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Flashcards in Ulcers Deck (38)
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1

What causes venous ulcers

Venous hypertension due to insufficiency
Incompetence valves caused by varicose veins / DVT
Leads to oedema

2

What are other RF

Immobility
Malnourishment
Recent major joint replacement

3

What are symptoms

Asymptomatic
General discomfort / ach
Often painful
Worse during the day / prolonged standing
Relieved raising the leg
Itchy skin

4

What area

Common in gaiter region
Common in malleolar (medial > lateral)

5

What is seen O/E

Large shallow irregular ulcer
Exudative
Red / pink granulation tissue
Yellow slough
Pitting oedema = 1st sign
Venous eczema
Haemosiderin staining
Varicose veins
Present pulses + warm skin

6

What is risk of venous ulcer

Develop into Marjolin's ulcer
Irregular, raised, foul smelling

7

What is needed

Inspection
Lavage
Wide excision of necrotic and malignant tissue

8

How do you investigate venous ulcers

ABPI to ensure not arterial - will be normal
Venous duplex to look for reflux / thrombosis and asses function

9

How do you manage

Principles of wound management
- Inspection
- Remove devitalised
- Dressing
Must treat underlying cause
May need Ax if infection
Possible surgery for various veins

10

What do you do for oedema

Compression bandaging
Elevation
Rarely diuretics

11

What causes arterial ulcers

Insufficient arterial supply
PVD
Smoking
Age
DM
Hypertension
Hyperlipid

12

What are symptoms

Critical ischaemia pain
Get pain at rest
Worse lying flat
Releived by standing or hanging feet over bed

13

What are signs on examination

Small sharply defined deep ulcer
PAINFUL
Necortic base
Well demarcated
Pale and dry
Little granulation
May see necrosis
Hair loss
Cold skin
Prolonged CRT
Absent pulses
Shiny pale skin
Loss of hair

14

What is Buerger

Elevate foot up to 30 degrees
Leads to colour fading and pain
When hang foot over bed then becomes deep red as fills with blood

15

How do you investigate

ABPI
Dupplex USS + angio
Percutaenous USS

16

How do you Rx

Basic wound
RF modification
Angioplasty or stent
Surgery - bypass or amputation

17

What causes diabetic foot ulcers

Hyperglycaemia = neuropathy and PVD
Autonomic = dry cracked skin
Motor = foot drop / deformity

18

What are symptoms

Sensory loss so ulcer are not painful
Foul smell if infected
Sx of poor glycemic control

19

What is seen O/E

Typically plantar
Thickened surrounding skin
Infection

20

What is common cause of amputation

Infection

21

How do you prevent

Education
BG control
Self foot care - examine regular, footwear, toenail care
Identify RF
Regular foot review

22

How do you Rx

Basic wound
Minimise neuropathy
Treat ischaemia - same as arterial

23

How do you minimise neuropathy

Offloading
Custom footwear
Resection of wound / bony deformity

24

What are pressure sores

Breakdown of skin and underlying tissue 2 to unrelieved pressure or friction

25

Where are common sites

Sacrum
Ischial tubersoity
Greater trochanter of femur
Heels

26

What are RF

Immobile
Incontinence
Poor nutrition
Poor sensation
Age

27

Stage 1

Non-blanching erythema
Red, warm, painful oedema
Skin intact

28

Stage 2

Partial loss of epidermis or dermis
Often shallow ulcer with red / pink wound bed
No slough

29

Stage 3

Full thickness loss
Subcutaneous involvement

30

Stage 4

Full thickness loss
Involvement of muscle / bone / tendon