Ulcers ☺️

Question 1

Venous

• causes and pathophysiology
• presentation
• types of insufficiency
• investigations
• management (1st and 2nd line)

Answer 1

Chronic venous insufficiency => venous HTN

• vessel stretched so fibrin leaks out, forms a cuff around vessel
• skin supplied by that region dies => ulcer forms

Painless above ankle

Deep venous insufficiency linked to past DVT
Superficial venous insufficiency linked to varicose veins

Edema, brown pigmentation, eczema, lipodermatosclerosis

Doppler US - assess for reflux
Duplex US - anatomy, flow

4 layer compression banding after arterial disease exclusion or surgery
No healing after 3months/10cm3+ => skin graft

Question 2

Arterial

• location and properties
• investigation findings

Answer 2

Toes, heels
Painful
Some gangrene

Cold, no pulse
Low ABPI

Question 3

Neuropathic

• location and associations
• management

Answer 3

Plantar surface of MT, hallux
-common cause of amputation in diabetics
Due to pressure

Cushioned shoes, reduce callous formation