Part 2 Flashcards
Causes of Neuropathic Ulcer
Vasculitis: RA / PAN
Inflammatory: CIDP
Toxic / Trauma: Alcohol / Lead
Alcohol / Drugs
Metabolic: DM / CKD / Hypothy
Infectious: TB
Inherited / Familial: Charcot-Marie-Tooth
Food: Low B12, Low B1
Differentials of Leg Pain
Vascular
- Intermittent Claudication
- Critical ischaemia
- DVT
Nerve
- Radiculopathy
- Peripheral nerve lesion
- Spinal claudication
Musculoskeletal
- muscle cramps
- muscle tears
- osteoarthritis
Causes of Arterial Ulcer
Large Vessel
- Arteritis
- Thromboangiitis
Small Vessel
- HTN
- DM
- Vasculitis (PAN)
- Rheumatoid Arthritis
Causes of Venous Ulcer
- Valvular disease: varicose veins, deep vein reflux (post DVT), Communicating Vein reflux
- Outflow tract obstruction: post-DVT
- Muscle Pump Failure
Primary: Stroke, NM disease
Secondary: ankle injury
Investigations for Ulcers
Fasting Glucose
ABPI
Duplex US
X-ray: exclude osteomyelitis
Swabs: exclude infection
Treatment for Arterial Ulcers
Vascular Reconstruction
- Reperfusion Therapy
- Tissue Viability Nurses
- Lifestyle mod (remove beta blockers)
Treatment for Venous Ulcers
Compression Bandaging: after excluding arterial disease w/ ABPI
>0.8 for compression bandaging
Treatment for Neuropathic Ulcers
Debridement
Get good footwear
Regular repositioning
Foot checking advice
NO barefoot walking
Location of Arterial Ulcers
Tip of toes
Pressure areas (metatarsal heads, soles, heels, toes)
Pre-tibial area
Location of Venous Ulcers
Gaiter area
Above medial malleolus
Location of Neuropathic Ulcers
Pressure points (metatarsal heads, soles, heels, toes)
Under calluses
What is the usual HOPC of an arterial ulcer
Nocturnal pain
Worse with elevated leg
What is the usual HOPC of a Venous Ulcer
Mild pain
Worse on standing
Ass/w Varicose veins
What is the usual HOPC of a Neuropathic Ulcer
Painless
Decrease peripheral sensation
What is seen O/E for an Arterial Ulcer
Small + deep
Well defined
Punched out
Necrotic base
- slough = infected
- no healthy granulation tissue = poor blood supply
What is ass/w an Arterial Ulcer
Weak pulse
Cool skin
Hairless
Nail dystrophy
Bone can be exposed @ base
O/E for a Venous Ulcer you will see an ulcer which is…
Large + Superficial
Irregular
Sloping edges
Exudative (seropurulent discharge)
Granulating Base (Pink/White)
What is Ass/w a Venous Ulcer
Varicosities
Venous eczema
Haemosiderin staining
Atrophie blanche
Lipodermatosis
Oedema
Surrounding skin is warmer than the rest of the leg
O/E for a Neuropathic Ulcer you will see an ulcer which is…
Small and deep
Well-defined
Punched out
Granulating Base
Also do a neuro exam of LL (sensation and pain)
Check for Peripheral Pulses
Skin Temp checks
What is Ass/w with a Neuropathic Ulcer
Telangectasia
Spider Naevi
Glove + stocking sensory loss
Overlying hyperkeratosis
