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Flashcards in Peripheral Vascular Disease Deck (27):
1

RFs for venous ulcers?

Varicose veins
Prev DVT
Phlebitis
Prev fracture, trauma or surgery
FH
Venous insufficiency
Obesity

2

What is the major background RF for venous leg ulcers?

Venous insufficiency - leg pain, heavy legs, oedema, ache/itch, skin breakdown or pigmentation, eczema

3

Symptoms of venous insufficiency?

Leg pain
Heavy legs, oedema
Itching
Skin breakdown/eczema, pigmentation change

4

RFs for arterial leg ulcers?

Hx of arterial disease - CVD, CVA, HTN, PAD (intermittent claudication)
DM
Smoking
Obesity, immobility

5

Describe what venous ulcers look like?

Often the circumference of the lower leg, mid-calf down to medial malleoli
Large but shallow, moist pink granulation base with irregular border
May ooze a bit
Surrounding signs - oedema, varicose veins, stasis dermatitis, hyperpigmentation, lipodermatosclerosis

6

What pain may be experienced in association with venous ulcers?

Venous insufficiency pain - eased by elevation

7

Where are venous ulcers typically found?

Circumference of lower leg, often distribution of medial saphenous venous system (mid calf down to malleoli)

8

What ulcer is typically shallow and has a moist, pink granulation base with irregular borders?

Venous

9

If handling causes oozing, what type of ulcer does that suggest?

Venous

10

What do arterial ulcers look like?

Often deeper and more distal than venous, on the dorsum of foot/toes
May be quite well defined
Grey granulation tissue at base
Surrounding signs - chronic ischaemia (pale, pulseless, cold, hairless, nail dystrophy and calf muscle wastage)

11

What pain may be associated with arterial ulcers?

Intermittent claudication
Or nocturnal pain which is eased by dangling leg over bed

12

Signs of chronic limb ischaemia?

Pale
Pulseless (diminished)
Cold
Painful
Paraesthesia
Paralysis/muscle wastage
Hair loss/nail dystrophy

13

What ulcer is indicated by a well-defined, deep grey lesion on the dorsum of the foot?

Arterial

14

What is the typical appearance associated with neuropathic ulcers?

Punched out - deep
Under pressure points and surrounded by chronic inflammatory tissue

15

What ulcers are prone to painless, heavy bleeding on palpation?

Neuropathic

16

Possible presentations of diabetic ulcers?

Often a mixed picture as neuropathic, arterial and even venous components may contribute
However often over a bony prominence (in a known DM patient!)

17

How do hypertensive ulcers typically present?

Lateral aspect of leg, painful with necrotic edges

18

What is a normal ABPI?

Around 1

19

What does a raised ABPI generally suggest?

If there are ulcers present they are likely to be venous
May be due to calcification of arteries - atherosclerosis, DM

20

What type of ulcers are more likely to be present with a raised ABPI?

Venous

21

What does an ABPI of

Probably arterial disease - ulcers are likely to be arterial unless obviously clinically venous

22

What must be absolutely avoided in an ABPI of

Compression stockings

23

2 conditions that can give a 'falsely raised' ABPI?

Atherosclerosis
DM

24

Systemic vascular disease types of ulcers?

Rheumatoid ulcers
Systemic vasculitis associated (wegeners, SLE, scleroderma)

25

What must be excluded before giving compression devices for venous insufficiency symptoms?

DM, arterial disease (ABPI) and neuropathy

26

What medication can be used for chronic venous ulcers?

Pentoxyfilline

27

What are the most common type of leg ulcer?

Venous