Vascular: Arterial, Venous, Neuropathic Ulcers and Lymphedema ☺️ Flashcards
What are ulcers
Abnormal breaks in skin or mucous membranes
Venous ulcers
- risk factors
- pathophysiology
Most common ulcer
Increased venous pooling => reduced venous return => uneven, impaired tissue perfusion => ulceration, delayed healing
Age Existing/Hx venous problems -VTE -varicose veins Pregnancy, obesity, physical inactivity Leg trauma
Venous ulcer
-presentation
Before ulcers appear - Aching, itching
Painful Superficial, irregular borders Gaiter region Leg edema Varicose veins
Infection prone (cellulitis)
Hemosiderin staining - hemosiderin pools in veins
Venous eczema
Lipodermatosclerosis
Atrophie blanche - white scar after ulcer heals
Venous ulcer
-investigations
Clinical diagnosis
Investigation only confirms findings
-insufficiency confirmed by duplex
If infection present - swabs and ABx
Venous ulcer
-management
Definitive - compression bandaging
Conservative - leg elevation, increased physical activity
-weight reduction
ABx if infection found
Arterial ulcer
- risk factors
- pathophysiology
CV risk factors
Reduction in arterial blood flow => reduced perfusion and poor healing
Arterial ulcer
-presentation
Existing intermittent claudication or critical limb ischemia
Develops over long period of time with v little healing
Small deep lesions Well demarcated Long CRT Patient may sleep in a chair, increase blood flow to legs Distal to trauma sites Pressure areas
Cold limbs Reduced/no pulse Thick, necrotic toes Hair loss Shiny taut skin
Arterial ulcer
-investigations
Clinical diagnosis but confirm location and severity with investigations
ABPI - measure severity of PAD
- 1 = :)
- 0.5+ = PAD
- U0.5 = critical limb ischemia
Duplex => assess location of arterial disease leading to distal ischemia
Arterial ulcer
-management
Vascular review needed if ulcers present (critical limb ischemia)
- Conservative - CV risk lifestyle changes
- Medical - lipid modification, aspirin, HTN, DM
Surgical - if extensive disease
-angioplasty, stenting
Neuropathic ulcer
- risk factors
- pathophysiology
Result of peripheral neuropathy
-loss of protective sensation => unnoticed injuries resulting in painless ulcers on pressure points
Healing complicated by concurrent vascular disease
Most common causes
-DM
-B12 deficiency
Ulcer risk made worse by existing foot deformity, PVD
Neuropathic ulcer
-presentation
Hx of peripheral neuropathy -burning, tingling, pain in legs -weakness, balance issues -length dependent neuropathy Hx of PVD
Punched out appearance of ulcers on pressure sites
Warm feet, pulses unless concurrent arterial disease
Difference between wet and dry gangrene
Gangrene - tissue death from ischemia
Dry - chronic ischemia without infection
-cannot be saved
Wet - ischemia leading to necrosis + bacterial infection
Neuropathic ulcers
-investigations
Glucose check
B12 check
Assess for arterial disease - ABPI, duplex
If infection - swab
Assess extent of peripheral neuropathy with tuning fork
Neuropathic ulcers
-management
Optimise diabetic control
-HbA1c
-diet, exercise
Optimise CV risk factors
Regular chiropody
- foot hygiene
- good footwear
Signs of infection - ABx
Ischemic/necrotic tissue - debride or amputate
What is Charcot’s Foot
Loss of joint sensation => continuous joint trauma leading to foot deformity
-increased risk of neuropathic ulcers
Swollen, distorted, painful foot
Specialist review needed
- offload abnormal weight
- immobilise joint in plaster
