for knowledge

1. ulcer
Aeliya rukhsar
PG first year
Department of surgery

2. Definition
Etiology
classification
examination
pathophysiology
investigation
treatment
Objectives

3. An ulcer is break in the
continuity of covering
epithelium skin or mucous
membrane.
DEFINATION

4. Traumatic cause
mechanical
physical
chemical
vascular insufficiency
arterial
venous
metabolic cause
diabetes mellitus
ETIOLOGY

5. Malnutrition
tropical ulcer
Infective process
TB
syphilis
Neurogenic cause
bed sores
Etiology….

6. 1.Clinical classification
spreading ulcer
healing ulcer
callous ulcer
classification
Pathological classification
Specific ulcer
Tuberculous ulcer
Syphilitic ulcer
Actinomycosis
Meleney’s ulcer
Malignant
ulcer
carcinomatous ulcer
rodent ulcer
melonotic ulcer
Non specific ulcer
Traumatic ulcer
Arterial ulcer
Venous Ulcer
Trophic Ulcer
Tropic Ulcer
Infective Ulcer
Bazin’s Ulcer
Martorell’s Ulcer

7. Classification on basis duration
Acute
ulcer-
duration is
less than 2
weeks
Chronic
ulcer-
duration
is more
than 2
weeks

8. Examination of ulcer
size,shape,number,site,edge,flooor,disc
harge,surrounding area
Palpation-
tempreture,tenderness,edge,
]margin,depth,base,bleeding,surroundi
ng skin
percussion
auscultation

9. Inspection
Shape of ulcer
Venous ulcer –
Vertically oval
Tubercular
ulcer-oval
Carcinomatous ulcer-
irregualr

10. Venous
ulcer-
medial
malleo
li
Rodent ulcer-
face(above
line joining
angle of mouth
to ear lobule
Tuberculou
s ulcer-neck
axilla groin
Trophic
ulcer-
heel,
bail,sole
of foot

11. Site of an ulcer
Gummatous ulcer-over
subcutaneous bone tibia,
sternum palate or skull
Malignant ulcer-on lips,
tongue, breast, penis.

12. Edges of ulcer
Sloping edge

13. Undermined
edges-TB
Puched out edge-
gummatous and trophic
ulcer
Edges of ulcers

14. Raised and pearly white beaded
edges-rodent ulcer(bcc)
Rolled out and everted edges-
squamous cell carcinoma

15. Floor of ulcer
Floor rest
on the
base. base
is not seen
only felt
floor
contain
Floor contain
red granulation tissue-
healing ulcer
pale granulation tissue- non
healing ulcer
Thick slough-callous ulcer
Wash leather slough-
gummatous and malignant
ulcer

16. Discharge from ulcer
Serous-healing
ulcer
Serosenguinous-
malignant
tubercular ulcer
Purulent-infective
ulcer
Greenish-
pseudomo
nas

17. Palpation of ulcer
Tenderness
Acute ulcer-tender
Chronic ulcer- non
tender
Slightly tender-
tuberculous and
syphilitic ulcer
Edges and margins
Marked induration of edges
is feature of carcinoma
base
On which ulcer
rest it is felt
better than seen
Slight-
induration-
chronic ulcer
Marked
induration-
SCC
Depth of ulcer in
mm and cm

18. 1. Haemogram with ESR.
2. chest x-ray in suspected tubercular ulcers.
3. FNAC of the lymph node
4. Blood culture and sensitivity.
5. Gram staining
6. Serum glucose
7. Xray of affected limb
8. Edge biopsy
9. Doppler USG
Investigation for ulcer

19. Pathogenesis of ulcer
1.Extensive
phase
2.Transition
phase
3.Repair
phase
Extensive phase-the floor is covered with exudates and slough
Base is indurated
The discharge is purulent or even with blood stained

20. Pathogenesis……
Transition phase
Prepares for healing .
The floor becomes cleaner and slough seprates.
The induration of the base diminished.
The discharge become more serous.
Small reddish area of granulation tissue appear on floor.

21. Treatment of ulcers
Conservative
treatment
Surgical
treatment
1.Dressing
2.Limb elevation
3.Control blood glucose
4.Hyperbaric oxygen therapy
1.Surgical debridement
2.Skin grafting
3.Sloughectomy
4.Flaps
5.Limb amputation