Ulcers Flashcards
Ulcers
- A persistent discontinuity in the integrity of skin despite sufficient time for healing.
- Must be able to distinguish three types: Arterial, Venous, Neuropathic.
Venous Ulcer
- Maleolarlocation (usually Medial)
- Irregular margins
- Hemosiderin staining (browning)
- Varicose veins and pitting edema
Arterial Ulcer
- Doral or Distal location (toes)
- Sharp margins
- Painful
- Pallor, loss of hair, nail dystrophy
Neuropathic Ulcer
- Plantar location - Metatarsal heads (especially 2nd), sole of foot, balls of toes
- “Punched Out” margins, usually correspond to pressure point
- Insensate, patient often diabetic with peripheral neuropathy
- May have arterial insufficiency S/S
Differential Diagnosis for Ulcers
- Pain due to vascular causes increases with workload
- Neurogenic pain not affected by workload but by posture
- Edema typical with venous or lymph pathology not usualluarterial
- Pain: ask about TYPE and LOCATION
- Intermittent claudication
Intermittent Claudication
- Cramping type pain, due to ischemia, better with rest-not typically “burning”
- Usually in calves, although can be thigh or buttock
- Pain correlates with area of obstruction: hip and buttock= aorto-iliac occlusion, thigh pain=iliofemoral occlusion, prox2/3 calf-superficial femoral artery, distal 1/3calf= popliteal artery, foot= tibial artery
Symptoms of Venous v Arterial Disorders
Venous- Aching, burning, heaviness, fatigue while standing
Arterial- Aching, cramping that is predictable with activity or elevation
Elevation of Venous v arterial disorders
venous- lessens symptoms
arterial- worsens symptoms, dependency improves symptoms
Walking of venous v arterial disorders
venous- lessens symptoms
arterial- aching begins at specific time.distance, improves with rest
Limb size of venous v arterial disorders
venous- swollen in chronic disease
arterial- decreased due to muscle wasting
Skin temperature of venous v arterial disorders
venous- normal
arterial- cool
Skin color of venous v arterial disorders
venous- hyperpigmented, often superior to medial malleolus- hemosiderin
arterial- cyanotic or pale, dependent rubor
Skin appearance of venous v arterial disorders
venous- cellulitis, dermatitis
arterial- reduced hair, thick/brittle toe nails, shiny skin
Pulses of venous v arterial disorders
venous- normal, but may be difficult to palpate
arterial- may be decreased or absent, bruits
Ulcers of venous v arterial disorders
venous- near medial malleolus, irregular border, pink base
arterial- pale base, discrete borders, high-pressure sites like heal or toes
