Week 3.5 Flashcards
What are chronic leg ulcers
open lesion between the knee and ankle joint that remains unhealed for at least 4 weeks
What causes arterial leg ulcers
Peripheral arterial disease causing insufficient blood supply to lower limbs
Peripheral arterial disease often caused by
Atherosclerosis - narrows the peripheral arteries so less blood flow
Presentation of arterial ulcers
Deep
Punched out appearance (like someone made a hole)
Surrounding skin is cold and white
Intermittent claudication
Pain at night
Absent peripheral pulses
What may patients describe that they do at night to relief the pain caused by arterial ulcers
hang their legs off the end of the bed
What is claudication
Muscle pain triggered by activity and relieved by rest
Investigations for arterial leg ulcers
ABPI
Doppler ultrasound
What is the ABPI for arterial leg ulcers
< 0.9
Management for arterial leg ulcers
Statin
Antiplatelet
Treat hypertension
(the aim is to reduce the modifiable risk factors)
Which type of leg ulcer is the most common
Venous leg ulcer
What causes venous leg ulcer
Chronic venous insufficiency
Describe the pathophysiology of chronic venous insufficiency
- Elevation in venous pressure in legs causing veins to dilate and valves to become insufficient
- This causes varicose veins to develop
- The increased hydrostatic pressure in the vessels causes red blood cell leakage into tissues
- this causes venous dermatitis, swelling
- Skin does not heal well from the dermatitis due to poor blood supply hence it breaks down and forms an ulcer
Venous ulcers usually occur in
Above the medial malleolus = gaiter area
Presentation of venous ulcers
Superficial, shallow
larger than arterial ulcers
Warm
Exudative - oozing
Haemosiderin deposition (brown pigment)
Varicose veins
Investigations for venous ulcers
Clinical
ABPI and doppler ultrasound to exclude arterial cause
Management for venous ulcers
4 layer compression bandaging
Compression stockings
Pain relief
Leg elevation
What is the 4 layer compression bandaging
Graduated pressure - highest at the ankle lowest at the knee