Leg Ulcers Flashcards

You may prefer our related Brainscape-certified flashcards:
1
Q

What is the definition of a CHRONIC leg ulcer?

A

open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What type of leg ulcer is most common?

A

60-80% of leg ulcers are venous in nature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What other forms of leg ulcers can be developed by patients?

A

22% arterial disease
9% rheumatoid arthritis (due to defective neuropathy)
5% diabetic (due to defective neuropathy)
Mixed arterial venous disease 10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The prevalence of leg ulcers increases with age. True/False?

A

True

=> will become more of a problem with the ageing population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who is responsible for treatment of leg ulcers?

A

> 80% of chronic venous leg ulcers cared for in the community

12% community and secondary care

5% in-patient treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What distressing symptoms may leg ulcers cause?

A
pain
leakage
smell
infection
social isolation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How much does it roughly cost the NHS per year to treat 1 leg ulcer?

A

£1500 per annum to treat 1 leg ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do leg ulcers cost so much to treat?

A

By time patient presents, the degree of disease is extensive:

Delay in full assessment and diagnosis
Delay in ABPI’s or none at all
Delay in commencing compression
Lack of confidence in compression application
Expensive dressings and inappropriate use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What other causes should you consider when examining a leg ulcer?

A
Venous
Arterial (or mixed arterio-venous)
Vasculitic
Malignant
Inflammatory
“Hydrostatic” - dependant limb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the order of assessment in a patient with a leg ulcer?

A

Patient
leg
ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What background factors should you consider about the patient before thinking about their leg and ulcer?

A
Current medication
Social circumstances
Smoker past or present
Mobility
Pain
Sleep disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Lipodermatosclerosis and why is it important in the formation of a leg ulcer?

A

A sclerotic reaction to venous hypertension:
skin thickens
insufficient blood supply
more likely to form ulcer if trauma occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why does venous dermatitis occur?

A

the non-nutritious venous blood irritates the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What ulcers can be found in the “gaiter area” ?

A

Venous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of ulcers are commonly found further up the calf?

A

Arterial OR Skin cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where can pressure ulcers be found?

A

On the heels

patients get these if bedbound for significant amount of time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What type of ulcers are common in the foot?

A

Diabetic due to lack of feeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is slough?

A

skin debris and dead bacteria on top of ulcerated tissue

often yellow in colour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What disease is Necrobiosis Lipoidica linked to?

A

Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the most common causes of vasculitis?

A

Infection or drugs

21
Q

What is vasculitis?

A

group of disorders in which there are inflamed blood vessels

e.g. capillaries, arterioles, venules and lymphatics.

22
Q

Describe how vasculitis can present clinically

A

Painful
Sudden onset
Purpuric rash/pustules
Necrotic

23
Q

How would an arterial ulcer usually appear?

A
Hairless leg
Cool/pale leg
Painful
Sharp edge
Punched out lesion
Can sometimes see tendon (due to ulcer depth)
24
Q

Describe the difference between a normal and abnormal ABPI

A
<0.8 = vascular disease
~1 = normal
>1.5 = calcification **often noise is continually heard on Doppler as arteries wont compress due to extensive calcification**
25
Q

What differentials must be considered if a suspected venous ulcer is not healing with compression?

A

Basal cell carcinoma

Squamous cell carcinoma

26
Q

When would you swab an ulcerated wound?

A

Only if showing clinical signs of infection

=> ulcer increasingly painful/exudate/malodour/
enlarging

27
Q

At what point would a leg ulcer patient benefit from patch testing?

A

If they become allergic to previous ulcer treatments

eg. Bandages, dressings, creams

28
Q

What agents can be used to get rid of slough on a wound?

A

hydrogel
honey
Maggot therapy

29
Q

Leg elevation can help in the management of venous ulcers. Where should the leg be raised to?

A

Above hip height

30
Q

How are compression stockings graded?

A

Class 1(weak) to class 3 (strong).

31
Q

What shape should compression bandages aim to create on the leg?

A

Leg padded to a cone shape

32
Q

How often should a compression bandage be changed?

A

Weekly

33
Q

How long should it take to heal a venous ulcer through compression?

A

12 weeks

if not healed by then consider other differentials

34
Q

Can venous ulcers be healed by dressings?

A

No, the compression is what heals the ulcers

35
Q

How are wound beds usually prepped for further therapy?

A

Autolytic: The use of dressings to create moist wound environment and hydrate necrotic tissue

Sharp debridement: With scalpel or scissors

Biological: larvae therapy

Surgical: under general anaesthetic

36
Q

What other component is used as a barrier around the perimeter of the wound to stop it leaking during larvae therapy?

A

Zinc Oxide (ZnO)

37
Q

What is slough?

a) Healthy skin
b) Active infection
c) Skin debris and dead bacteria
d) Granulation tissue

A

C

38
Q

How can slough be removed?

a) Compression bandaging
b) Hydrogels
c) Manual debridement
d) All of the above

A

D

39
Q

Which ulcers should be swabbed?

a) All ulcers
b) Sloughy ulcers
c) Painful ulcers
d) Only those showing signs of clinical infection

A

D

40
Q

How should a leg ulcer be cleaned?

a) Warm tap water and soap substitute
b) Sterile saline solution
c) Hibiscrub
d) They shouldn’t be washed

A

A

41
Q

How should venous dermatitis be managed?

a) Apply regular emollients
b) Consider patch testing
c) Topical steroids
d) Compression bandages or stockings
e) All of the above

A

E

42
Q

Which of the following could be the cause of a non-healing leg ulcer?

a) Skin cancer
b) Inflammatory skin disease
c) Poor hygiene
d) a and b

A

D

43
Q

Which of these conditions are important in the management of leg ulcers?

a) Cardiovascular disease
b) Diabetes
c) Deep venous thrombosis
d) All of the above

A

D

44
Q

Why is ABPI performed?

a) To check for DVT
b) To examine the varicose veins prior to surgery
c) To assess the arterial system
d) To measure oxygen levels in the feet

A

C

45
Q

What shape are you aiming for when padding and shaping a leg prior to bandaging?

a) Oval
b) Rectangle
c) Cone
d) Triangle

A

C

46
Q

What is the most important therapy in healing venous leg ulcers?

a) Dressings
b) Antibiotics
c) Skin grafts
d) Compression

A

D

47
Q

Once a venous ulcer is healed, what should the patient be advised to do?

a) Nothing
b) Use regular emollient
c) Wear appropriate strength compression stockings
d) b and c

A

D

48
Q

How long do compression stockings last?

4-6 months
Forever
2 months
12 months

A

A