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Dermatology - Clinical Medicine IV > Ulcers > Flashcards

Ulcers Flashcards

1
Q

What causes venous infufficiency?

A

varicose veins

incompetent venous valves

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2
Q

What causes incompetent venous valves?

A

thrombus formation or congenital

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3
Q

What are the risk factors for venous insufficiency?

A 
Age
Obesity
Lifestyle
Sedentary; Occupation
Pregnancy
H/o DVT
Leg injury
Phlebitis
Female
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4
Q

Which one is more common: venous or arterioal insufficiency?

A

venous

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5
Q

What is the presentation of venous insufficiency?

A 
Burning
Swelling
Throbbing
Cramping
Aching
Heaviness
Restless leg
Leg fatigue
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6
Q

What is seen on PE of venous insufficiency?

A 
Edema 
Varicose veins
Hyperpigmentation
Chronic cellulitis
Cutaneous infarction
Atrophie blanche
Lipodermatosclerosis
Stasis dermatitis
Ulceration
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7
Q

What are early signs of venous insufficiency?

A

statis dermatitis, inflammation of skin

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8
Q

What is lipdermatosis also called?

A

champagne bottle legs

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9
Q

Who gets stasis dermatitis more?

A

women, increase risk with age

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10
Q

What are signs and symptoms of stasis dermatitis?

A

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

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11
Q

What are the treatments for stasis dermatitis?

A

Control venous insufficiency and edema
Compression
Ligation of vessels?

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12
Q

What ABX do you use for stasis derm?

A

topical for erosions

Oral if cellultis

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13
Q

What steroid do you use for stasis derm?

A

triamcinolone 0.1% ointment

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14
Q

What is most common of lower extremity ulcers?

A

venous ulcers

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15
Q

What are risk factors for venous ulcers?

A 
Venous Insufficiency
Age
Obesity
Previous Leg injury
DVT
Phlebitis
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16
Q

Who gets venous ulcers more often?

A

> 65 yo

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17
Q

How do you dx venous ulcers?

A

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

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18
Q

Where do you see venous ulcers?

A

medial!

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19
Q

What is the treatment for venous ulcers?

A 
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
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20
Q

What are the dressing types for venous ulcers?

A 
Hydrocolloids
Hydrogels
Foams
Pastes
Simple nonadherent dressings
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21
Q

What meds can you use for venous ulcer treatment?

A 
Pentoxifylline (Trental)
ASA
Iloprost
?? Oral Zinc
Antibiotics
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22
Q

What does pentoxifylline do?

A

Inhibits platelet aggregation, decreases blood viscosity and improves microcirculation

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23
Q

What is the surgical treatment for venous ulcers?

A

debridement, grafing, venous insufficiency

24
Q

What is the treatment for venous insufficiency?

A 
Vein ablation
Phlebectomy
Stripping
Sclerotherapy
Laser therapy
25
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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

Dermatology - Clinical Medicine IV (31 decks)

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