Total Pageviews

Wednesday 6 February 2013

Clinical Examination of an Ulcer

                  Clinical Examination of an Ulcer

 

 

Definition of an Ulcer
  An  ulcer  is  defined  as  a  break   in  the  continuity  of   surface  epithelium   with     superadded    infection.
Clinical Classification of Ulcer
  Spreading- with surrounding inflammation
  Healing – Slopping edge with red granulation tissue
  Callous- Ulcer with no tendency to heal-with pale granulation tissue.
Pathological Classification of Ulcer
  Specific- Tuberculous, Syphylitic,Actinomycotic
  Non specific- Traumatic( Mechanical, Physical,Chemical)
Cryopathic, Arterial, Venous, Neurogenic, Trophic, Tropical, Bazin’s, Martorell’s, Meleney’s ulcer
  Malignant- Squamous cell carcinoma, Basal Cell Carcinoma, Melanoma
Classification of Ulcer based on duration
  Acute  Ulcers    < 12 weeks
  Chronic  Ulcers  > 12 weeks
Classification Based on Pain
  Painful Ulcers
        Tuberculous
        Arterial
        Advanced Malignancy

  Painless Ulcers-
       
        Syphilitic
        Trophic
        Early Malignancy
Modes of Onset of Ulcer
      Traumatic
      Spontaneous-
      Secondary changes on a Swelling-Tuberculous lymphadenopathy
      From a Previous Scar-Marjolin’s Ulcer

Causes for Chronic Ulcers
1.     Malnutrition
2.     Anemia
3.     Immunosuppression
4.     Systemic Diseases (Diabetes)
5.     Site & Size of an Ulcer
6.     Arterial / Venous Disorders
7.     Neurological Disorders
8.     Infection
9.     Chronic Irritation ( Dental Ulcers )  or  Lack of Rest ( Ulcer over a Joint )
10.   Malignancy
Discharge from the ulcer – Note the Colour, Amount & Smell
  Serous-Healing ulcer
  Sanguinous ( Blood Stained )- Malignant/Chronic
  Purulent-Bacterial infection
  Greenish- Pseudomonas infection
  Yellowish - Sulphur Granules ( Actinomycosis )
Parts of an Ulcer
      Margin-line of demarcation between normal and abnormal
      Floor-the exposed part of an ulcer ( Inspection)
      Edge-the part between the margin and the floor of an ulcer
      Base-the structure on which the ulcer rests (Palpation)
Types of Floor of an Ulcer
  Slough-Moist dead tissue
  Scab-Dry dead tissue
  Unhealthy granulation tissue
  Healthy granulation tissue
  Subcutaneous fat
  Muscle/tendons
  Bone
Types of Edges of an Ulcer
  Slopping- Healing ulcer
  Punched out-Decubitous ulcer/Gummatous ulcer
  Undermined- Tuberculous ulcer
  Raised / Beaded- Basal cell carcinoma
  Rolled out / Everted- Squamous cell carcinoma
Examination of an Ulcer-Inspection
  Site
  Size
  Shape
  Number
  Margin
  Edge
  Discharge
Importance of Site of Ulcer

 

Face-Basal Cell Carcinoma

 

Neck-Tuberculous/Actinomycotic


Decubitus ulcer-Over pressure points like sacral/occiput/heel


Shin-Gummatous


Medial malleolus-Varicose ulcer



Examination of an Ulcer – Palpation
  Local rise of Temp & tenderness
  Exact dimensions - depth
  Induration ( thickening ) of edge-in chronic ulcer and in malignancy
  Base – fixity to underlying structures
  Bleeding on touch-is a feature of malignant/ Chronic ulcer
Examination of the Surrounding Area of an Ulcer
  Skin
  Adjacent Joint
  Regional Lymph nodes
  Arterial pulse
  Varicose veins
  Neurological deficit
  Gait of the patient
A Golden Rule
Whenever you see a lesion look for an enlarged draining lymph node;
Whenever you come across an enlarged lymph node in our body look for a lesion in the area of its lymphatic drainage.

17 comments:

  1. If you must speak ill of another, do not speak it, write it in the sand near the water's edge. See the link below for more info.



    #edge
    www.ufgop.org

    ReplyDelete
  2. Perfect, keep the good work

    ReplyDelete
  3. So nice article!Please kindly refer your reference books Doctor.

    ReplyDelete
  4. thank you , helpful in my revision

    ReplyDelete
  5. very nice and informative and to the point

    ReplyDelete
  6. well done,good work.thank you.

    ReplyDelete
  7. I was diagnosed with stage 3 breast cancer in August of 2010. A precious friend told me about Dr Itua Herbal Center in West Africa,She gave me his contact number and email address,I contacted him quickly so he give me guaranty that his herbal medicine will cure my cancer and i will be heal forever I said Okay.I ask him about the process for the cure,he ask me to pay for the fees which i did and within 7 working days he sent me the herbal medicine then he instructed me on how to drink it for two weeks to cure.I told Gomez my friend about the herbal medicine so he gave me go ahead to drink it.So after drinking it for two weeks i was cured I'm so grateful and i promise i will recommend anyone with cancer to him and that what i'm doing.Dr Itua Herbal Medicine makes me believes there is a hope for people suffering from,Parkinson's disease,Schizophrenia,Cancer,Scoliosis,Bladder Cancer,Colorectal Cancer,Tach Disease,Ovarian Cancer,Pancreatic Cancer,Breast Cancer,Kidney Cancer,Leukemia,Lung Cancer,Skin Cancer,
    Glaucoma.measles, tetanus, whooping cough, tuberculosis, polio and diphtheria, Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,Obsessive Compulsive Disorder,
    Dementia.Uterine Cancer,Prostate Cancer,Fibromyalgia,a
    Syndrome Fibrodysplasia ,Parkinson's disease,Epilepsy Dupuytren's disease,
    Diabetes ,Coeliac disease, Angiopathy, Ataxia,Arthritis,Tach Disease,Amyotrophic Lateral Sclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpes,Inflammatory bowel disease ,Copd,Diabetes.
    Here Is His Contact Info......[Email...drituaherbalcenter@gmail.com/ info@drituaherbalcenter.com. Whatsapp...+2348149277967]

    ReplyDelete
  8. Very concise,adequately descriptive and highly useful for trainees &
    post- grad.students in preparation for a theory examination

    ReplyDelete
  9. your General Surgeon Hospital in Hyderabad providing a complete range of diagnostics and treatment services with advanced technology equipment's

    ReplyDelete
  10. Get latest laparoscopic hiatus hernia treatment in Sarita Vihar, Delhi from Dr. Sushant Wadhera, laparoscopic acid reflux GERD surgery. Get best acid reflux treatment in Delhi

    ReplyDelete