Ulcers Flashcards Preview

Dermatology - Clinical Medicine IV > Ulcers > Flashcards

Flashcards in Ulcers Deck (56):
1

What causes venous infufficiency?

varicose veins
incompetent venous valves

2

What causes incompetent venous valves?

thrombus formation or congenital

3

What are the risk factors for venous insufficiency?

Age
Obesity
Lifestyle
Sedentary; Occupation
Pregnancy
H/o DVT
Leg injury
Phlebitis
Female

4

Which one is more common: venous or arterioal insufficiency?

venous

5

What is the presentation of venous insufficiency?

Burning
Swelling
Throbbing
Cramping
Aching
Heaviness
Restless leg
Leg fatigue

6

What is seen on PE of venous insufficiency?

Edema
Varicose veins
Hyperpigmentation
Chronic cellulitis
Cutaneous infarction
Atrophie blanche
Lipodermatosclerosis
Stasis dermatitis
Ulceration

7

What are early signs of venous insufficiency?

statis dermatitis, inflammation of skin

8

What is lipdermatosis also called?

champagne bottle legs

9

Who gets stasis dermatitis more?

women, increase risk with age

10

What are signs and symptoms of stasis dermatitis?

Pruritis
Discoloration
Medial ankle involvement and progression to foot &/or calf
Edema

11

What are the treatments for stasis dermatitis?

Control venous insufficiency and edema
Compression
Ligation of vessels?

12

What ABX do you use for stasis derm?

topical for erosions
Oral if cellultis

13

What steroid do you use for stasis derm?

triamcinolone 0.1% ointment

14

What is most common of lower extremity ulcers?

venous ulcers

15

What are risk factors for venous ulcers?

Venous Insufficiency
Age
Obesity
Previous Leg injury
DVT
Phlebitis

16

Who gets venous ulcers more often?

>65 yo

17

How do you dx venous ulcers?

Ankle-brachial index
Ratio of BP at ankle to arm
Color duplex ultrasonography
Venography

18

Where do you see venous ulcers?

medial!

19

What is the treatment for venous ulcers?

Underlying Cause
Compression therapy
-Caution with arterial insufficiency
-Elastic
-Inelastic
---Unna boot: zinc oxide-impregnated, moist bandage that hardens after application
-Intermittent pneumatic compression
Leg elevation
Wound vac - negative pressure
Meds
Hyperbaric oygen therapy
surgery

20

What are the dressing types for venous ulcers?

Hydrocolloids
Hydrogels
Foams
Pastes
Simple nonadherent dressings

21

What meds can you use for venous ulcer treatment?

Pentoxifylline (Trental)
ASA
Iloprost
?? Oral Zinc
Antibiotics

22

What does pentoxifylline do?

Inhibits platelet aggregation, decreases blood viscosity and improves microcirculation

23

What is the surgical treatment for venous ulcers?

debridement, grafing, venous insufficiency

24

What is the treatment for venous insufficiency?

Vein ablation
Phlebectomy
Stripping
Sclerotherapy
Laser therapy

25

Look at chart in PPT

kjlkkkjjklhkh

26

What is the most common cause of arterial insufficiency?

atherosclerosis

27

What are the risk factors for atherosclerosis?

Cigarette smoking
Diabetes Mellitus
Dyslipidemia
Hypertension

28

What isi the signs and symptoms of arterial insufficiency?

Intermittent claudication
Progresses to resting pain/night pain
Pallor
Cyanosis
Livedoid vascular pattern
Loss of hair
Decreased pulses

29

What are 25% of leg ulcers?

arterial ulcers

30

What is the etiology of arterial ulcers?

Atherosclerosis
Diabetes
Thromboangiitis
Thalassemia
Sickle cell disease

31

What is the presentation of arterial ulcers?

painful, punched out, necrotic base, at pressure sites

32

What are pressure sites that get arterial ulcers?

distal toes, pretibial, supramalleolar - lateral

33

How do you dx arterial ulcers?

ABIs
Duplex Ultrasonography
CT angiography
MR angiography

34

How do you treat arterial ulcerS?

Underlying cause
Endarterectomy
By-pass surgery
Wound care
Dressings
debridement
Medications

35

What medications do you use for arterial ulcers?

heparin, warfarin, analgesics

36

What is the most common cause of neuropathic ulcers?

diabetic neuropathy

37

What is sensory neuropathy caused?

urecognized trauma

38

What does motor neuropathy cause?

biomechanical changes leading to increased mechanical stress

39

What dose autonomic neuropathy cause?

AV shunting causing decreased perfusion
decreased sweating
increased dryness and fissuring

40

What do you get to dx neuropathic ulcers?

NCS/EMG
ABI
Labs: CBC, ESR, CRP
Wound cultures
Imaging
Plain Films
MRI

41

What is the treatment of neuropathic ulcers?

underlying problems
pt education
wound care - skin graph
surgery
Hyperbaric oxygen tx
medications

42

What are the surgery tx for neuropathi ulcers?

debridement, revision surgery, vascular reconstruction

43

What is the medication for neuropathic ulcers?

Pentoxifylline (Trental)
-Improved blood flow and enhances tissue oxygenation
Cilostazol (Pletal)
-Dilation of vascular beds thus decreasing symptoms of intermittent claudication
Antiplatelet agents
-Clopidogrel (Plavix)
-ASA

44

What are some wound healing agents for neuropathic ulcers?

becaplermin (Regranex) - topical recombinant human PDGF

45

What are pressure ulcer?

decubitus or bed sores

46

Where are the common spots of pressure ulcers?

heels, sacrum, ischial tuberosities, lateral> medial malleolus, greater trochanter

47

What are less common spots of pressure ulcers?

head, back, elbows, shoulders

48

What is a pressure ulcer?

Compression of bony prominence against external surface

49

What causes pressure ulcers?

continuous pressure, shearing forces/friction, moisture

50

What are risk factors for pressure ulcers?

Elderly
Sensory deficits
Poor nutrition
Nursing home resident

51

What has the highest prevalence of pressure ulcers?

crit care/ICU

52

What is the age distribution for pressure ulcers?

3rd decade related to spinal cord
>75 yo

53

What is the gender relation in pressure ulcers?

younger male predom
older female predom

54

What is the pressure ulcer presentation?

Good history of the onset of ulcer
Associated medical history
Neurologic cause
Bedridden
Pain
Odor
Stage of ulcer
Fever, chills, increased pain

55

What are diagnostic studies for pressure ulcers?

CBC, CRP, ESR
Blood cultures
Nutritional status
UA and culture- urinary incontinence
Stool exam- fecal incontinence
Imaging
Plain films
Bone Scan
MRI

56

What is the treatment for pressure ulcers?

prevention - pressure reduction, positive change
nutrition supplements
wound care
surgical debridement