Leg Ulcers Flashcards

1
Q

What is an ulcer?

A

Discontinuity of surface epithelium

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2
Q

What are features of leg ulcers?

A
  • Discontinuity of squamous epithelium of skin around ankle + foot
  • Acute or chronic (>4-6wks)
  • Usually co-infection w/ Staph Aureus, Strep Pyogenes + E. Coli
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3
Q

What is the aetiology of leg ulcers?

A
  • Venous disease (70%)
  • Mixed (15%)
  • Arterial disease (2%)

Others: neuropathy, vasculitis, malignancy, infection, trauma

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4
Q

What are key features of venous leg ulcers?

A
  • Mostly due to HTN 2o to chronic venous insufficiency (deep or superficial)
  • Deep related to DVT, superficial related to varicose veins
  • Sx → oedema, brown pigmentation (hemosiderin), lipodermatosclerosis, eczema
  • Location → medial malleolus, above ankle, painless
  • RFs → VV, DVT, venous insufficiency, AV fistulae, obesity, fractures
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5
Q

How is ABPI interpreted?

A
  • > 1.2 → may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
  • 1.0 - 1.2 → normal
  • 0.9 - 1.0 → acceptable
  • < 0.9 → likely PAD. Values < 0.5 indicate severe disease which should be referred urgently
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6
Q

Which investigations should be done for venous leg ulcer?

A
  • ABPI to assess for arterial disease
  • Doppler USS → presence of reflux
  • Duplex USS → anatomy/flow of vein
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7
Q

What is the management for venous leg ulcers?

A
  • Charing cross 4-layer compression bandaging
  • Skin grafting if fail to heal after 12wks or >10cm2
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8
Q

What are features of arterial leg ulcers?

A
  • Occur on toes and heel
  • Painful, may be areas of gangrene
  • Cold + no palpable pulses
  • ABPI <0.9
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9
Q

What is the treatment for aterial leg ulcers?

A
  • Antiplatelet
  • Statin
  • Surgical revascularisation
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10
Q

What are the features and management of neuropathic ulcers?

A
  • Commonly over plantar surface of metatarsal head and plantar surface of hallux, due to pressure
  • Plantar neuropathic ulcer most commonly leads to amputation in diabetic pts
  • Rx → cushioned shoes to reduce callous formation
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11
Q

What are features of pressure ulcers?

A
  • Develop in pts unable to mobilise due to illness, age or paralysis
  • Typically over bony prominences such as heel or sacrum
  • RFs → malnutrition, incontinence, immobility, pain (less movement)
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12
Q

What is the Waterlow score?

A

To screen for patients who are AT RISK of developing pressure sores

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13
Q

How are pressure ulcers graded?

A
  • European Pressure Ulcer Advisory Panel classification system
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14
Q

What is the management of pressure ulcers?

A
  • Pressure relieving mattresses + cushions
  • Frequent repositioning
  • Encourage moist wound environment w/ hydrocolloid dressings
  • Discourage wound swabs as most are colonised
  • Refer to tissue viability nurse
  • Abx only if evidence of infection (surrounding cellulitis)
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15
Q

What is Marjolin’s ulcer?

A
  • Squamous cell carcinoma
  • Occurring at sites of chronic inflammation eg. burns, osteomyelitis after 10-20 yrs
  • Mainly occur on lower limb
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16
Q

What is pyoderma gangrenosum?

A
  • Associated w/ inflammatory bowel disease & rheumatoid arthritis
  • Can occur at stoma sites
  • Erythematous nodules or pustules which ulcerate