Leg ulcer Flashcards Preview

Year 3 - Medicine and Surgery book > Leg ulcer > Flashcards

Flashcards in Leg ulcer Deck (28)
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1
Q

What are the ddx for leg ulcer?

A

Venous ulcer (most common)
Mixed arterial/venous ulcer
Pressure ulcer
Neuropathic ulcer

2
Q

Which type of ulcers are less painful when elevated?

A

Venous

3
Q

Arterial ulcers are caused by ichaemia to the leg. How does elevation affect the degree of pain

A

Elevation increases the pain in arterial ulcers

4
Q

Which type of ulcers are not painful

A

Neuropathic ulcers

5
Q

Describe the onset of venous vs arterial ulcers

A

Venous ulcers - present late (less painful). Often have long and recurrent history

Arterial ulcers present early (more painful)

6
Q

A long history should raise suspicions of what type of ulcer

A

Marjolins ulcer

7
Q

What complications arise from venous ulcers

A

Varicose veins, pruritic stasis eczema, discolouration of surrounding skin, ankle oedema/swollen ankles

8
Q

What complications can arise from arterial ulcers

A

Symptoms of PAD, CAD or cerebrovascular disease. Symptoms include claudication, night pain, rest pain, cold extremeties, angina or SOB on exertion, stroke/TIA history.

Useful to ask patients how far they can walk without pain in their calves

9
Q

Neuropathic ulcers are associated with what symptoms

A

Sensory loss - causing an unsteady gait

10
Q

What are the RFs for venous ulcers

A

Varicose veins, immobile patients, recurrent DVTs, pelvic masses which compress iliac veins, arteriovenous malformations, major joint replacement

11
Q

What are the RFs for arterial ulcers

A

RFs for atherosclerosis, CAD, cerebrovascular disease

12
Q

Alcohol abuse and diabetes mellitus may predispose to?

A

Neuropathic ulcers

13
Q

What are RFs for pressure ulcers

A

Bedridden patient, immobilisation, poorly applied splints/braces/casts

14
Q

Where do venous ulcers typically occur

A

Gaiter area the legs (area covered by a large sock) - often just above medial malleolus

15
Q

Where do arterial ulcers often occur

A

Distal areas of the foot (e.g. between toes) or areas that are frequently compressed

16
Q

Where do neuropathic ulcers often occur

A

In pressure areas where foot rubs on poorly fitting footwear (e.g. under metatarsal heads)

17
Q

Where do pressure ulcers typically occur

A

Heel or overlying the malleoli in immobile patients

18
Q

Describe the appearance of a venous ulcer

A

Shallow, wet, irregularly white fragile borders

19
Q

Describe the appearance of an arterial ulcer

A

Deep, punched out, dry, elliptical

20
Q

Calluses are a sign of what type of ulcer

A

Neuropathic or pressure ulcers

21
Q

Pyoderma gangrenosum is associated with what condition?

What is its appearance like

A

Associated with IBD

Has a characteristic dark blue/purple halo around it

22
Q

Absent weak pulses, poor capillary refill, venous guttering are signs of what type of ulcer

A

Arterial

23
Q

What investigations should be done in someone with a suspected venous leg ulcer

A
  1. FBC, lipids
  2. Capillary glucose
  3. Urinalysis
  4. Venous duplex US
  5. ABPI - measured to exclude arterial disease as a cause of ulcer (ABPI <0.8 indicates mixed arterial/venous picture)
  6. Swabbing
  7. ?Biopsy
24
Q

How is a venous stasis managed

A
  1. Nutrition - encourage healing
  2. Lifestyle modification - mobilise
  3. Leg elevation - reduce venous stasis in lower limb
  4. Compression bandages
  5. Elastic stockings
  6. Varicose vein surgery
25
Q

What investigations should be done in suspected arterial ulcer

How are arterial ulcers managed

A
  1. Arterial duplex US
  2. ECG
  3. Fasting lipids, glucose, HbA1c, FBC
Dressing ulcer (prevent infection), analgesia, antibiotics
Then do surgery: either angioplasty (with/out) stunting, bypass surgery, amputation
26
Q

What are the 6 Ps of acute limb ischaemia

A

Painful, pale, pulseless, paralysed, perishingly cold, parasthaesia

Acute limb ischaemia = surgical emergency

27
Q

How do you manage a neuropathic ulcer

A
  1. Foot care
  2. Manage diabetes
  3. Debridement
  4. Treat infections
28
Q

If a chronic venous ulcer turns into a squamous cell carcinoma (as suggested if you see fungation), what is this ulcer called

A

Marjolin ulcer

Fungating ulcer suggests infection or malignancy

Marjolin ulcers are managed by wide excision and split skin grafting