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Vascular YR3 > Leg ulcers - venous, arterial and diabetic > Flashcards

Leg ulcers - venous, arterial and diabetic Flashcards

1
Q

3 origins of ulcers

A
  • Venous- majority
  • Arterial insufficiency
  • Diabetic neuropathy
  • Can also get pressure ulcers
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2
Q

Venous ulcers

A
  • Shallow ulcers
  • Granulated base
  • Other features of venous insufficiency present eg varicose eczema, haemosiderin
  • Classically medial malleolus
  • Prone to infection - can present with cellulitis features
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3
Q

Arterial ulcers

A
  • Distant sites
  • Well defined borders
  • Other features of arterial insufficiency
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4
Q

Neuropathic ulcers

A
  • Painless ulcers
  • Areas of abnormal pressure, plantar surface
  • Secondary to joint deformities in diabetics
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5
Q

Pathophysiology of venous ulcers

A
  • Impaired venous return (valvular incompetence or venous outflow obstruction)
  • Trapped WBC in capillaries
  • Formation of fibrin cuff around vessel, hindering O2 delivery
  • Release of inflammatory mediators
  • = tissue injury, poor healing, necrosis
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6
Q

Define ulcer

A
  • Break in epithelial continuity
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7
Q

RF for venous ulcer

A
  • Increasing age
  • Pre-existing venous incompetence/history of VTE (inc varicose veins)
  • Pregnancy
  • Obesity or physical inactivity
  • Leg injury/trauma
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8
Q

Anatomy of ulcer

A
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9
Q

Classification of ulcers - edge

A
  • SUPER
  • Sloping edge - venous
  • Undermined edge - TB/pressure sores
  • Punched out edge - arterial, diabetes, syphilis
  • Everted edge - SCC
  • Raised edge - BCC
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10
Q

Site of ulcers and common cause

A
  • Medial malleolus - venous, varicose
  • Upper part of face, above line joining mouth and ear - BCC/rodent ulcer
  • Foot sole, great toe sole - diabetic ulcer, painless
  • Digits of lower limbs - arterial
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11
Q

Investigations for venous ulcer

A
  • Duplex USS - looks for reflux and flow
  • APBI to rule out arterial insuffienciency
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12
Q

Management venous ulver

A
  • Multicomponent pressure bandaging - changed every week
  • Leg elevation, increased exercise, weight loss improved nutrition
  • Use emoilients too
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13
Q

Surgery for venous ulcers?

A

If varicose veins present - treat with endovenous techniques or open surgery

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14
Q

RF for arterial ulcers

A
  • PAD RF eg
  • Smoking
  • Diabetes mellitus
  • HTN
  • Hyperlipidaemia
  • Increasing age
  • Positive FH
  • Physical inactivity
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15
Q

Reasons for amputation (3D’s)

A
  • Dead - dry gangrene, sometimes autoamputates
  • Deadly - malignant tumours, sepsis
  • Damn nuisance - retaining limb worse than keeping - eg severe loss function, malformation
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16
Q

Management neuropathic ulcer

A
  • Optimise diabetic control - good diet and exercise
  • Regular chiropody - cushioned shoes, foot hygiene
  • Diabetic foot clinics
  • If infection - swab and start abx (flucloxacillin)
  • Ischaemic or necrotic tissue will need debridement
17
Q

Clinical features of arterial ulcer

A
  • History of intermittent claudication
  • Develops over long period of time, no healing
  • Painful
  • Limbs cold with absent or weak pulses
  • Shiny thin skin - less blood to skin = hair loss, atrophy easy to damage
18
Q

Investigations for arterial ulcer

A
  • ABPI
  • Imaging - duplex USS, CT angiograph MR angiogram
19
Q

Management arterial ulcer

A
  • Vascular review
  • Conservative - classic reduce RF
  • Medical - statin, aspirin or clopidogrel, optimise BP and BMs
  • Surgery - angioplasty +/- stent or bypass grafing
20
Q

Investigations for neuropathic ulcer

A
  • Blood glucose levels - random or HbA1C
  • B12 levels
  • Infection - swab
  • X-ray to assess osteomyelitis
  • Assess neuropathy with 10g monofilament and 128Hz vibtration tuning fork
21
Q

Chronic/non-healing ulcer

A
  • remains more than 6 weeks
  • Not responding to management
22
Q

Charcot foot

A
  • Seen alongside neuropathic ulcers
  • Loss of joint sensation = continual unnoticed trauma and deformity
  • Present with swelling and disortion
  • Loss of transverse arch - rocker bottom foot
  • Need immbolisation in plaster
23
Q

What is Marjolin ulcer

A
  • Site of chronic inflamm - burns, osteomyelitis after 10-20 years
  • Type of SCC
  • Mainly lower limb
24
Q

What is pyoderma gangrenosum?

A
  • Associated with IBD and RA
  • Can occur at stoma sites
  • Erythematous nodules or pustules which ulcerate
25
Q
A

Vascular YR3 (16 decks)

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