26449597
Descripción
Fichas por Jenna Paterson, actualizado hace más de 1 año
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Creado por Jenna Paterson
hace alrededor de 4 años
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| Pregunta | Respuesta |
| Define 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. |
| What are the main types of ulcer? | Arterial, venous, mixed, neuropathic/diabetic, pressure sores. Other = malignancy, infections (TB), trauma (osteomyelitis) |
| What type of ulcer is more common on the leg? | Venous (65%) Arterial (15%) Other (20%) |
| What type of ulcer is more common on the foot? | Arterial (70%) Venous (5%) Other (15%) |
| What are the risk factors for developing an arterial ulcer? | - Coronary heart disease - Stroke/TIA - Peripheral arterial disease (intermittent claudication) - Obesity - Diabetes - Immobility |
| What are the risk factors for developing a venous ulcer? | - Varicose veins - Previous history of trauma/injury - FHx venous disease - Previous DVT/phlebitis |
| Where are venous ulcers typically found? | Lower calf/ankle region |
| What 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) |
| What pathophysiological factors can increase the risk of venous ulcers? | Thrombophlebitis - venous inflammation and clots Venous stasis (poor blood flow through veins) |
| What 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). |
| What 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). |
| What 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 |
| Where are arterial ulcers generally found? | More distal than venous - dorsum of feet/toes |
| What are the causes of arterial ulcers? | Arterial occlusion/PVD (atherosclerosis, vasospasm, inflammatory vascular disease) - loss of nutrients and oxygen lead to tissue break down. |
| What 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) |
| What do arterial ulcers look like? |
'Punched out border' - ulcer base contains greyish granulation tissue.
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| Where are neuropathic ulcers generally found? | Often under calluses or over pressure points. |
| What 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. |
| What 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. |
| What do neuropathic ulcers look like? |
Punched-out appearance with a deep sinus. Often surrounded by chronic inflammatory tissue.
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| How 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 |
| How 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) |
| How 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 |
| How 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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