Flashcards
Leg Ulcers
Cards in this deck (24)
- 1Define a leg ulcer.Full thickness skin loss on the leg or foot due to any cause.
--> loss of skin below the knee on the leg or foot, which takes >2 weeks to heal. - 2What are the main types of ulcer?Arterial, venous, mixed, neuropathic/diabetic, pressure sores.
Other = malignancy, infections (TB), trauma (osteomyelitis) - 3What type of ulcer is more common on the leg?Venous (65%)
Arterial (15%)
Other (20%) - 4What type of ulcer is more common on the foot?Arterial (70%)
Venous (5%)
Other (15%) - 5What are the risk factors for developing an arterial ulcer?- Coronary heart disease
- Stroke/TIA
- Peripheral arterial disease (intermittent claudication)
- Obesity
- Diabetes
- Immobility - 6What are the risk factors for developing a venous ulcer?- Varicose veins
- Previous history of trauma/injury
- FHx venous disease
- Previous DVT/phlebitis - 7Where are venous ulcers typically found?Lower calf/ankle region
- 8What are the signs and symptoms of venous ulcers?Relatively painless unless infected
Associated with aching, swollen lower legs that feel more comfortable when elevated.
May be surrounded by mottled brown/black staining and/or dry, itchy and reddened skin (venous eczema)
Can be associated with varicose veins (incompetence of superficial venous system) - 9What pathophysiological factors can increase the risk of venous ulcers?Thrombophlebitis - venous inflammation and clots
Venous stasis (poor blood flow through veins) - 10What are the symptoms of venous insufficiency?Pain and heaviness, poor mobility, restless leg syndrome, leg cramps/spasms, itch (can be problematic as already have thin skin - scratching may cause entry point for infections).
- 11What is venous insufficiency?A condition that occurs when the venous wall and/or valves don't work properly, therefore blood pools in the legs (venous stasis).
- 12What are the causes of venous insufficiency?Overweight
Pregnancy
Family history
Injury/trauma
Previous DVT
Sitting or standing for long periods over time
Lack of exercise
Smoking
Phlebitis - 13Where are arterial ulcers generally found?More distal than venous - dorsum of feet/toes
- 14What are the causes of arterial ulcers?Arterial occlusion/PVD
(atherosclerosis, vasospasm, inflammatory vascular disease) - loss of nutrients and oxygen lead to tissue break down. - 15What are the signs and symptoms of arterial ulcers?Nocturnal pain - worse when supine and relieved by dangling legs out of bed.
Associated features of chronic ischaemia (hairlessness, pale skin, absent pulses, nail dystrophy and wasting of calf muscles) - 16What do arterial ulcers look like?'Punched out border' - ulcer base contains greyish granulation tissue.
- 17Where are neuropathic ulcers generally found?Often under calluses or over pressure points.
- 18What are the causes of neuropathic ulcers?Diabetes
Peripheral neuropathy
This is due to loss of sensation due to sensory neuropathy which makes patients vulnerable to physical/chemical/thermal trauma. - 19What are the signs and symptoms of neuropathic ulcers?Usually painless ulcer, with surrounding area having reduced sensation.
Probing or debriding may lead to brisk bleeding. - 20What do neuropathic ulcers look like?Punched-out appearance with a deep sinus. Often surrounded by chronic inflammatory tissue.
- 21How do you investigate ulcers?Bloods (raised CRP/WCC ?infection, HBA1c/glucose)
Swab if evidence of infection (culture and sensitivities
ABPI (<0.9 suggests arterial disease)
Doppler US (evidence of thrombophlebitis? Underlying DVT?)
Medical photography - 22How are arterial ulcers managed?General advice - stop smoking, good nutrition, attention to hygiene, limit risk factors.
Treat underlying arterial insufficiency
Refer to vascular
Medical (statin, antiplatelets) vs surgical management (angioplasty, bypass grafting) - 23How are venous ulcers managed?General advice - stop smoking, good nutrition, attention to hygiene, limit risk factors.
Good nursing care
Dressings/compression bandages
Refer to tissue viability/district nurses - 24How are neuropathic ulcers managed?General advice - stop smoking, good nutrition, attention to hygiene, limit risk factors.
Investigate cause
Optimise management of underling care (e.g. improve HbA1c)
Regular foot checks (CPR)
Bespoke footwear to off load pressure
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- Dermatology Flashcards on Leg Ulcers, created by Jenna Paterson on 09/10/2020.
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- Jenna Paterson
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