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Vascular > Leg ulcers > Flashcards

Leg ulcers Flashcards

1
Q

Why do arterial ulcers occur- physiology

A

Due to poor blood supply to the skin due to peripheral arterial disease

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2
Q

Why do venous ulcers occur-

physiology

A

Pooling of blood and waste products in the skin secondary to venous deficiency (varicose veins, DVT, phebilitis- inflammation of the vein)

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3
Q

Mixed ulcers- what are they

A

Combination of arterial and venous ulcers

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4
Q

Distinguishing features of arterial ulcers

A
  • Absent pulses
  • Pallor
  • Tend to be smaller
  • More regular border
  • Grey colour due to poor blood supply
  • Less likely to bleed
  • More painful than venous ulcers
  • Pain at night when legs elevated
  • Pain worse on elevating the leg- improved by hanging
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5
Q

Venous ulcers distinguishing features

A
  • Oedematous flushed skin
  • Hyperpigmentation to skin
  • Varixose eczema
  • tend to larger
  • Irregular border
  • More likely to blled
  • Pain relieved by elevation and worse on hanging
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6
Q

Management of ulcers (general)

A

Treat underlying cause

Would care- debridement, cleaning, dressing, antibiotics where infected

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7
Q

Arterial ulcers location

A
  • End of toes
  • Top of feet (dorsum)
  • Lateral ankle region (malleolus)
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8
Q

Appearance of arterial ulcers

A
  • Very little drainage
  • Little tissue granulation- pale pink or necrotic black
  • Deep punched out appearance with noticeable margins/edges
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9
Q

Appearance of venous ulcers

A
  • Medial parts of lower legs
  • Medial ankle region
  • Swollen with drainage
  • Granulation present- pink to red
  • Edges irregular
  • Shallow
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10
Q

Position to help alleviate pain of arterial ulcers

A

Dangling legs down - elevation makes pain WORSE

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11
Q

Position to help alleviate pain of venous ulcers

A

Elevation of legs- decreases swelling and helps with blood flow

Dangling legs or standing for long periods makes pain and edema worse

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12
Q

Arterial ulcer pain

A
  • Sharp- worst at night
    Intermittent claudication
  • Activity causes severe pain in the calf muscle, thighs, buttocks
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13
Q

Venous ulcer pain

A

Heavy, dull, throbbing, achy
Pain worst when standing or sitting

  • Elevating legs easer pain
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14
Q

Skin changes in arterial ulcers

A
  • Cool to touch
  • Thin, dry, scaly skin
  • Hairless
  • Thick toenails
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15
Q

Skin changes in venous ulcers

A
  • Warm to touch
  • Thick, tough skin
  • Brownish colour
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16
Q

Pulses in arterial ulcers

A

Very poor/absent

17
Q

Pulses in venous ulcers

A

Present, typically normal

18
Q

In which type of ulcer is oedema present?

A

Venous

19
Q

Name for area in the leg where venous ulcers occur

A

Gaiter’s area

20
Q

Link between venous hypertension and venous ulcers

A

Ulcers as a result of venous hypertension in the superficial vein due to incompetent valves in the deep/perforating veins or previous DVT

  • Increases pressure leads to extravastion of fibrinogen through capillary walls
21
Q

Causes of venous ulcers

A

Venous hypertension

  • Arterial disease
  • Neuropathic
  • Neoplastic
  • Vasculitis
  • Infection
  • Haematological
  • Drugs-
22
Q

Management of venous ulcers

A

High-compression bandaging- 4 layer bandaging and leg elevation due to reduced venous hypertension

  • Diuretics to help ease the swelling
  • Doppler scan
23
Q

Management of arterial ulcers

A

Keep the ulcer clean and remove pressure or trauma from the affected area

24
Q

Buerger’s disease- what is it

A

Buerger’s disease (also known as thromboangiitis obliterans) is a small and medium vessel vasculitis that is strongly associated with smoking.

25
Q

features of Buerger’s disease

A 
Features
extremity ischaemia
intermittent claudication
ischaemic ulcers
superficial thrombophlebitis
Raynaud's phenomenon
26
Q

Distinguishing between Buerger’s disease and critical limb ischaemia

A

Young male smoker with symptoms critical to limb ischaemia

CLI- more risk factors- DM, hypertension

27
Q

Critical limb ischaemia features

A

rest pain in foot for more than 2 weeks
ulceration
gangrene

28
Q

Interpretation of ABPI

A

> 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
1.0 - 1.2: normal
0.9 - 1.0: acceptable
< 0.9: likely PAD. Values < 0.5 indicate severe disease which should be referred urgently

Vascular (4 decks)

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