VENOUS ULCERS

Question 1

DEFINE venous ulcers

Answer 1

Large, shallow, usually painless usually found superior to the MEDIAL MALLEOLI. BUZZ

They are caused by incompetent valves in the lower limbs leading to venous stasis and ulceration.

Question 2

Explain the aetiology of venous ulcers

Answer 2

• They are caused by incompetent valves in the lower limbs
• Valve incompetence leads to venous stasis and increased venous pressure
• This results in ulceration

Question 3

Explain the risk factors of venous ulcers

Answer 3

o  Obesity  
o  Immobility 
o  Recurrent DVT  
o  Varicose veins  
o  Previous injury/surgery to the leg   
o  Age

Question 4

Summarise the epidemiology of venous ulcers

Answer 4

• VERY COMMON

* Increases with age

Question 5

Recognise the presenting symptoms of venous ulcers

Answer 5

Large, shallow, relatively painless ulcer with an
irregular margin situated above the medial malleoli
(most of the time)

Question 6

What features of the history are present in venous ulcers

Answer 6

o  Varicose veins  
o  DVT  
o  Phlebitis  
o  Fracture, trauma or surgery   
o  Family history  
o  Other symptoms of venous insufficiency:  
•  Swelling 
•  Itching   
•  Aching

Question 7

Recognise the signs of venous ulcers on physical examination

Answer 7

Large, shallow, relatively painless ulcer with an

irregular margin situated above the medial malleoli

Question 8

Identify appropriate investigations for venous ulcers

Answer 8

• ABPI
o Exclude arterial ulcer
o If ABPI < 0.8 M do NOT apply a pressure bandage as this could worsen the ulcer
• Measure surface area of ulcer - allows monitoring of progression
• Swabs for microbiology - if signs of infection
• Biopsy - if possibility of Marjolin’s ulcer

Question 9

Generate a management plan for venous ulcers

Answer 9

• Graduated compression (reduced venous stasis)
o NOTE: must exclude diabetes, neuropathy and PVD before this is attempted
• Debridement and cleaning
• Antibiotics - if infected
• Topical steroids - may help with surrounding dermatitis

Question 10

Identify possible complications of venous ulcers

Answer 10

• Recurrence

* Infection

Question 11

Summarise the prognosis for patients with venous ulcers

Answer 11

GOOD

• Results are better if patients are mobile with few comorbidities

Question 12

What are 3 sings on physical examination of PROGRESSIVE venous ulcer disease?

Answer 12

o Stasis eczema
o Lipodermatosclerosis (inverted champagne bottle sign if SEVERE)
o Haemosiderin deposition (dark colour)