Leg ulcers Flashcards
what is a chronic leg ulcer?
open lesion between knee and ankle that lasts over 4weeks
What are the majority of leg ulcers due to?
vascular problem
60-80% venous
What are the causes of leg ulcers?
- venous
- mixed arterial and venous
- arterial
- infection or malignancy
How many patients with leg ulcers have diabetes?
5%
Why do diabetic patients get leg ulcers?
venous/arterial disease
neuropathic
ulceration of necrobiosis lipidica
Why do patients with rheumatoid arthritis get leg ulcers?
venous/arterial disease
vasculitis
Why do venous leg ulcers develop?
venous insufficiency causes stasis and pooling in the leg causing venous hypertension
leakage and oedema block supply of oxygen and nutrients so there is ischaemia and necrosis
Why does venous insufficiency occur?
valve incompetence (eg. after DVT) calf muscle pump insufficiency
Which conditions suggest venous cause of leg ulcers?
DVT
varicose veins
same side fractures or surgery
Which conditions suggest arterial cause of leg ulcers?
peripheral arterial disease
IHD
stroke
hx of smoking
Which clinical signs would be seen on examination of a limb with venous disease?
venous eczema varicose veins oedema haemosiderin staining lipodermatosclerosis atrophie blancie
Which clinical signs would be seen on examination of a limb with arterial disease?
pale, cold
absent/reduced pulses
delayed cap refill
loss of hair
Where are venous ulcers classically found?
lower leg/ankle
What do venous ulcers look like?
shallow and oval
Are arterial or venous ulcers painful?
arterial are classically more painful but both can be sore
