Venous Ulcers

Question 1

Define venous ulcers.

Answer 1

Venous ulcers are caused by venous stasis in the leg and thus less painful when elevated and drained of blood. Only 30% of venous ulcers are painful.

Question 2

Explain the aetiology/risk factors of venous ulcers.

Answer 2

Varicose veins
Immobility
Malnourished (reduced healing)
Patients with recurrent DVT
Pelvic mass (compressing iliac veins)
Arteriovenous malformations
Major joint replacement

Question 3

Summarise the epidemiology of venous ulcers.

Answer 3

Venous ulcers commonly present in older people who have varicose veins are quite immobile.

Question 4

Recognise the presenting symptoms of venous ulcers. Recognise the signs of venous ulcers on physical examination.

Answer 4

Location: where venous pressure is highest (e.g. medial malleolus)
Shallow, wet, irregular borders that look white and fragile
Oedema
Extravasation
Death of erythrocytes (atrophie blanche)
Superficial varicose veins

Question 5

Identify appropriate investigations for venous ulcers and interpret the results.

Answer 5

Investigate for signs of atherosclerotic disease:
BM
FBC
Fasting lipids
Urinalysis
Venous duplex ultrasound
Ankle-brachial pressure index
Biopsy

Question 6

Generate a management plan for venous ulcers.

Answer 6

Adequate nutrition
Lifestyle modification
Leg elevation
Compression bandages
Graduated class I or II elastic stockings
Varicose vein surgery

Question 7

Identify the possible complications of venous ulcers and its management.

Answer 7

Risk of infection
Blood loss

Question 8

Summarise the prognosis for patients with venous ulcers.

Answer 8

With management, 80% of venous ulcers will heal within 6 months.