how to examine ulcers part2
TRANSCRIPT
ExaminationExaminationSiteSite ShapeShape SizeSize
FloorFloor
Edge Edge (5 types)(5 types)
DepthDepth
1- Sloping
The ulcer is shallow & the epithelium is The ulcer is shallow & the epithelium is growing in from the edge in an attempt to growing in from the edge in an attempt to
healheal
ExaminationExamination
Edge Edge (5 types)(5 types)
1- Sloping
2- Punched-out
or square cutsquare cut: It results from rapid death & loss of the whole thickness of the skin with minimal attempt of healing
Gamma of 3ry syphilis Leprosy Neuropathic ulcer in the
sole of foot
ExaminationExamination
Edge Edge (5 types)(5 types)
1- Sloping
2- Punched-out
3- Undermined edge
When infection is affecting the subcutaneous tissue more than the skin, the edge becomes
undermined
Pressure bed sore in the buttock.
Subcutaneous fat is more susceptible to pressure
than the skin
Tuberculous ulcer
Undermined edge in Pyoderma gangrenosa
Undermined edge in diabetic foot infection
ExaminationExamination
Edge Edge (5 types)(5 types)
1- Sloping
2- Punched-out
3- Undermined
4- Rolled
Develops when there is slow growth of tissue in the edge of the ulcer
Basal cell carcinoma (rodent ulcer):
Pale pink edge with clumps & clusters of cells visible through the paper thin superficial covering of squamous cells
ExaminationExamination
Edge Edge (5 types)(5 types)
1- Sloping
2- Punched-out
3- Undermined
4- Rolled
5- Everted edge
Develops when the tissue in the edge of the ulcer is growing quickly and spilling out of
the ulcer to overlap the normal skin.
This edge is typical of carcinoma at any site
Malignant ulcer colon carcinoma
Malignant transformation in a chronic venous ulcer
“Marjulin” ulcer
ExaminationExaminationSiteSite ShapeShape SizeSize
FloorFloor
EdgeEdge
DepthDepth
DischargeDischargeMay be: serous, sanginous, serosanguinous or purululent
A dry discharge forms a scab that covers the ulcer
Purulent discharge from infected bed sore
Serosanguinous discharge from infected diabetic foot
ulcer
Dry scab covering the ulcer
ExaminationExaminationSiteSite ShapeShape SizeSize
FloorFloor
EdgeEdge
DepthDepth
DischargeDischarge
Skin Skin (or tissues)(or tissues) around aroundCellulitis around the ulcer
Hyperpigmentation of ch. Recurrent infection
Pigmentation around venous ulcer
ExaminationExamination
SiteSite ShapeShape SizeSize
FloorFloor
EdgeEdge
DepthDepth
DischargeDischarge
RelationsRelations (adherent (adherent to deeper tissues)to deeper tissues)
Skin Skin (or tissues)(or tissues) around around
It is important to know if the ulcer is adherent to the
deep structures
ExaminationExamination
SiteSite ShapeShape SizeSize
FloorFloor
EdgeEdge
DepthDepth
DischargeDischarge
RelationsRelations (adherent to deeper tissues)(adherent to deeper tissues)
Skin Skin (or tissues)(or tissues) around around
Draining LNsDraining LNs
The draining LNs may be enlarged 2ry to infection or 2ry to tumour deposits.
Infected LNs may be tender