Ulcers Of Lower Limb Flashcards
(35 cards)
What are ulcers?
Abnormal breaks in the skin or mucous membranes
What are the three most common types of ulcers of the lower limb?
Venous (80%)
Arterial
Neuropathic (diabetic neuropathy)
What cause venous ulcers?
Venous insufficiency
Describe the appearance of venous ulcers?
Shallow with irregular borders and granulated base, usually located over the medial malleolus
What are the risk factors for venous ulcers?
Increasing age Venous incompetence (VTE/Varicose veins) Pregnancy Obesity or physical inactivity Trauma
What are the associated symptoms of chronic venous disease?
Aching, itching, or a brusting sensation, will be present often before venous leg ulcers appear
What are the features of venous sufficiency?
Varicose eczema Thrombophlebitis Haemosiderin skin staining Lipodermatosclerosis Atrophied blanche
How is is underlying venous insufficiency confirmed?
Duplex ultrasound
What is used to assess for any arterial component to the ulcers?
Ankle Brachial Pressure Index (ABPI)
Asses if whether compression therapy will be suitable
What should you do if suspect infection?
Take swab culture and give antibiotics
What is the conservative management for venous leg ulcers?
Leg elevation
Increased exercise
Lifestyle change e.g weight loss and improved nutrition
What is the mainstay management for venous ulcers?
Multi component compression bandaging
- change once/twice a week
- most will heal in 6 months
What other treatment is important in venous ulcers?
Appropriate dressings
Emollients
Treating underlying venous insufficiency
What causes arterial ulcers?
Reduction in arterial blood flow leading to decreased perfusion of tissues and subsequent poor healing.
How would you describe arterial ulcers?
Where do they occur?
Small deep lesions with well -defined borders ad necrotic base
Commonly occurs in sites of trauma and pressure areas
What are the risk factors for arterial ulcers?
Peripheral arterial disease, smoking, DM, hypertension, hyperlipidaemia, increasing age, positive family history, obesity and physical inactivity
What is the typical history for a pt with suspected arterial ulcer?
Intermittent claudication
Critical limb ischaemia (pain at night)
Develops over long period of time with no healing
What are the associated signs of arterial ulcers?
Cold limbs Thickened nails Necrotic toes Hair loss Absent pluses on examination
What investigations could be done for suspected arterial ulcers?
Ankle Brachial pressure index (ABPI)
(>0.9 = normal, 0.9-0.8 = mild, 0.8-0.5 = moderate, <0.5 = severe)
Clinical examination followed by:
- Duplex ultrasound
- CT angiography
- Magnetic Resonance Angiogram (MRA)
What is the conservative management for arterial ulcer?
Lifestyle advise (smoking cessation, weight loss and increased exercise)
What is the medical management for arterial ulcers?
CVD risk modification:
- Statin therapy
- antiplatelet agent (aspirin or clopidogrel)
Optimise BP and Glucose
What is the surgical management of arterial ulcers?
Angioplasty (with or without stenting) Bypass grafting (more extensive disease)
For non-healing ulcers despite a good blood supply may also be offered skin reconstruction with grafts
What causes neuropathic ulcers?
Peripheral neuropathy leading often to painless ulcers
This is due to loss of protective sensation and repetitive stress and unnoticed injuries.
What are the risk factors for neuropathic ulcers?
Anything that cause peripheral neuropathy such as:
- DM
- B12 deficiency
Foot deformities or concurrent peripheral vascular disease
