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Dermatology > Leg ulcers > Flashcards

Leg ulcers Flashcards

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Dermatology Board Prep flashcards
1
Q

describe the presenting history and physical of social risks of venous disease

A 
previous history of DVT
varicose veins
reduced mobility 
traumatic injury to the lower leg
obesity
pregnancy
previous vein surgery

presents as non healing ulceration
recurrent phlebitis

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2
Q

describe the presenting history and physical of social risks of arterial disease

A 
diabetes 
hypertension
smoking
previous history of vascular disease 
inability to elevate limb
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3
Q

what is the typical position of a venous ulcer

A

gaiter area of leg

medial aspect of the leg

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4
Q

what is the typical position of a arterial ulcer

A

lateral malleolus and tibial area
toes and feet
over pressure points

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5
Q

what is the pain like in venous disease

A

throbbing, aching, heavy feeling in the legs

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6
Q

what is the pain like in arterial disease

A

intermittent claudication
worse at night/rest
improves with dependency

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7
Q

what are the characteristics of a venous ulcer

A

shallow with flat margins
often presents with slough at the base with granulation tissue
moderate to heavy exudate

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8
Q

what are the characteristics of an arterial ulcer

A

punched out, occasionally deep

irregular in shape

unhealthy appearance of wound bed

presence of necrotic tissue or fixed slough

low exudate unless infected

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9
Q

what is the usual condition of the leg in venous disease (9)

A

haemosiderin staining

thickening and fibrosis

dilated veins at the ankle

crusty dry hyperkeratotic skin

eczematous, itchy skin

pedal pulses present

normal cap refil

limb oedema common

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10
Q

what is the usual condition of the leg in arterial disease

A

thin, shiny, dry skin

reduced/no hair

skin cool to touch

pallor on leg elevation

absence or weak pedal pulses

delayed cap refil time

development of gangrene

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11
Q

what are the perimeters of ABPI

A 
1-1.2 normal 
0.9-0.99 acceptable
0.8-0.89 mild arterial disease 
0.5-0.79 moderate 
<0.5 severe
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12
Q

what are the 5 P’s of critical limb ischemia

A 
pain 
pallor
pulseless
paralysis
perishingly cold
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13
Q

what is a chronic leg ulcer

A

an open lesion between the knee and ankle joint that remains unhealed for 4 weeks

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14
Q

why can PWIDs get drugs

A

inject into thigh- get clot in femoral vein that blocks venous drainage

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15
Q

where are the majority of leg ulcers treated

A

in the community

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16
Q

what type are the majority of ulcers

A

venous

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17
Q

why do diabetics get ulcers

A

neuropathy

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18
Q

what are the distressing symptoms of leg ulcers

A

pain, leakage, smell, infection, social isolation

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19
Q

what are the different diagnosis of a chronic leg ulcer (7)

A 
venous 
arterial 
mixed
vasculitic 
malignant
inflammatory 
hydrostatic- (dependant limb- dangling)
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20
Q

what do you need to asses in a venous ulcer

A

what is causing it
why isn’t it healing
SIGN tool- asses first patient then leg then ulcer

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21
Q

what extras are important to inclide in leg ulcer history

A

social circumstances
mobility
pain
sleep disturbance (sleeping in chair will create dependant limb)

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22
Q

what is lipodermatosclerosis

A

sclerotic skin (thickened, very hard) in response to venous hypertension

very likely to develop in to an ulcer

23
Q

how do you treat venous dermatitis

A

regular emollients, topical steroids and compression stockings

24
Q

what is important to record when visually assessing ulcer

A

position
surface area
depth
slough

25
Q

why do you get heal ulcers

A

pressure sores

26
Q

where do you get diabetic ulcers

A

toes

27
Q

what causes calf ulcers

A

aterial disease

28
Q

where do you get venous ulcers

A

gaitor area- over medial and lateral malleoli

29
Q

which ulcer is deep

A

arterial

30
Q

name the ulcer: painful, sharp edge, punched out

A

arterial

31
Q

what is hairless leg a sign of

A

arterial disease

32
Q

what type of ulcer is pyoderma gangrenosum

A

vasculitic

33
Q

what is vasculitis

A

group of disorders that cause inflamed blood vessels (can be capillaries, arterioles, venules and lymphatics)

34
Q

name the condition: painful, sudden onset, purpuric rash/ pustules, necrotic

A

vasculitis

35
Q

what does a low ABPI suggest

A

arterial problem

36
Q

when should you think malignancy

A

if doesn’t heal with compression

if not it usual area for venous, arterial or diabetic ulcers

37
Q

what investigations should be done

A 
ABPI- ALWAYS
wound swap ONLY if signs of infection (increasingly painful, exudate, malodour, enlarging)
bloods - (fbc, lfts, u+es, crp_
patch testing to previous treatments 
duplex scan if indicated
38
Q

what does a high ABPI (>1.5) mean

A

calification

39
Q

what should you do with an ABPI of 0.8-1.3

A

compress

40
Q

what is a normal ABPI

A

1

41
Q

what is the treatment for venous ulcer

A 
control pain 
non adherent dressing 
de-sloughing if necesscary (hydrogel/honey/maggots)
4 layer compression bandaging 
leg elevation
42
Q

how long should patients wear their compression stockings

A

forever

43
Q

how long to compression stockings last

A

6 months

44
Q

what are the different classes of compression stocking

A

class 1 (weak) to class 3 (strong)

45
Q

what shaped should the leg be compressed into

A

cone- 40mmHg at ankle, 25 mmHg at knee to aid venous return

46
Q

why should you change dressing weekly

A

to lessen disturbance of healing cells

47
Q

when should you aim to heal the ulcers by

A

12 weeks

48
Q

what colour is necrotic tissue

A

black

49
Q

how must you prepare the wound bed and the (4) methods for doing this

A

by the removal of devitalised tissue by debridement

autolytic- the use of dressings to create moist wound environment and hydrate necrotic tissue (hydrogel/ honey)

sharp debridement (with scalpel or scissors)

biological (larvae therapy)

surgical (under general anaesthetic)

50
Q

how should a leg ulcer be cleaned

A

warm tap water an soap substitute as chronic wound (not sterile)

51
Q

can inflammatory skin disease cause a non healing ulcer

A

yes

52
Q

how other than neuropathy can diabetes cause ulcer

A

causes arterial calcification

53
Q

what are signs of venous disease

A

oedema, venous flares, varicose veins

Dermatology (23 decks)

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