Common important problems Flashcards
(95 cards)
How are leg ulcers classified?
Three main types (clinically often present as a mix)
-Arterial
-Venous
-Neuropathic
Also
-vasculitic ulcers (purpuric, punched-out lesions)
-infected ulcers (purulent discharge, may have systemic signs)
-malignancy (e.g. SCC in long standing non-healing ulcers)
How does a venous ulcer present?
Often painful, worse on standing
Hx venous disease e.g. varicose veins, DVT
What are the common sites for venous ulcer?
Malleolar area (more often over medial vs lateral)
What is the typical appearance of a venous ulcer?
Large, shallow irregular ulcer
Exudative and granulating base
What features are associated with venous ulcer?
Warm skin
Normal peripheral pulses
Leg oedema, haemosiderin and melanin deposition (brown pigment)
Lipodermatosclerosis
Atrophie blanche (white scarring with dilated capillaries)
What investigations would be performed in suspected venous ulcer?
ABPI (normally 0.8-1.0)
What is the management for a venous ulcer?
Compression bandaging (after excluding arterial insufficiency)
How would an arterial ulcer present?
Painful, especially at night, worse when legs elevated
Hx arterial disease e.g. atherosclerosis
Where are the common sites for an arterial ulcer?
Pressure and trauma sites e.g. pretibial, supramalleolar (usually lateral)
Distal points e.g. toes
What is the normal appearance of an arterial ulcer?
Small, sharply defined deep ulcer
Necrotic base
What features are associated with chronic arterial ulcer?
Cold skin
Weak/absent peripheral pulses
Shiny pale skin
Loss of hair
What investigations could be performed in chronic arterial ulcer?
ABPI <0.8 = presence of arterial insufficiency
Doppler studies and angiography
How are arterial ulcers managed?
Vascular reconstruction
Compression bandaging is contraindicated
How does a neuropathic ulcer present?
Often painless
Abnormal sensation
Hx diabetes or neurological disease
What are the common sites for a neuropathic ulcer?
Pressure sites e.g. soles, heel, toes, metatarsal heads
What is the typical appearance of a neuropathic ulcer?
Variable size/depth
Granulating base
May be surrounded by or underneath a hyperkeratotic lesion e.g. callus
What features are associated with neuropathic ulcer?
Warm skin
Normal peripheral pulses (if cold, weak or absent pulses, may be a neuroischaemic ulcer)
Peripheral neuropathy
What Ix would be performed in a suspected neuropathic ulcer?
ABPI <0.8 implies neuroischaemic ulcer
Xray to exclude osteomyelitis
How is a chronic neuropathic ulcer managed?
Wound debridement
Regular repositioning, appropriate footwear and good nutrition
What are the causes of an itchy eruption?
Inflammatory condition e.g. eczema Infection e.g. varicella Infestation e.g. scabies Allergic reaction e.g. some cases of urticaria Idiopathic Autoimmune e.g. lichen planus
How does eczema commonly present?
Personal/FHx of atopy
Exacerbating factors e.g. allergens, irritants
What are the common sites for eczema?
Flexor aspects in chlidren/adults
Variable location
What is the classical appearance of eczema?
Dry erythematous patches
Erythematous, vesicular and exudative when acute
What features may be associated with eczema?
Secondary bacterial/viral infection
