Clinical examination of Ulcers

September 21, 2012 | By | Reply More

Clinical examination of Ulcers

Features to note on examination
  • Site. Neck, groin, and axilla (TB); legs and feet (vascular); anywhere (malignant).
  • Surface. Usually depressed. Elevated in malignancy, vascular granulations.
  • Size. Measure the ulcer. Is it large by comparison to the length of history?
  • Shape. Oval, circular, serpiginous, straight edges.
  • Edge. Eroded (actively spreading), shelved (healing), punched out (syphilitic), rolled or everted (malignant).
  • Base. Fixed to underlying structures? Mobile? Indurated? Penetrating?
  • Discharge. Purulent (infection), watery (TB), bleeding (granulation or malignancy).
  • Pain usually occurs during the extension phase of non-specific ulcers. In diabetic patients ulcers are relatively painless.
  • Number. Widespread locally (local infection such as cellulitis), widespread generally (constitutional upset).
  • Progress. Short history (pyogenic), chronic (vascular or trophic, e.g. post-phlebitic syndrome, decubitus ulceration of paraplegia).
  • Lymph nodes in the region of an ulcer may indicate secondary infection or malignant change.
Natural history
  • Extension. There is discharge, thickened base, inflamed margin. Slough and exudates cover the surface.
  • Transition. Slough separates and the base becomes clean. The discharge becomes scanty, the margins less inflamed.
  • Repair. Granulation becomes fibrous tissue and forms a scar after re-epithelialization.
Investigations
History, biopsy, and histology, serology, as indicated by presentation.

Category: Pathology, Surgery

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