Leg ulcers Flashcards
Different aetiologies of ulcer? (6)
Venous Arterial (and mixed) Neuropathic (most commonly diabetic neuropathy) Vasculitic Malignant Trauma
What is the commonest form of leg ulcer?
Venous leg ulcer
What is the essential underlying process leading to venous ulceration?
Chronic venous hypertension
What clinical signs are there which indicate chronic venous hypertension? (5)
Palpable varicosities Oedema Stasis eczema Hyper pigmentation Lipodermatosclerosis
What is the underlying cause of persistent venous hypertension?
Incompetent valves and ineffective muscle pump (obesity, arthritis, inactivity)
Symptoms of venous hypertension? (6) When are these symptoms typically worse?
Pain (burning, aching) Heaviness Itching Cramping Swelling Restless legs Worse after standing, at end of day
Signs of venous hypertension? (4)
Brown pigmentation (haemosiderin from red cell breakdown) Prominent varicose veins Atrophie blanche (ivory white scarring) Lipodermatosclerosis (hardened, hyperpigmented skin)
Where is venous ulceration most commonly found?
In the “gaiter” area between midcalf and medial malleolus
How do venous ulcers typically appear?
Large and shallow, with base of granulation tissue
When should culture-positive ulcers be treated with oral antibiotics?
Only if clinical evidence of infection e.g. pyrexia, purulent discharge, rapid extension of the ulcer, surrounding cellulitis, sepsis response
Features which distinguish arterial ulcers from venous? (3)
Deeper
May also have claudication and absent pedal pulses
Punched-out appearance
Features which suggest vasculitic ulceration?
Start as painful, palpaple purpuric lesions, turning into punched out ulcers
Which type of skin malignancy most commonly presents as an ulcer?
Squamous cell carcinoma
Investigations in leg ulcers?
Blood glucose
Full blood count to detect anaemia which will delay healing
Ulcer swab if evidence of infection
Colour flow duplex ultrasound to detect venous incompetence
Doppler ultrasound (ABPI)
Investigation of vasculitis (e.g. ANA, FR, CRP)
What does an ABPI of greater than 0.8 suggest?
Ulcer is unlikely to be due to arterial disease
