Venous ulcers

Question 1

Define:

Answer 1

Large, shallow and sometimes painful ulcers usually found above the medial malleoli

Question 2

Aetiology:

Answer 2

Caused by incompetent valves which lead to the stasis of blood and an increase in pressure leading to ulceration.

Question 3

Risk factors:

Answer 3

immobility

obesity

recurrent DVT

previous leg injury and surgery

varicose veins

age

Question 4

Epidemiology:

Answer 4

very common

incidence increases with increased age

Question 5

Symptoms:

Answer 5

Large + shallow usually painless ulcers above the medial malleoli
- have an IRREGULAR MARGIN

History of:

• DVT
• Varicose veins
• phlebitis
• trauma
• fracture
• surgery
• family history

may have other symptoms:

• swelling
• aching
• itching

Question 6

Signs:

Answer 6

as above

stasis eczema

lipodermatosclerosis (can look like reverse champagne bottle if severe)

Haemosidern deposition (dark colour)

Question 7

Investigations:

Answer 7

ABPI - if less than 0.8 do not apply pressure bandage as it can make it a lot worse.

measure surface area to check the progression of the ulcer

swabs for microscopy

biopsy

Question 8

management:

Answer 8

gradual compression to increase venous stasis - make sure you exclude: diabetes, PVD, neuropathy etc

debridement + cleaning

antibiotics if infected

topical steroids - help with surrounding dermatitis

Question 9

complications:

Answer 9

recurrence

infection

Question 10

prognosis:

Answer 10

good

better if there are fewer comorbidities