Leg Ulcer Flashcards
List a differential diagnosis of leg ulcers.
Venous ulcers Mixed ulcers Arterial ulcers Neuropathic ulcers Pressure ulcers Lymphoedema ulcers Traumatic ulcers Vasculitic ulcers Marjolin’s ulcers
What type are the majority of leg ulcers?
Venous ulcers – 70%
List two key features of the ulcer history.
Is the ulcer painful?
How long has the ulcer been there?
What is a Marjolin’s ulcer?
A squamous cell carcinoma arising from chronically inflamed tissue
How does the pain differ in: Venous Ulcers Arterial Ulcers Neuropathic Ulcers Pressure Ulcers
- Venous Ulcers Not particularly painful Pain is relieved when the leg is elevated (because pain/ulcer is caused by venous stasis) - Arterial Ulcers Quite painful Pain is worse when the leg is elevated (because pain is due to ischaemia) - Neuropathic Ulcers NO pain - Pressure Ulcers Exquisitely tender Not necessarily painful
How does the time of presentation of ulcers differ in: Venous Ulcers Arterial Ulcers Neuropathic Ulcers Pressure Ulcers Marjolin Ulcers
- Venous Ulcers
Present late because they aren’t that painful
Tend to have long, recurring history - Arterial Ulcers
Present early because they are painful
Often present secondary to trivial trauma - Neuropathic Ulcers
Present late because they are not painful - Pressure Ulcers
Can develop surprisingly fast (especially in hospital because of bed rest) - Marjolin Ulcers
Long-history of an ulcer/chronic skin inflammation that has suddenly changed
List some key associated features of:
Venous Ulcers
Arterial Ulcers
Neuropathic Ulcers
- Venous Ulcers
Varicose veins
Skin changes: haemosiderin deposition, stasis dermatitis, lipodermatosclerosis
Ankle oedema - Arterial Ulcers
Peripheral vascular disease (e.g. claudication, night pain, rest pain)
Coronary artery disease (e.g. angina, SOBOE)
Cerebrovascular disease (e.g. stroke, TIA) - Neuropathic Ulcers
Sensory loss
Unstable gait
Infected ulcers (mainly in diabetics)
List risk factors for: Venous Ulcers Arterial Ulcers Neuropathic Ulcers Pressure Ulcers
- Venous Ulcers Presence of varicose veins Immobility Malnourishment Recurrent DVTs Pelvic mass compressing iliac veins AV malformations Major joint replacement (carries high subclinical DVT risk) - Arterial Ulcers Atherosclerosis risk factors: hypertension, diabetes, smoking, hypercholesterolaemia etc. - Neuropathic Ulcers Diabetes mellitus Alcohol abuse - Pressure Ulcers Long-term bed rest/ long lie
Describe the common sites of the following types of ulcer: Venous Ulcers Arterial Ulcers Neuropathic Ulcers Pressure Ulcers
- Venous Ulcers
Gaiter area of the legs (mainly above the medial malleolus)
This is where venous pressure is highest - Arterial Ulcers
Distal areas (e.g. between the toes) and frequently compressed areas (e.g. ball of foot) - Neuropathic Ulcers
Pressure areas (e.g. ball of foot) – because it is subject to repetitive trauma - Pressure Ulcers
Bony prominences that experience constant pressure (e.g. heel)
Describe the characteristics of:
Venous Ulcers
Arterial Ulcers
Neuropathic Ulcers
- Venous Ulcers Shallow Wet Irregular borders that look white and fragile - Arterial Ulcers Deep Dry Punched-out appearance Often elliptical - Neuropathic Ulcers Thick, keratinized raised edges surrounding the ulcer
Which diseases are associated with pyoderma gangrenosum?
Inflammatory bowel disease Blood dyscrasias (e.g. multiple myeloma)
Describe the typical appearance of pyoderma gangrenosum.
An ulcer with a characteristic purple halo around it
Venous ulcers can scar leading to white patches of scarred skin. What is this feature called?
Atrophie blanche
What is the term used to describe severe lipodermatosclerosis?
Inverted champagne bottle sign
Describe some features of the affected limb in a patient with arterial ulcers.
Cold Pale Absent/weak pulses Delayed capillary refill time Atrophic skin changes (dry, shiny, hairless)
