Ulcers Flashcards
What causes venous infufficiency?
varicose veins
incompetent venous valves
What causes incompetent venous valves?
thrombus formation or congenital
What are the risk factors for venous insufficiency?
Age Obesity Lifestyle Sedentary; Occupation Pregnancy H/o DVT Leg injury Phlebitis Female
Which one is more common: venous or arterioal insufficiency?
venous
What is the presentation of venous insufficiency?
Burning Swelling Throbbing Cramping Aching Heaviness Restless leg Leg fatigue
What is seen on PE of venous insufficiency?
Edema Varicose veins Hyperpigmentation Chronic cellulitis Cutaneous infarction Atrophie blanche Lipodermatosclerosis Stasis dermatitis Ulceration
What are early signs of venous insufficiency?
statis dermatitis, inflammation of skin
What is lipdermatosis also called?
champagne bottle legs
Who gets stasis dermatitis more?
women, increase risk with age
What are signs and symptoms of stasis dermatitis?
Pruritis
Discoloration
Medial ankle involvement and progression to foot &/or calf
Edema
What are the treatments for stasis dermatitis?
Control venous insufficiency and edema
Compression
Ligation of vessels?
What ABX do you use for stasis derm?
topical for erosions
Oral if cellultis
What steroid do you use for stasis derm?
triamcinolone 0.1% ointment
What is most common of lower extremity ulcers?
venous ulcers
What are risk factors for venous ulcers?
Venous Insufficiency Age Obesity Previous Leg injury DVT Phlebitis
Who gets venous ulcers more often?
> 65 yo
How do you dx venous ulcers?
Ankle-brachial index
Ratio of BP at ankle to arm
Color duplex ultrasonography
Venography
Where do you see venous ulcers?
medial!
What is the treatment for venous ulcers?
Underlying Cause Compression therapy -Caution with arterial insufficiency -Elastic -Inelastic ---Unna boot: zinc oxide-impregnated, moist bandage that hardens after application -Intermittent pneumatic compression Leg elevation Wound vac - negative pressure Meds Hyperbaric oygen therapy surgery
What are the dressing types for venous ulcers?
Hydrocolloids Hydrogels Foams Pastes Simple nonadherent dressings
What meds can you use for venous ulcer treatment?
Pentoxifylline (Trental) ASA Iloprost ?? Oral Zinc Antibiotics
What does pentoxifylline do?
Inhibits platelet aggregation, decreases blood viscosity and improves microcirculation
What is the surgical treatment for venous ulcers?
debridement, grafing, venous insufficiency
What is the treatment for venous insufficiency?
Vein ablation Phlebectomy Stripping Sclerotherapy Laser therapy
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What is the most common cause of arterial insufficiency?
atherosclerosis
What are the risk factors for atherosclerosis?
Cigarette smoking
Diabetes Mellitus
Dyslipidemia
Hypertension
What isi the signs and symptoms of arterial insufficiency?
Intermittent claudication Progresses to resting pain/night pain Pallor Cyanosis Livedoid vascular pattern Loss of hair Decreased pulses
What are 25% of leg ulcers?
arterial ulcers
What is the etiology of arterial ulcers?
Atherosclerosis Diabetes Thromboangiitis Thalassemia Sickle cell disease
What is the presentation of arterial ulcers?
painful, punched out, necrotic base, at pressure sites
What are pressure sites that get arterial ulcers?
distal toes, pretibial, supramalleolar - lateral
How do you dx arterial ulcers?
ABIs
Duplex Ultrasonography
CT angiography
MR angiography
How do you treat arterial ulcerS?
Underlying cause Endarterectomy By-pass surgery Wound care Dressings debridement Medications
What medications do you use for arterial ulcers?
heparin, warfarin, analgesics
What is the most common cause of neuropathic ulcers?
diabetic neuropathy
What is sensory neuropathy caused?
urecognized trauma
What does motor neuropathy cause?
biomechanical changes leading to increased mechanical stress
What dose autonomic neuropathy cause?
AV shunting causing decreased perfusion
decreased sweating
increased dryness and fissuring
What do you get to dx neuropathic ulcers?
NCS/EMG ABI Labs: CBC, ESR, CRP Wound cultures Imaging Plain Films MRI
What is the treatment of neuropathic ulcers?
underlying problems pt education wound care - skin graph surgery Hyperbaric oxygen tx medications
What are the surgery tx for neuropathi ulcers?
debridement, revision surgery, vascular reconstruction
What is the medication for neuropathic ulcers?
Pentoxifylline (Trental)
-Improved blood flow and enhances tissue oxygenation
Cilostazol (Pletal)
-Dilation of vascular beds thus decreasing symptoms of intermittent claudication
Antiplatelet agents
-Clopidogrel (Plavix)
-ASA
What are some wound healing agents for neuropathic ulcers?
becaplermin (Regranex) - topical recombinant human PDGF
What are pressure ulcer?
decubitus or bed sores
Where are the common spots of pressure ulcers?
heels, sacrum, ischial tuberosities, lateral> medial malleolus, greater trochanter
What are less common spots of pressure ulcers?
head, back, elbows, shoulders
What is a pressure ulcer?
Compression of bony prominence against external surface
What causes pressure ulcers?
continuous pressure, shearing forces/friction, moisture
What are risk factors for pressure ulcers?
Elderly
Sensory deficits
Poor nutrition
Nursing home resident
What has the highest prevalence of pressure ulcers?
crit care/ICU
What is the age distribution for pressure ulcers?
3rd decade related to spinal cord
>75 yo
What is the gender relation in pressure ulcers?
younger male predom
older female predom
What is the pressure ulcer presentation?
Good history of the onset of ulcer Associated medical history Neurologic cause Bedridden Pain Odor Stage of ulcer Fever, chills, increased pain
What are diagnostic studies for pressure ulcers?
CBC, CRP, ESR Blood cultures Nutritional status UA and culture- urinary incontinence Stool exam- fecal incontinence Imaging Plain films Bone Scan MRI
What is the treatment for pressure ulcers?
prevention - pressure reduction, positive change
nutrition supplements
wound care
surgical debridement
