Flashcards in Ulcers Deck (21):
characteristics of venous ulcer?
Generally above malleoli
Sloughy granulating base
Discharge may be present
Warm, oedematous surrounding skin
Pain usually alleviated with elevation
risk factors for venous ulcer?
Risk factors DVT, venous insufficiency, lipodermatosclerosis
management of venous ulcer?
Compression therapy- stockings
Pain and wound management
Elevation of limb for venous return
Surgery for incompetent valves- phlebectomy
characteristics of arterial ulcer?
Usually located on the sole of foot, toes etc
'punched out appearance'
Painful- often worse with elevation
risk factors for arterial ulcer?
peripheral vascular disease, critical limb ischaemia and atherosclerosis
common locations for pressure ulcers?
Common sites for pressure ulcers include the sacrum, buttocks, ischial tuberosities, greater trochanters, heels and malleoli.
Characteristics of diabetic foot ulcers?
Surrounding skin has reduced sensation
May be associated with Charcott's deformity and gangrenous toes
pathophys of diabetic foot ulcers?
combination peripheral neuropathy and peripheral vascular disease secondary to accelerated atherosclerosis
management of diabetic foot ulcers?
Aggressive glycaemic control
Refer to specialist diabetic foot clinic
Amputation if gangrene present
what is pyoderma gangrenosum?
Destructive, non infective inflammatory ulcer.
The ulcer expands and grows over time.
What is pyoderma gangrenosum associated with?
Often associated with autoimmune inflammatory disease such as inflammatory bowel disease
how is pyoderma gangrenosum treated?
Immunosuppressive therapy- prednisolone, azathioprine, mycophenolate, infliximab etc.
Hold off on surgical intervention!
what type of bacteria can cause ulcers?
list the differential causes of ANY ulcer
why do diabetics get foot ulcers?
peripheral neuropathy --> unperceived trauma, deformity
leads to infection
Poor wound healing due to immunosuppression and PVD
what is the evidenced based protocol for diabetic foot ulcers?
1. Peripheral neuropathy
5. Maximise diabetes control
general management of DFU?
• Take pressure off the ulcer with air mattresses and orthotics (TCC and Cam walker)
• Angiography for PVD. If required, stenting can be performed.
• Assess for osteomyelitis
• Send off tests for RBC, WCC, ESR, CRP, Alk Phos
• Order x-rays/ other imaging as required
• Debride infected dry skin around the ulcer
• Order bone biopsy if required for dx of osteomyelitis
TIME principle. T= removed dead tissue. I= remove bacterial load. M= maintain moisture E= assess edge of wound
If required, amputation should be performed
what is the clinical diagnosis of infection in the ulcer?
Pus and two of- pain/swelling/redness/warmth
what is a bony complication of ulceration? What do we look for?
osteomyelitis. Look for sausage toe. And perform probe to bone
what are some serum markers that we can Ix for in the setting of an ulcer?
1. ALk phosphate (may indicate osteomyelitis)
3. CRP WCC