Wed - Spoelhof - Ulcers Flashcards
What is “the best” way of providing nutritional support to someone with an ulcer?
Protein, 1-1.5 g/kg/day
Should you give individual zinc and vit C supplements to an ulcer patient.
He said its not helpful, just give a multi vit.
What should you clean an ulcer with
Saline, avoid antiseptics.
Types and rates of lower extremity ulcers
Venous insufficiency: 80 - 90%
Arterial insufficiency: 5%
Neurotrophic ulcers: 2% (and climbing with increased diabetes)
Where do venous leg ulcers typically present, describe them?
Medial malleolus. Hyperpigmentation, edema that will not diurese, sometimes varicose veins.
Normal pulse
superficial, often large
Arterial ulcers
Circumscribed, “punched out” often multiple. Shiny, hairless skin. Claudication (pain in extremity during exercise).
absent foot pulse
deep ulcer painful
cold toes thick nails hairloss
ABI
Ankle-Brachial index - blood pressure in ankle over brachial BP
normal is 1 or above
below .8 causes claudication
below .4 causes rest pain
Allen test
push blood out of hand, occlude radial and ulnar arteries, open hand, release ulnar artery. blood should perfuse back into hand.
Buerger’s disease
Thrombangiitis obliterans, or blockage of vessels in hands and feet due to smoking.
Neurotrophic ulcer. Treatment?
type of pressure ulcer on the plantar aspect of foot or toe. caused by peripheral neuropathy, usually diabetic. can have loss of the arch of the foot (charcot foot).
Reduced sensation,
callosity
Total contact cast
Basal cell carcinoma
Most common skin cancer.
heaped up or rolled edges.
usually sun-exposed surfaces.
does not metastasize usually.
Squamous cell skin cancer
May occur as a complication of previously benign ulcer. May metastasize, check regional lymph nodes.
Pyoderma Gangrenosum
Autoimmune. (steroids may help)
A pustule or blister precedes this, it pops and spreads fast. edges of hamburger looking tissue have a purple hue.
When an ulcer is atypical or doesn’t respond, what do you do
BIOPSY.
