Venous ulcers

Question 1

Define venous ulcers?

Answer 1

large, shallow, sometimes painful ulcers found superior to medial malleoli

They are caused by incompetent valves in lower limbs leading to venous stasis and ulceration

Question 2

explain the aetiology of venous ulcers?

Answer 2

incompetent valves in the lower limbs

valve incompetence leads to venous stasis and increasing venous pressure

This results in ulceration

Question 3

what are the risk factors for venous ulcers?

Answer 3

obesity

immobility

recurrent DVT

varicose veins

previous injury surgery to leg

age

Question 4

summarise the epidemiology of venous ulcers?

Answer 4

very common

increases with age

Question 5

what does a venous ulcer look like

Answer 5

Large, shallow, relatively painless ulcer with an irregular margin with sloping sides situated above the medial malleoli - gaiter area (most of the time) May weep serous fluid

Question 6

what are the significant features of the history for venous ulcers?

Answer 6

Varicose veins

DVT

Phlebitis

Fracture, trauma or surgery

Family history

Other symptoms of venous insufficiency:

• Swelling
• Itching
• Aching

Question 7

what are the signs of venous ulcers on physical examination?

Answer 7

Large, shallow, relatively painless ulcer with an irregular margin with sloping sides situated above the medial malleoli - gaiter area (most of the time) May weep serous fluid

• Stasis eczema
• Lipodermatosclerosis (inverted champagne bottle sign if SEVERE)
• Haemosiderin deposition (dark colour)
• Atrophie blanche
• Oedema

Question 8

what are the appropriate investigations for venous ulcers?

Answer 8

Duplex USS

ABPI

• Exclude arterial ulcer
• If ABPI < 0.8 - do NOT apply a pressure bandage as this could worsen the ulcer

Measure surface area of ulcer - allows monitoring of progression

Swabs for microbiology - if signs of infection

Biopsy - if possibility of Marjolin’s ulcer

Question 9

what are the possible complications of venous ulcers?

Answer 9

Recurrence

Infection

Question 10

summarise the prognosis for patients with venous ulcers?

Answer 10

GOOD

results are better if patients are mobile with few comorbidities

Question 11

compare the risk factors and epidemiology for arterial and venous ulcers?

Answer 11

Question 12

compare the investigations for arterial and venous ulcers?

Answer 12