lower limb ulcers

Question 1

what is the most common type of LL ulcer?

Answer 1

80% are venous

Question 2

what are the causes of lower limb ulcers? (8)

Answer 2

venous
arterial
neuropathic
vasculitis
malignancy
trauma
infection
pressure

Question 3

where are venous ulcers found and what do they look like?

Answer 3

they are found in the gaiter region and they are shallow with granulation tissue.

Question 4

what are the clinical feautures of venous ulcers

Answer 4

there will be other signs of venous insufficiency, such as lower limb oedema, haemosiderin staining, varocose veins, lipodermatosclerosis and white scars from healing. they will be painful

Question 5

what invesitations would you choose for venous ulcers?

Answer 5

if looks infected swab.
ABPI to see if arterial insuffiency as well as contraindicated in wrapping. identify the venous occlusion with dopler.

Question 6

what treatment can be offered for venous ulcers?

Answer 6

elevate, weight loss, good nutrition and exercise. treat the varicose veins. compression bandages.

Question 7

what causes arterial ulcers?

Answer 7

Caused by a reduction in blood flow , leading to decreased perfusion of the tissues leading to poor wound healing.

Question 8

what are the clinical features of arterial ulcers?

Answer 8

small deep lesions, well defined borders and necrotic base, sites of trauma and pressure areas.

Question 9

what are some risk factors for for arterial ulcers

Answer 9

moking, diabetes, hypertension, age, family history, obesity, physical inactivity.

Question 10

what are some key historical features of artirial ulcers?

Answer 10

intermittent claudication, critical limb ischaemia (pain in the leg at night)

Question 11

what are the expected examination findings in arterial ulcers

Answer 11

there will be no granulation tissue, ie no healing, cold limbs, thickened nails, necrotic toes and hair loss, absent pulses, sensation maintained.

Question 12

how would you investigate arterial ulcers?

Answer 12

Investigate with ankle brachial pressure index , duplex ultrasound, CT angiogrpahy and MRI angiogram.

Question 13

what are the management options for arterial ulcers?

Answer 13

1. Conservative : lifestyle changes
   
   2. Medical : cardiovascular risk factor modification, statin, aspirin or clopidogrel, antihypertensive and glucose monitoring.
      Surgical : angioplasty with or without stenting or artery bypass grafting.

Question 14

what are the most significant risk factors for neuropathic ulcers?

Answer 14

diabetes and vitamin B12 deficiency.

Question 15

what examination findings would you expect in a neruopathic ulcer?

Answer 15

the ulcers look punched out in appearance can be different sizes a shapes, peripheral neuropathy with glove and stocking distribution.
Test fine touch and vibration.

Question 16

how would you investigate for a neuropathic ulcer?

Answer 16

Glucose
Bloods for B12
Look for arterial disease with ABPI
If infected needs swabs
Imaging for osteomyelitis.

Question 17

how would yo manage neuropathic ulcers?

Answer 17

1. Conservative: increase exercise, get sugars under control, MDT, manage cardiovascular risk factors.
   
   2. Medical: infection treat with flucloxicillin.
      Surgical: ischaemic or necrotic tissue will need to be debrided.

Question 18

what is charcot foot?

Answer 18

Neuropathic ulcers are common with charcot foot.
This is a neuroarthropathy
Patients present with deformity and pain from multiple unnoticed insults.
Treat with offloading.