Venous ulcers Flashcards
(18 cards)
What is the prevalence of venous ulcers in women?
<1 - 40% women
Prevalence rates vary, with a mean of <1-17%.
List the risk factors associated with venous ulcers.
- Age
- Sex
- Pregnancy
- Prolonged standing
- Height
These factors increase the likelihood of developing venous ulcers.
What are the most common causes of venous ulcers?
- Venous insufficiency
- Venous hypertension
These conditions lead to increased pressure in the veins, contributing to ulcer formation.
What is the primary mechanism that drives blood from the legs toward the heart?
Contraction of calf muscle
This muscle action is essential for venous return.
What happens when venous valves are incompetent?
Elevation of pressures, termed venous hypertension or venous insufficiency
This condition can lead to various complications, including ulcers.
What is the main theory explaining the pathogenesis of venous ulcers?
Microvascular leukocyte-trapping hypothesis
This theory suggests that elevated venous pressures lead to the entrapment of leukocytes, initiating an inflammatory response.
What are the characteristic clinical features of venous ulcers?
- Swelling/aching of legs
- Muscle cramps
- Pruritus
- Restless legs
- Ulcer characteristics: irregular border, yellow fibrinous exudate, shallow base
- Characteristic associated features:
○ Varicose veins
○ Stasis dermatitis
Haemociderin deposition - lipodermatoscleosis
These features can vary from mild to severe.
Where are venous ulcers most commonly located?
Above the medial malleolus
This area is particularly prone to ulcer formation due to venous pressure.
What investigations would you perform?
- Duplex ultrasound (USS)
uplex USS- ABI
- Screen for neuropathy
- Ascending venography – recommended in those with post-thrombotic disease
- Descending venography – recommended in those with valvular disease to assess reflux severity
- MR-V + CT-V àexperience with these modalities still limited
- Swab if signs of infection
What are the non-specific pathological features observed in the skin surrounding a venous ulcer?
- Reactive epithelial hyperplasia
- Dermal fibrosis
- Inflammatory infiltrate
- Proliferation of capillaries
- Extravasation of RBCs
- Deposition of hemosiderin within macrophages
These changes indicate underlying venous disease.
What is the differential diagnosis (DDx) for venous ulcers?
- Malignancy
- Vasculitis
- Peripheral arterial disease
- Infection (e.g., atypical mycobacterial)
- Thrombophilia in cases of livedoid vasculopathy or recurrent DVTs
- Vasculopathy: embolic, coagulative disorders
Distinguishing venous ulcers from other conditions is crucial for appropriate treatment.
What is the role of moisture and occlusion in the treatment of venous ulcers?
Stimulates collagen synthesis, promotes hypoxic environment, encourages re-epithelialization, decreases pain
Proper wound care is essential for healing.
What types of debridement methods are used in wound management?
- Sharp
- Mechanical
- Autolytic
- Enzymatic (chemical)
- Maggot debridement
Each method has specific indications based on the wound characteristics.
Fill in the blank: Compression therapy with _______ is recommended for venous ulcers.
elastic stockings
Graduated compression helps heal ulcers and prevent recurrence.
What topical antibiotics are commonly used for infections in venous ulcers?
- Mupirocin
- Neomycin
These antibiotics help manage bacterial colonization and infection.
True or False: Venous reflux correction surgically improves existing ulcers.
False
Surgical correction will prevent further ulcers but does not improve current ones.
What topical medications can stimulate neovascularization in venous ulcers?
- 0.025% tretinoin cream
- 0.5% timolol
- PDGF (topical growth factors)
These medications promote healing through enhanced blood flow and tissue regeneration.
How do you distinguish between wound infection vs colonisation?
Infection - pain, erythema, increased exudate, purulent discharge, swelling, increased ulcer size, malodourous or friable granulation tissue
