Limb Ulceration + Gangrene Flashcards

1
Q

What is gangrene?

A

Death of tissue from poor vascular supply, a sign of critical ischaemia

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2
Q

What is dry gangrene?

A
  • Necrosis in absence of infection
  • Linear demarcation between living + dead tissue
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3
Q

What is the management of dry gangrene?

A

Restoration of blood supply +/- amputation

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4
Q

What is wet gangrene?

A

Tissue death and infection

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5
Q

What is the management of wet gangrene?

A
  • Analgesia
  • Broad spectrum antibiotics
  • Surgical debridement +/- amputation
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6
Q

What is gas gangrene and risk factors??

A
  • Subset of necrotising fascitis
  • Caused by spore-forming clostridial species
  • Rapid onset of myonecrosis, muscle swelling, gas production, sepsis + severe pain
  • RFs → DM, trauma, malignancy
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7
Q

What is the management of gas gangrene?

A
  • Remove dead tissue eg. amputation
  • Benzylpenicillin +/- clindamycin
  • Hyperbaric O2 can reduce number of debridements
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8
Q

What are features of necrotising fascitis?

A
  • Rapid progressive infection of deep fascia causing necrosis of subcut tissue
  • Usually by Group A B-haemolytic strep, but mostly polymicrobial
  • Sx → intense pain of skin and underlying muscle
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9
Q

What is the management of necrotising fascitis?

A
  • Radical debridement +/- amputation
  • IV Abx eg. benzylpenicillin + clindamycin
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10
Q

What are differentials for shin lesions?

A
  • Erythema nodosum → symmetrical, erythematous, tender, heal without scarring; caused by strep, sarcoidosis, IBD, drugs (pencillins, sulphonamiddes, OCP)
  • Pretibial myxoedema → symmetrical, erythematous lesions, Graves’; shiny orange peel skil
  • Pyoderma gangrenosum → initially small red papule, later deep red necrotic ulcers, violaceous border, 50% idiopathic, also seen in IBD, connective tissue disorders
  • Necrobiosis lipoidica diabeticorum → shiny, painless areas of yellow/red skin on shin in diabetics, associated w/ telangiectasia
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11
Q

What are features of pyoderma gangrenosum?

A
  • Typically on lower limbs
  • Initially → small red papule
  • Later → deep red necrotic ulcers + violaceous border
  • +/- fever & myalgia
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12
Q

What are causes of pyoderma gangrenosum?

A
  • Idiopathic (50%)
  • IBD: UC + Crohn’s
  • Rheumatoid arthritis, SLE
  • Myeloproliferative disorders
  • Lymphoma, myeloid leukaemias
  • Primary biliary cirrhosis
  • Monoclonal gammopathy (IgA)
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13
Q

What is the management of pyoderma gangrenosum?

A
  • Potential for rapid progression is high in most pts
  • Most drs advocate oral steroids as first-line treatment
  • Other immunosuppressive therapy, eg. ciclosporin + infliximab have a role in difficult cases
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