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palpation of ulcer
- 2. TENDERNESS An acutely inflamed ulcer is always exquisitely tender. Chronic ulcers are slightly tender. Eg., Tuberculous / Syphilitic ulcers Neoplastic ulcers are never tender.
- 3. MARGIN, EDGE AND BASE MARGIN EDGE FLOOR BASE
- 4. Different types of edges of the ulcer are corroborated with the findings of the inspection.
- 5. INDURATION INDURATION POSSIBLE CAUSE Marked Carcinoma Slight Chronic ulcers The margin, edge and base must be examined for induration.
- 6. DEPTH Should be recorded in millimeters.
- 7. BLEEDING Whether the ulcer bleeds on touch should be checked.
- 8. RELATION TO DEEP STRUCTURES The ulcer is made to move over the deeper structures to know whether it is fixed to any of these structures.
- 9. SURROUNDING SKIN Tenderness, rise in temperature. Induration. Loss of sensation or motor deficit. Condition of the vessels.
- 10. LYMPH NODES Ulcer Regional Nodes 1. Acute Infectious Ulcer Enlarged, Tender 2. Tubercular Ulcer Enlarged, Matted 3. Gummatous Ulcer No change 4. Rodent Ulcer No change 5. Malignant Ulcer Stony hard, fixed
- 11. VASCULAR INSUFFICIENCY When ulcer is situated in lower part of leg, one should examine for- varicosities in upper part of leg or thigh. If it is not present, arteries proximal to the ulcer should be examined.
- 12. NERVE EXAMINATION TROPHIC ULCERS: indicate some neurological deficit.
Editor's Notes
- Bone depth – suspect trophic ulcers.
- as it is a common feature of malignant ulcer.
- A gummatous ulcer over a subcutaneous tissue or bone is often fixed to it. Malignant ulcer will be fixed to any of the deeper structure by infiltration.
- Tenderness, rise in temperature- acute inflammatory origin Induration – as previously described. Loss of sensation – indicates involvement of nerves in the causation of ulcer Vessels: eg., Artery – blocked in arterial ulcer- buergers, raynauds Vein – venous ulcers Buerger's disease (thromboangiitis obliterans) is a rare disease of the arteries and veins in the arms and legs. In Buerger's disease, your blood vessels become inflamed, swell and can become blocked with blood clots (thrombi). This eventually damages or destroys skin tissues and may lead to infection and gangrene. Buerger's disease usually first shows in your hands and feet and may eventually affect larger areas of your arms and legs. Virtually everyone diagnosed with Buerger's disease smokes cigarettes or uses other forms of tobacco, such as chewing tobacco. Quitting all forms of tobacco is the only way to stop Buerger's disease. For those who don't quit, amputation of all or part of a limb is sometimes necessary. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Raynaud's (ray-NOHZ) disease causes some areas of your body — such as your fingers and toes — to feel numb and cold in response to cold temperatures or stress. In Raynaud's disease, smaller arteries that supply blood to your skin narrow, limiting blood circulation to affected areas (vasospasm). Women are more likely than men to have Raynaud's disease, also known as Raynaud or Raynaud's phenomenon or syndrome. It appears to be more common in people who live in colder climates. Treatment of Raynaud's disease depends on its severity and whether you have other health conditions. For most people, Raynaud's disease isn't disabling, but can affect quality of life.
- A gumma is a soft, non-cancerous growth resulting from the tertiary stage of syphilis. Rodent: Early obliteration of lymphatics by neoplastic cells.
- Artery – occlusion – poor circulation – ulcer – raynauds, buergers.
- Trophic ulcers develop as a result of repeated trauma to an insensitive part of the body Therefore it indicates some neurological deficit. Hence nerve examination becomes imperative in cases of trophic ulcer.