Ulcer - Lecture notes 1 and 2 PDF

Preview

Summary

Easy notes...

Description

ULCER

Definition An ulcer is a break in the continuity of the covering epithelium, either skin or mucous membrane due to molecular/cell death.

Parts of an Ulcer *Margin It may be regular or irregular It may be rounded or oval. *Edge Edge is the one, which connects floor of the ulcer to the margin. Different edges are:

1. Sloping edge

It is seen in healing ulcer. Its inner part is red because of red, healthy granulation tissue.

2. Punched out edge is seen in gummatous (syphilitic) ulcer, trophic ulcer and pressure sores. It is due to endarteritis.

3. Raised and beaded edge (pearly white) is seen in rodent ulcer (BCC).

4. Everted edge (rolled out edge): It is seen in carcinomatous ulcer.

Floor It is the one, which is seen. Floor may contain discharge, granulation tissue, or slough. Base Base is the one where ulcer rests. It may be bone or soft tissues.

CLASSIFICATION I (CLINICAL)

1. Spreading ulcer: Here edge is inflamed and edematous.

2. Healing ulcer : Edge is sloping with healthy pink/red granulation tissue with serous discharge.

3. Callous ulcer: Floor contains pale unhealthy granulation tissue with indurated edge/base .Ulcer has no tendency to heal. It lasts for many months to years. It is due to callous attitude of the patient .

CLASSIFICATION II (PATHOLOGICAL)

Specific Ulcers

1. Tuberculous ulcer

2. Syphilitic ulcer: It is punched out, deep ulcer, with 'wash-leather' slough in the floor and with indurated base.

3. Actinomycosis. Meleney's ulcer.

4. Meleneys ulcer

Malignant Ulcers

1. Carcinomatous ulcer.

2. Rodent ulcer.

3. Melanotic ulcer.

Nonspecific Ulcers

1. Traumatic ulcer: It may be due to mechanical, physical, chemical injury.

2. Arterial ulcer: Atherosclerosis, TAO. Venous ulcer (gravitational ulcer, post phlebitic ulcer).

3. Trophic ulcer.

4. Infective ulcers: Pyogenic ulcer.

5. Tropical ulcers: It occurs in tropical countries. It is callous type of ulcer, e.g. Vincent's ulcer. ▸ Ulcers due to chilblains and frostbite 1(cryopathic ulcer).

4. Martorell's hypertensive ulcer: It occurs due to obliteration of end arteries. It is observed in skin over the back of calf region. Ulcer is severely painful with deep, non-healing ischemic look.

5. Bazin's ulcer: It is seen exclusively in the legs and ankles of young females, as erythematous purplish nodules and non healing ulcers. It may be due to ischemic /hypersensitive/tuberculous etiology. It is treated with antituberculous drugs, dressings, vasodilators and often by sympathectomy. It is also called as Erythrocyanosis frigida.

6. Diabetic ulcer

7. Ulcers due to leukemia, polycythemia, jaundice, collagen dis lymphede ma.

8. Cortisol ulcers are due to long time application of cortisol (steroid) creams to certain skin diseases. These ulcers are callous ulcers, last for long time and requires excision with skin grafting.

Note: Maggots may form in ulcer and they eat only dead tissues

Investigations for an Ulcer

1. Study of discharge: Culture and sensitivity,AFB study, cytology.

2. Edge biopsy: Biopsy is taken from the edge because edge contains multiplying cells. Usually two biopsies are taken. Biopsy from the center may be inadequate because of necrosis.

3. X-ray of the part.

4. FNAC of the lymph node.

5. Chest X-ray, Mantoux test is done in suspected case of tuberculous ulcer

Treatment of an Ulcer

1. Treat the cause like diabetes, anemia, and malnutrition. Often needs blood Aransfusion.

2. Antibiotics are given depending on the culture and sensitivity.

3. Regular dressings using EUSOL (Edinburgh University Solution containing calcium hydroxide, boric acid, sodium hypochlorite),H₂O₂, povidone iodine.

4. Wound excision/slough excision/debridement of the wound at regular intervals.

5. Once wound granulates well, split skin grafting is done to cover the defect

6. If there is no adequate blood supply, or if bone is exposed then flap is needed depending on the location of ulcer, either groin flap, pectoralis major flap, etc.

Debridement of an ulcer

• It is removal of devitali...