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Anaesthetics, ED and Plastics > Ulcers > Flashcards

Ulcers Flashcards

1
Q

What causes venous ulcers

A

Venous hypertension due to insufficiency
Incompetence valves caused by varicose veins / DVT
Leads to oedema

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2
Q

What are other RF

A

Immobility
Malnourishment
Recent major joint replacement

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3
Q

What are symptoms

A 
Asymptomatic
General discomfort / ach
Often painful 
Worse during the day / prolonged standing
Relieved raising the leg 
Itchy skin
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4
Q

What area

A

Common in gaiter region

Common in malleolar (medial > lateral)

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5
Q

What is seen O/E

A 
Large shallow irregular ulcer 
Exudative
Red / pink granulation tissue
Yellow slough
Pitting oedema = 1st sign
Venous eczema
Haemosiderin staining 
Varicose veins
Present pulses + warm skin
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6
Q

What is risk of venous ulcer

A

Develop into Marjolin’s ulcer

Irregular, raised, foul smelling

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7
Q

What is needed

A

Inspection
Lavage
Wide excision of necrotic and malignant tissue

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8
Q

How do you investigate venous ulcers

A

ABPI to ensure not arterial - will be normal

Venous duplex to look for reflux / thrombosis and asses function

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9
Q

How do you manage

A 
Principles of wound management 
- Inspection
- Remove devitalised
- Dressing 
Must treat underlying cause
May need Ax if infection 
Possible surgery for various veins
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10
Q

What do you do for oedema

A

Compression bandaging
Elevation
Rarely diuretics

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11
Q

What causes arterial ulcers

A 
Insufficient arterial supply 
PVD
Smoking
Age
DM
Hypertension
Hyperlipid
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12
Q

What are symptoms

A

Critical ischaemia pain
Get pain at rest
Worse lying flat
Releived by standing or hanging feet over bed

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13
Q

What are signs on examination

A 
Small sharply defined deep ulcer 
PAINFUL 
Necortic base 
Well demarcated 
Pale and dry
Little granulation
May see necrosis 
Hair loss
Cold skin 
Prolonged CRT
Absent pulses
Shiny pale skin
Loss of hair
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14
Q

What is Buerger

A

Elevate foot up to 30 degrees
Leads to colour fading and pain
When hang foot over bed then becomes deep red as fills with blood

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15
Q

How do you investigate

A

ABPI
Dupplex USS + angio
Percutaenous USS

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16
Q

How do you Rx

A

Basic wound
RF modification
Angioplasty or stent
Surgery - bypass or amputation

17
Q

What causes diabetic foot ulcers

A 
Hyperglycaemia = neuropathy and PVD
Autonomic = dry cracked skin
Motor = foot drop / deformity
18
Q

What are symptoms

A

Sensory loss so ulcer are not painful
Foul smell if infected
Sx of poor glycemic control

19
Q

What is seen O/E

A

Typically plantar
Thickened surrounding skin
Infection

20
Q

What is common cause of amputation

A

Infection

21
Q

How do you prevent

A 
Education 
BG control
Self foot care - examine regular, footwear, toenail care 
Identify RF
Regular foot review
22
Q

How do you Rx

A

Basic wound
Minimise neuropathy
Treat ischaemia - same as arterial

23
Q

How do you minimise neuropathy

A

Offloading
Custom footwear
Resection of wound / bony deformity

24
Q

What are pressure sores

A

Breakdown of skin and underlying tissue 2 to unrelieved pressure or friction

25
Q

Where are common sites

A

Sacrum
Ischial tubersoity
Greater trochanter of femur
Heels

26
Q

What are RF

A 
Immobile
Incontinence
Poor nutrition
Poor sensation
Age
27
Q

Stage 1

A

Non-blanching erythema
Red, warm, painful oedema
Skin intact

28
Q

Stage 2

A

Partial loss of epidermis or dermis
Often shallow ulcer with red / pink wound bed
No slough

29
Q

Stage 3

A

Full thickness loss

Subcutaneous involvement

30
Q

Stage 4

A

Full thickness loss

Involvement of muscle / bone / tendon

31
Q

What does stage 4 have high risk of

A

OM

32
Q

How do you prevent

A

Risk assess WATERLOW
Air mattress
Pressure relief

33
Q

How do you Rx

A 
Basic wound management
Plastic surgeon for skin graft 
Nutrition 
Mobilisation
Support surfaces / mattress
34
Q

What is typical history of neuropathic ulcer

A

Often painless
Abnormal sensation
Hx DM / neuro disease

35
Q

What is ulcer like

A 
Common on pressure sites
- Heel / toes / metatarsals 
Variable size and depth 
Maybe surrounded by hyperkeratotic lesion e.g. callus 
Warm skin
Normal pulses
Peripheral neuropahty
36
Q

What are possible investigations

A

ABPI
If <0.8 implies neuroischaemic ulcer common in DM
X-ray to exclude OM

37
Q

How do you manage

A

Wound debridement
Regular repositioning
Appropriate footwear
Good nutrition

38
Q

What are other types of ulcer

A

Vasculitic- purpuric and punched out
Infected - dischagrge + systemic unwell
Malignancy - SCC on background of chronic inflammation / non-healing ulcer

Anaesthetics, ED and Plastics (14 decks)

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