Flashcards in 29. Leg Ulcer Deck (19)
What are 5 differentials for leg ulcers?
Venous ulcer (~70%)
Mixed arterial/ venous ulcer
What would you want to know about the history of a leg ulcer?
Is the ulcer painful?
How long has it been there?
What are associated symptoms for venous ulcers due to chronic venous insufficiency?
Discolouration of surrounding skin
What are 7 associated symptoms of arterial ulcers?
Stroke/ TIA Hx
What are associated symptoms of neuropathic ulcers?
Secondary infection (if anaerobes= foul smell)
What are 7 venous ulcers risk factors?
Immobility (reduced drainage)
Malnourishment (reduced healing)
Pelvic mass compressing iliac veins
Arteriovenous malformations (increased venous pressure)
What are risk factors of arterial ulcers?
FH atherosclerotic disease
What are risk factors of neuropathic ulcers?
How quickly can pressure ulcers develop? What are risk factors of pressure ulcers?
Within hours of constant pressure on one area:
Splints/ plaster casts
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
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
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
What are investigations for a venous ulcer?
Bloods: FBC, lipids, raised inflammatory markers
Urinanalysis- if vasculitis suspected
Venous duplex ultrasound
Ankle-brachial pressure index (ABPI)
How do you manage venous ulcers?
Stockings to prevent recurrence
Varicose vein surgery
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
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
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
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