Leg ulcers

Question 1

Which sex are more likely to develop leg ulcers?

Answer 1

women

Question 2

What are the different types of ulcers?

Answer 2

1. Arterial
2. Venous
3. Neuropathic/diabetic
4. Pressure sores
5. Mixed

Question 3

What are the risk factors for arterial ulcers?

Answer 3

coronary heart disease
stroke/TIA
diabetes
peripheral arterial disease
obesity
immobility

Question 4

What are the risk factors for venous ulcers?

Answer 4

varicose veins
previous injury
previous DVT, phlebitis
FHx venous disease

Question 5

What is the distribution of venous ulcers?

Answer 5

lower calf/ankle

Question 6

Are venous ulcers painful?

Answer 6

painless unless infected

Question 7

What are the symptoms of venous insufficiency?

Answer 7

darkened, hard, leathery skin
restless leg syndrome
leg cramps or spasms
itchy skin 
pain and heaviness

Question 8

What is the distribution of arterial ulcers?

Answer 8

more distal and on dorsum of foot/toes

Question 9

What do arterial ulcers look like?

Answer 9

punched out border, round

Question 10

How does pain differ in arterial vs venous ulcers?

Answer 10

arterial ulcers associated with nocturnal pain, worsened when suppine and relieved by dangling legs out of bed

Question 11

What are the associated symptoms/signs of arterial ulcers?

Answer 11

features of chronic limb ischaemia- hairlessness, pale skin, absent pulses, nail dystrophy, wasting of calf muscles

Question 12

What is the distribution of neuropathic ulcers?

Answer 12

under calluses or over pressure points on feet

Question 13

What are the associated symptoms with neuropathic ulcers?

Answer 13

painless and surrounding area has reduced sensation

Question 14

What are important points to ask in PMHx for ulcers?

Answer 14

diabetes, CDV disease, PVD, autoimmune disease e.g. SLE, IBD, RA

Question 15

Important qs to address in DHx for ulcers?

Answer 15

steroids, NSAIDs, beta blockers (reduce peripheral blood flow)

Question 16

What investigations would you conduct for ulcers?

Answer 16

bloods- CRP/WCC -> infection?
HbA1C + glucose
swab if infection
doppler US

Question 17

Differential diagnosis for bandaged lower legs?

Answer 17

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

Question 18

What is the general management for ulcers?

Answer 18

stop smoking, good nutrition, attention to hygiene, limit risk factors

Question 19

What is the management of arterial ulcers?

Answer 19

1. treat underlying arterial insufficiency
2. refer to vascular
3. medical (statin, antiplatelets) v surgical management (angiolpasty, bypass grafting)

Question 20

What is the management of venous ulcers?

Answer 20

1. good nursing care (can take several weeks to heal)
2. dressings/compression bandages
3. refer to tissue viability/district nurses

Question 21

What is the management of neuropathic ulcers?

Answer 21

1. Treat underlying cause and optimise management e.g. diabetes
2. Regular foot checks
3. Appropriate footwear to relieve pressure load