Ulcers Flashcards
Where do you see venous ulcers vs arterial ulcers vs neuropathic ulcers
Venous - mainly medial malleolus
Arterial - mainly at pressure points/trauma areas
Neuropathic - pressure points
What is the appearance of a venous ulcer?
Shallow
Irregular border
Granuloma
What is the appearance of an arterial ulcer?
Deep
Well defined border
What is the appearance of a neuropathic ulcer?
Punched out ulcer
What other changes do you see in neuropathic ulcers?
Rocker bottom feet due to Charcot’s foot
Amotrophic neuropathy
Tingling/burning
What skin changes do you see in venous ulcers?
Thickening and champagne bottle appearance of calf due to fibrosis from lipo-dermato-sclerosis
Brown skin - haemosiderin skin staining
Thrombophlebitis changes?
Blanching atrophy?
What other leg changes do you see in arterial ulcers?
Cold limbs
Absent pulses
Necrotic toes
Thick nails
Sensation intact (not intact in neuropathic ulcer)
Associated symptoms in venous ulcers
Burning
Aching
Itching
Associated symptoms in arterial ulcers
Intermittent claudication/critical limb ischemia pain
Associated symptoms in neuropathic ulcers
Loss of sensation
Investigations for venous ulcers
USS Doppler
ABPI (to see if compression stockings will be tolerated with good arterial blood flow)
Swab cultures
Investigations for arterial ulcers
ABPI
CT Angiography
Investigations for neuropathic ulcers
BM/HbA1c
Swab
X-ray for osteomyelitis
Neuro exam for sensation and vibration
Management of a venous ulcer
Ivx - USS Doppler and ABPI to exclude an arterial ulcer
Conservative
- elevate legs + lots of exercise
- graded compression bandaging/stockings (30-75% heal in 6m)
- emollients
- varicose vein treatment
Management of an arterial ulcer
Invx - ABPI, CT angiography
Risk factor modification
Statin
Antiplatelet meds
Optimise BP + DM
Surgery:
Angioplasty with or without stenting
Bypass grafting
