painless unless infected
What are the symptoms of venous insufficiency?
darkened, hard, leathery skin restless leg syndrome leg cramps or spasms itchy skin pain and heaviness
What is the distribution of arterial ulcers?
more distal and on dorsum of foot/toes
What do arterial ulcers look like?
punched out border, round
How does pain differ in arterial vs venous ulcers?
arterial ulcers associated with nocturnal pain, worsened when suppine and relieved by dangling legs out of bed
What are the associated symptoms/signs of arterial ulcers?
features of chronic limb ischaemia- hairlessness, pale skin, absent pulses, nail dystrophy, wasting of calf muscles
What is the distribution of neuropathic ulcers?
under calluses or over pressure points on feet
What are the associated symptoms with neuropathic ulcers?
painless and surrounding area has reduced sensation
What are important points to ask in PMHx for ulcers?
diabetes, CDV disease, PVD, autoimmune disease e.g. SLE, IBD, RA
Important qs to address in DHx for ulcers?
steroids, NSAIDs, beta blockers (reduce peripheral blood flow)
What investigations would you conduct for ulcers?
bloods- CRP/WCC -> infection?
HbA1C + glucose
swab if infection
doppler US
Differential diagnosis for bandaged lower legs?
cellulitis, leg ulcer, falls, peripheral oedema (Remember patient on resp ward who was weeping from his legs, lost 6 stone from water loss), trauma/injury
What is the general management for ulcers?
stop smoking, good nutrition, attention to hygiene, limit risk factors
What is the management of arterial ulcers?
- treat underlying arterial insufficiency
- refer to vascular
- medical (statin, antiplatelets) v surgical management (angiolpasty, bypass grafting)
What is the management of venous ulcers?
- good nursing care (can take several weeks to heal)
- dressings/compression bandages
- refer to tissue viability/district nurses
What is the management of neuropathic ulcers?
- Treat underlying cause and optimise management e.g. diabetes
- Regular foot checks
- Appropriate footwear to relieve pressure load
