EXAMINATION AND CLINICAL APPROACH OF AN ULCER.pptx

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

1. EXAMINATION AND CLINICAL APPROACH OF AN ULCER DR RAGUL S MD PART I DEPT OF ORGANON

2. ULCER An ulcer is a break in the continuity of the covering epithelium, either skin or mucous membrane due to cell death. Parts of an ulcer: Margin Edge Floor Base

3. LOCAL EXAMINATION - INSPECTION Site of an ulcer: Trophic ulcer – Heel and ball of feet (pressure sores) Tuberculous ulcer – Neck, axilla, groin Gummatous ulcer – Sternum, skull, tibia Traumatic ulcer – Leg Rodent ulcer – Face Arterial ulcer – Toes, fingers, feet, legs Venous ulcer – around ankle Neuropathic ulcer – Heads of 1 st and 2 nd metatarsals

4. Common sites of pressure sores

5. Size, Shape and Number of an ulcer Size should be assessed both vertically and horizontally. Shape: Oval – venous ulcer Circular/crescentic/oval – tuberculous ulcer Irregular – malignant ulcer Number: solitary – malignant ulcer multiple – venous ulcer, tuberculous ulcer

6. Malignant ulcer (irregular) Varicose ulcer (Oval) Tuberculous ulcer (circular)

7. Margin and Edge Margin is the junction of normal skin to the outermost end of the edge. Regular/ irregular/ well defined/ ill defined Edge is a part from floor to margin Sloping edge – healing ulcer Punched out edge – trophic ulcer, gummatous ulcer Undermined edge – tuberculous ulcer Raised edge – rodent ulcer Everted edge – malignant ulcer

8. Floor is one what is seen Floor may be covered with crust/scab/slough Red granulation tissues – healing ulcer Pale, unhealthy – non healing ulcer Thick slough – chronic callous ulcer Pigmented tissues - melanoma

9. ULCER WITH SLOUGH ULCER WITH GRANULATION TISSUE

10. Discharge from ulcer Quantity: Profuse – spreading ulcer Scanty – venous, arterial, trophic ulcer Absent – syphilitic chancre, gummatous ulcer, carcinomatous ulcer Quality: Purulent – spreading ulcer Serous – healing ulcer Serosanguinous – tuberculous ulcer Bloody – malignant ulcer

11. Colour: Yellow or dark brown – spreading ulcer reddish or pinkish – healing ulcer Greenish – pseudomonas infection Yellow caseous – tuberculous ulcer Smell: Odourless – healing ulcer Foul smell – bacterial infection Surrounding area has to be examined for inflammation, pallor, pigmentation, eczema, texture, scar, loss of hair, visible vein.

12. PALPATION Temperature Induration Base is the one which ulcer lies. May be fascia, soft tissues, bone. Mobility Bleeding on palpation Surrounding area should be palpated for tenderness, sensation, warmness Examination of adjacent joints Examination of regional lymph nodes Examination of varicose veins Examination of peripheral pulse

13. GUESS THE TYPE OF ULCER VENOUS ULCER

14. ARTERIAL ULCER

15. TUBERCULOUS ULCER

16. RODENT ULCER

17. TROPHIC ULCER

18. GUMMATOUS ULCER