Venous Disease including Chronic Ulcers Flashcards

Question

What is the conservative treatment of chronic venous disease?

Answer 1

``` Elevate legs - Not ideal in long-term management Avoid standing still - Not ideal in long-term managemt Dressings for ulceration Graduated compression stockings ```

Answer 2

People with early venous disease Preventative; eg: after ankle fusion Possibly for some elderly patients because many can't put on tighter socks

Answer 3

Inject something to shut down vein Done under ultrasound Less invasive

Answer 4

Sclerotherapy Open surgery Endovenous laser therapy Radiofrequency ablation

Answer 5

Ischaemic Neuropathic Stasis/venous Can be mixed aetiology

Answer 6

``` Infective - Syphilis - Mycobacterium - Osteomyelitis Neoplastic - Squamous cell carcinoma - Basal cell carcinoma - Melanoma - Metastatic - Kaposi's sarcoma Systemic disease - Pyoderma gangrenosum Traumatic - Thermal burns - Radiation - Bites ```

Answer 7

Condition causing tissue to become necrotic, causing deep ulcers on, usually on legs

Answer 8

Painful - but not always; eg: if have severe neuropathy History of claudication/rest pain Cardiovascular risk factors Previous peripheral vascular surgery

Answer 9

Location - Distal periphery - Over dorsum of foot/pretibia Punch-out edges = clearly demarcated edge, quite deep Ulcer base = poorly developed grey granulation tissue Surrounding skin pale/mottled with no signs of inflammation Little bleeding when debrided - Slow weeping bleed

Answer 10

``` Atrophic nails/skin Venous guttering Slow capillary return Absent pulses Beurger's positive ```

Answer 11

``` Elevate leg Drop legs (both for comparison) Bright rubor of skin as blood returns to limb ```

Answer 12

Usually cooler > compare to area on contralateral limb

Answer 13

Painless - May not feel pain directly - If neuropathic person suddenly feels pain > most likely deep tissue infection History of diabetes/other causes of neuropathy

Answer 14

``` Alcohol Stroke Myesthenia gravis Illicit drug use Chemotherapy HIV Syphilis Multiple sclerosis Congenital Sometimes severe B12 deficiency ```

Answer 15

``` Deep Location: pressure points/calluses - Plantar surface of metatarsophalangeal joints - Bunion/bunionette areas - Dorsum of interphalangeal joints - Base of 5th metatarsal - Callused posterior rim of heel pad Signs of neuropathy - Hypoaesthesia - Proprioception - 2-point discrimination - Vibratory perception Features of distorted foot architecture - Hyperextension of metatarsophalangeal joints - Hyperflexion of interphalangeal joints - Charcot's deformity ```

Answer 16

Because of motor neuropathy Small muscles of foot become weaker Larger muscles deform foot Loss of muscle bulk > loss of padding in foot

Answer 17

``` History of venous insufficiency? - Varicose veins - Superficial thrombophlebitis/deep vein thrombosis - Variceal bleeding Previous venous surgery ```

Answer 18

``` Larger and irregular edge Shallow Location: over gaiter area - Commonly medial malleolus Moist granulating base Surrounded by zone of inflammation and stasis dermatitis Associated signs of venous insufficiency ```

Answer 19

Lower part of leg, above ankle

Answer 20

``` Varicose veins Pitting oedema Varicose eczema Pigmentation Lipodermatosclerosis Atrophie blanche ```

Answer 21

``` Blood tests Swab X-ray +/- bone scan +/- MRI Duplex CT angiography Digital subtraction angiography Punch biopsy ```

Answer 22

``` Full blood exam Urea and electrolytes CRP Glucose HbA1c Vasculitis screen ESR Thrombophilic screen ```

Answer 23

Clean wound | Get to red area

Answer 24

Punch biopsy

Answer 25

``` Bed rest Elevation/dependency IV antibiotics Dressings Debridement Treat underlying aetiology - Try and do this first otherwise management won't work ```