29. Leg Ulcer Flashcards
What are the differentials for leg ulcers?
Venous ulcer, mixed arterial/ venous ulcers, arterial ulcers, pressure ulcer, neuropathic ulcer
What would you want to know about the history of a leg ulcer?
Is the ulcer painful?
Venous ulcers- less painful when elevated
Arterial ulcers- more painful when elevated
Neuropathic ulcers- caused by loss of sensation and therefore not painful
Pressure ulcers- caused by prolonged pressure on the affected site, tend to be very tender
How long has it been there?
Venous- present late, long recurring history
Arterial- present early due to pain, occur secondary to trivial trauma
Neuropathic ulcers- associated with loss of sensation and present late
Pressure ulcers- variable
What are associated symptoms for venous ulcers?
Chronic venous insufficiency may lead to varicose veins, eczema, discolouration of surrounding skin, ankle oedema
What are associated symptoms of arterial ulcers?
Peripeheral arterial disease, coronary artery or cerebrovascular disease, claudication, night pain, rest pain, cold extremities, angina, SOB, history of TIA
What are associated symptoms of neuropathic ulcers?
Sensory loss, unsteady gait, secondary infection
What are venous ulcers risk factors?
Varicose veins, immobility, recurrent DVTs, pelvic mass compressing iliac veins, arteriovenous malformations, joint replacements
What are risk factors of arterial ulcers?
atherosclerosis RFs: smoking diabetes, hypertension, family history of atherosclerotic disease, CAD, PAD
What are risk factors of neuropathic ulcers?
Patients with diabetes mellitus or alcohol misuse
What are risk factors of pressure ulcers?
Pressure ulcers can develop within hours of constant pressure in one area- bedridden patients, those with immobility
Where are the different types of leg ulcers usually found?
Venous ulcers- gaiter of legs, just above medial malleolus
Arterial ulcers- between toes, where arterial blood supply is worst
Neuropathic ulcers- beneath metatarsals
Pressure ulcers- bony prominences
What are characteristics of the different types of ulcers?
Venous- shallow, wet and with irregular borders that look white and fragile
Arterial ulcers- deep, punched and dry, elliptical
Neuropathic and pressure- thick keratinized raised edges
Pyoderma gangrenosum- characteristic dark blue/ purple halo
What are associated signs of the different types of ulcers?
Venous- oedema, extravasation, scarring, ankle flare
Arterial- cold pale limbs, poor capillary refill, absent or weak pulses
Neuropathic- vibration and proprioception loss, glove and stocking peripheral sensory neuropathy, foot deformities
What are investigations for a venous ulcer?
Bloods: FBC, raised inflammatory markers Capillary glucose Urinanalysis- if vasculitis suspected Venous duplex ultrasound ABPI Swabbing Biopsy
How do you manage venous ulcers?
Adequate nutrition, encourage mobilisation, leg elevation, compression bandages, stockings to prevent recurrence, varicose vein surgery
