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Dermatology - Clinical Medicine IV > Ulcers > Flashcards

Ulcers Flashcards

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1
Q

What causes venous infufficiency?

A

varicose veins

incompetent venous valves

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2
Q

What causes incompetent venous valves?

A

thrombus formation or congenital

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3
Q

What are the risk factors for venous insufficiency?

A 
Age
Obesity
Lifestyle
Sedentary; Occupation
Pregnancy
H/o DVT
Leg injury
Phlebitis
Female
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4
Q

Which one is more common: venous or arterioal insufficiency?

A

venous

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5
Q

What is the presentation of venous insufficiency?

A 
Burning
Swelling
Throbbing
Cramping
Aching
Heaviness
Restless leg
Leg fatigue
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6
Q

What is seen on PE of venous insufficiency?

A 
Edema 
Varicose veins
Hyperpigmentation
Chronic cellulitis
Cutaneous infarction
Atrophie blanche
Lipodermatosclerosis
Stasis dermatitis
Ulceration
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7
Q

What are early signs of venous insufficiency?

A

statis dermatitis, inflammation of skin

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8
Q

What is lipdermatosis also called?

A

champagne bottle legs

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9
Q

Who gets stasis dermatitis more?

A

women, increase risk with age

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10
Q

What are signs and symptoms of stasis dermatitis?

A

Pruritis
Discoloration
Medial ankle involvement and progression to foot &/or calf
Edema

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11
Q

What are the treatments for stasis dermatitis?

A

Control venous insufficiency and edema
Compression
Ligation of vessels?

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12
Q

What ABX do you use for stasis derm?

A

topical for erosions

Oral if cellultis

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13
Q

What steroid do you use for stasis derm?

A

triamcinolone 0.1% ointment

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14
Q

What is most common of lower extremity ulcers?

A

venous ulcers

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15
Q

What are risk factors for venous ulcers?

A 
Venous Insufficiency
Age
Obesity
Previous Leg injury
DVT
Phlebitis
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16
Q

Who gets venous ulcers more often?

A

> 65 yo

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17
Q

How do you dx venous ulcers?

A

Ankle-brachial index
Ratio of BP at ankle to arm
Color duplex ultrasonography
Venography

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18
Q

Where do you see venous ulcers?

A

medial!

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19
Q

What is the treatment for venous ulcers?

A 
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
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20
Q

What are the dressing types for venous ulcers?

A 
Hydrocolloids
Hydrogels
Foams
Pastes
Simple nonadherent dressings
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21
Q

What meds can you use for venous ulcer treatment?

A 
Pentoxifylline (Trental)
ASA
Iloprost
?? Oral Zinc
Antibiotics
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22
Q

What does pentoxifylline do?

A

Inhibits platelet aggregation, decreases blood viscosity and improves microcirculation

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23
Q

What is the surgical treatment for venous ulcers?

A

debridement, grafing, venous insufficiency

24
Q

What is the treatment for venous insufficiency?

A 
Vein ablation
Phlebectomy
Stripping
Sclerotherapy
Laser therapy
25
Q

Look at chart in PPT

A

kjlkkkjjklhkh

26
Q

What is the most common cause of arterial insufficiency?

A

atherosclerosis

27
Q

What are the risk factors for atherosclerosis?

A

Cigarette smoking
Diabetes Mellitus
Dyslipidemia
Hypertension

28
Q

What isi the signs and symptoms of arterial insufficiency?

A 
Intermittent claudication
Progresses to resting pain/night pain
Pallor
Cyanosis
Livedoid vascular pattern
Loss of hair
Decreased pulses
29
Q

What are 25% of leg ulcers?

A

arterial ulcers

30
Q

What is the etiology of arterial ulcers?

A 
Atherosclerosis
Diabetes
Thromboangiitis
Thalassemia
Sickle cell disease
31
Q

What is the presentation of arterial ulcers?

A

painful, punched out, necrotic base, at pressure sites

32
Q

What are pressure sites that get arterial ulcers?

A

distal toes, pretibial, supramalleolar - lateral

33
Q

How do you dx arterial ulcers?

A

ABIs
Duplex Ultrasonography
CT angiography
MR angiography

34
Q

How do you treat arterial ulcerS?

A 
Underlying cause
Endarterectomy
By-pass surgery
Wound care
Dressings
debridement
Medications
35
Q

What medications do you use for arterial ulcers?

A

heparin, warfarin, analgesics

36
Q

What is the most common cause of neuropathic ulcers?

A

diabetic neuropathy

37
Q

What is sensory neuropathy caused?

A

urecognized trauma

38
Q

What does motor neuropathy cause?

A

biomechanical changes leading to increased mechanical stress

39
Q

What dose autonomic neuropathy cause?

A

AV shunting causing decreased perfusion
decreased sweating
increased dryness and fissuring

40
Q

What do you get to dx neuropathic ulcers?

A 
NCS/EMG
ABI
Labs: CBC, ESR, CRP
Wound cultures
Imaging
Plain Films
MRI
41
Q

What is the treatment of neuropathic ulcers?

A 
underlying problems
pt education
wound care - skin graph
surgery
Hyperbaric oxygen tx
medications
42
Q

What are the surgery tx for neuropathi ulcers?

A

debridement, revision surgery, vascular reconstruction

43
Q

What is the medication for neuropathic ulcers?

A

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

44
Q

What are some wound healing agents for neuropathic ulcers?

A

becaplermin (Regranex) - topical recombinant human PDGF

45
Q

What are pressure ulcer?

A

decubitus or bed sores

46
Q

Where are the common spots of pressure ulcers?

A

heels, sacrum, ischial tuberosities, lateral> medial malleolus, greater trochanter

47
Q

What are less common spots of pressure ulcers?

A

head, back, elbows, shoulders

48
Q

What is a pressure ulcer?

A

Compression of bony prominence against external surface

49
Q

What causes pressure ulcers?

A

continuous pressure, shearing forces/friction, moisture

50
Q

What are risk factors for pressure ulcers?

A

Elderly
Sensory deficits
Poor nutrition
Nursing home resident

51
Q

What has the highest prevalence of pressure ulcers?

A

crit care/ICU

52
Q

What is the age distribution for pressure ulcers?

A

3rd decade related to spinal cord

>75 yo

53
Q

What is the gender relation in pressure ulcers?

A

younger male predom

older female predom

54
Q

What is the pressure ulcer presentation?

A 
Good history of the onset of ulcer
Associated medical history
Neurologic cause
Bedridden
Pain
Odor
Stage of ulcer
Fever, chills, increased pain
55
Q

What are diagnostic studies for pressure ulcers?

A 
CBC, CRP, ESR
Blood cultures
Nutritional status
UA and culture- urinary incontinence
Stool exam- fecal incontinence
Imaging
Plain films
Bone Scan
MRI
56
Q

What is the treatment for pressure ulcers?

A

prevention - pressure reduction, positive change
nutrition supplements
wound care
surgical debridement

Dermatology - Clinical Medicine IV (31 decks)

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