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Ulcer examination

ulcer examination .. clinical significance of examination findings.

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Ulcer examination

  1. 1.  A break in the epithelial continuity  Discontinuity of the skin or mucous membrane which occurs due to the microscopic death of the tissues
  2. 2. A. Clinical B. Pathological
  3. 3. Spreading : (Edge - Inflamed & Edematous) Healing : (Edge is sloping with healthy red granulation tissue & serous discharge) Callous : (Floor contains pale unhealthy granulation tissue with indurated edge)
  4. 4. 1. Nonspecific 2. Specific 3. Malignant
  5. 5. Traumatic Ulcer Arterial Ulcer Venous Ulcer Neurogenic Ulcer Infective Ulcer
  6. 6. Tuberculosis Syphilis Actinomycosis Meleney’s ulcer Soft sore
  7. 7. Squamous cell ca Basal cell ca Malignant melanoma
  8. 8.  Mode of onset  Duration  Pain  Discharge  Associated disease
  9. 9.  General survey  Inspection  Palpation  Examination of lymph nodes  Vascular insufficiency  Nerve lesions
  10. 10.  SIZE AND SHAPE  NUMBER  POSITION  EDGE  FLOOR  DISCHARGE  SURROUNDING AREA
  11. 11. Arterial ulcer Tip of the toes, dorsum of the foot Long saphenous varicosity with ulcer Medial side of the leg. Short saphenous varicosity with ulcer Lateral side of the leg. Perforating ulcers Over the sole at pressure points. Nonhealing ulcer Over the shin
  12. 12. DEF: This is between the floor of the ulcer and the margin. The margin is the junction between the normal epithelium and the ulcer. These two parts represent areas of maximum activity.
  13. 13. A. Sloping edge All healing ulcers like traumatic ulcers, venous Ulcers
  14. 14. B. Punched out edge Gummatous ulcers and trophic ulcers.
  15. 15. C. Undermined edge Tuberculous ulcers
  16. 16. D. Raised edge (beaded edge) Rodent ulcers or basal cell carcinoma .
  17. 17. E. Everted edge (Rolled out) Squamous cell carcinoma.
  18. 18. DEF : This is the part of the ulcer which is exposed or seen. Red granulation tissue Healing ulcer Necrotic tissue, slough Spreading ulcer Pale, scanty granulation tissue Tuberculous ulcer Wash-leather slough Gummatous ulcer
  19. 19. Serous discharge Healing ulcer Purulent discharge Spreading ulcer Bloody discharge Malignant ulcer Discharge with bony spicules Osteomyelitis Greenish discharge Pseudomonas infection
  20. 20. Thick and pigmented Varicose ulcer. Thin and dark Arterial ulcer. Red and oedematous Spreading ulcers like diabetic ulcer.
  21. 21. TENDERNESS EDGE AND MARGIN BASE INDURATION BLEEDING RELATIONS WITH DEEPAR STRUCTURES SURROUNDING SKIN
  22. 22.  Induration (hardness) of the edge is very characteristic of squamous cell carcinoma.  It is said to be a host defense mechanism.  Tenderness of the edge is characteristic of infected ulcers and arterial ulcers.
  23. 23.  It is the area on which ulcer rests.  Marked induration at the base is diagnostic of squamous cell carcinoma.
  24. 24. • The edge, base and the surrounding area should be examined for induration. Maximum induration Squamous cell carcinoma Minimal induration Malignant melanoma. Brawny induration Abscess. Cyanotic induration Chronic venous congestion as in varicose ulcer.
  25. 25.  Malignant ulcer is friable like a cauliflower. On gentle palpation, it bleeds.  Granulation tissue as in a healing ulcer also causes bleeding.
  26. 26.  Thickening and induration is found in squamous cell carcinoma.  Tenderness and pitting on pressure indicates spreading inflammation surrounding the ulcer.
  27. 27.  REGIONAL LYMPH NODES Tender and enlarged Acute secondary infection. Non-tender and enlarged Chronic infection. Non-tender and hard Squamous cell carcinoma. Non-tender, large, firm, multiple Malignant melanoma.

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ulcer examination .. clinical significance of examination findings.

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