29. Leg Ulcer Flashcards Preview

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Flashcards in 29. Leg Ulcer Deck (19)
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1

What are 5 differentials for leg ulcers?

Venous ulcer (~70%)
Mixed arterial/ venous ulcer
Arterial ulcer
Pressure ulcer
Neuropathic ulcer

2

What would you want to know about the history of a leg ulcer?

Is the ulcer painful?
How long has it been there?

3

What are associated symptoms for venous ulcers due to chronic venous insufficiency?

Varicose veins
Eczema
Discolouration of surrounding skin
Ankle oedema

4

What are 7 associated symptoms of arterial ulcers?

Claudication
Night pain
Rest pain
Cold extremities
Angina
SOB
Stroke/ TIA Hx

5

What are associated symptoms of neuropathic ulcers?

Sensory loss
Unsteady gait
Secondary infection (if anaerobes= foul smell)

6

What are 7 venous ulcers risk factors?

Varicose veins
Immobility (reduced drainage)
Malnourishment (reduced healing)
Recurrent DVTs
Pelvic mass compressing iliac veins
Arteriovenous malformations (increased venous pressure)
Joint replacements

7

What are risk factors of arterial ulcers?

Atherosclerosis RFs:
smoking
diabetes
HTN
FH atherosclerotic disease
CAD
CVD
PAD

8

What are risk factors of neuropathic ulcers?

Diabetes mellitus
Alcohol misuse

9

How quickly can pressure ulcers develop? What are risk factors of pressure ulcers?

Within hours of constant pressure on one area:
Bedridden patients
Immobility
Splints/ plaster casts

10

Where are the different types of leg ulcers usually found?

Venous: gaiter of legs, just above medial malleolus
Arterial: between toes, where arterial blood supply is worst + frequently compressed ball of foot, lateral malleolus
Neuropathic: beneath metatarsals
Pressure: bony prominences- heel, malleoli

11

What are characteristics of the different types of ulcers?

Venous: shallow, wet + with irregular borders that look white + fragile
Arterial: deep, punched out + dry, elliptical
Neuropathic + pressure: thick, keratinized, raised edges
Pyoderma gangrenosum: dark blue/ purple halo

12

What are associated signs of the different types of ulcers?

Venous: oedema, extravasation, scarring, ankle flare
Arterial: cold pale limbs, poor capillary refill, venous guttering, absent or weak pulses, atrophic skin changes
Neuropathic: vibration + proprioception loss, glove + stocking peripheral sensory neuropathy, foot deformities

13

What are investigations for a venous ulcer?

Bloods: FBC, lipids, raised inflammatory markers
Capillary glucose
Urinanalysis- if vasculitis suspected
Venous duplex ultrasound
Ankle-brachial pressure index (ABPI)
Swabbing
Biopsy

14

How do you manage venous ulcers?

Adequate nutrition
Encourage mobilisation
Leg elevation
Compression bandages
Stockings to prevent recurrence
Varicose vein surgery

15

How does pain vary in the most common ulcers?

Venous: less painful when elevated
Arterial: more painful when elevated
Neuropathic: caused by loss of sensation + therefore not painful
Pressure: caused by prolonged pressure on the affected site, tend to be very tender

16

How does length of ulcer presence help differentiate cause?

Venous: present late, long recurring hx
Arterial: present early due to pain, occur secondary to trivial trauma
Neuropathic: associated with loss of sensation, present late
Pressure ulcers: variable
Marjolin ulcer: Long hx

17

In venous ulcers 2 signs are seen, what are these?

Atrophie blanche: scarring of the skin
Ankle flare: superficial varicose veins/ small darl engorged superficial veins

18

What is Buerger's test? What does it show?

Blanching of the foot on elevation to 45 + reactive hyperaemia on lowering the leg
Suggests arterial insufficiency

19

What are atrophic skin changes ?

Dry
Shiny
Hairless