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Examination of An Ulcer

This document provides information about examining ulcers. It defines an ulcer as a break in epithelial tissue due to cell death. It describes the parts of an ulcer including the margin, edge, and floor. It discusses different types of edges seen in various ulcers. Ulcers are classified clinically as spreading, healing, non-healing, or callous based on characteristics of the edge and floor. Pathological classifications include carcinomatous, rodent, and melanotic ulcers. A full examination of an ulcer involves assessing these features and taking a thorough medical history from the patient.

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Mahaprasad sahoo 77
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410 views27 pages

Examination of An Ulcer

This document provides information about examining ulcers. It defines an ulcer as a break in epithelial tissue due to cell death. It describes the parts of an ulcer including the margin, edge, and floor. It discusses different types of edges seen in various ulcers. Ulcers are classified clinically as spreading, healing, non-healing, or callous based on characteristics of the edge and floor. Pathological classifications include carcinomatous, rodent, and melanotic ulcers. A full examination of an ulcer involves assessing these features and taking a thorough medical history from the patient.

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Mahaprasad sahoo 77
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EXAMINATION OF

AN ULCER
BY- DR JAGADANANDA MISHRA, MS
HEAD OF DEPARTMENT, GENERAL SURGERY
IMS AND SUM HOSPITAL
ULCER: DEFINITION

 A BREAK IN THE CONTINUITY OF COVERING


EPITHELIUM, EITHER SKIN OR MUCOUS MEMBRANE
DUE TO MOLECULAR OR CELL DEATH
WOUND: DEFINITION

 DISRUPTION
OF ANY TISSUE, SOFT TISSUE OR BONE OR
INTERNAL ORGANS, STRUCTURALLY OR
FUNCTIONALLY.
 ULCER IS A TYPE OF WOUND.
PARTS OF AN ULCER:

 MARGIN- THE PERIPHERAL LIMIT OF THE ULCER


MAYBE REGULAR OR IRREGULAR, ROUNDED OR OVAL

 EDGE-
IS THE ONE WHICH CONNECTS FLOOR OF THE
ULCER TO THE MARGIN
DIFFERENT TYPES OF EDGE:

 SLOPING EDGE:

SEEN IN HEALING ULCER; INNER PART IS RED AND


CONTAINS GRANULATION TISSUE, MIDDLE PART IS WHITE
DUE TO SCAR/FIBROUS TISSUE; OUTER PART IS BLUE DUE
TO EPITHELIAL PROLIFERATION
 UNDERMINED EDGE:

SEEN IN TUBERCULAR ULCER;

DISEASE PROCESS ADVANCES IN SUBCUTANEOUS TISSUE


WHEREAS EPIDERMIS PROLIFERATES IN WOUND.
 PUNCHED OUT EDGE:

SEEN IN GUMMATOUS ULCER AND TROPHIC ULCERS;


IT IS DUE TO ENDARTERITIS
 RAISED AND BEADED EDGE:

(PEARLY WHITE), IS SEEN IN RODENT ULCER(BASAL CELL


CARCINOMA); BEADS ARE DUE TO PROLIFERATING ACTIVE
CELLS
 EVERTED(ROLLED OUT) EDGE:

SEEN IN CARCINOMATOUS ULCER; DUE TO SPILL OF THE


PROLIFERATING MALIGNANT TISSUES OVER THE
NORMAL SKIN
FLOOR OF THE ULCER:

 IS THE AREA WHICH


IS SEEN; MAY CONTAIN DISCHARGE,
GRANULATION TISSUE OR SLOUGH.

BASE OF THE ULCER:

 BASE IS THE AREA ON WHICH THE ULCER RESTS


 IT IS FELT, NOT SEEN.
LIFE HISTORY OF AN ULCER:

1. STAGE OF EXTENSION- INFLAMMATION SPREADS.


2. STAGE OF TRANSITION- GRANULATION TISSUE AND
SEROUS DISCHARGE IN THE FLOOR.
3. STAGE OF REPAIR- FORMATION OF HEALTHY
GRANULATION TISSUE, NEO-EPITHELIALISATION,
FIBROSIS AND SCARING.
TYPES OF EDGES IN ULCER:
CLASSIFICATION OF ULCERS(CLINICAL):

1. SPREADING
2. HEALING
3. NON-HEALING
4. CALLOUS
1. SPREADING ULCER:

 EDGE IS INFLAMMED, EDEMATOUS


 GRANULATION TISSUE IS ABSENT IN FLOOR
 PURULENT DISCHARGE WITH SLOUGH
 DRAINING LYMPH NODES MAY BE ENLARGED, TENDER.
2. HEALING ULCER:

 SLOPINGEDGE WITH HEALTHY RED/PINK GRANULATION


TISSUE WITH MINIMAL SEROUS DISCHARGE.
 NO SIGNS OF INFLAMMATION
 BASE IS NOT INDURATED
3 ZONES: INNERMOST- RED,
MIDDLE-BLUE,
OUTER- FIBROSIS AND SCAR FORMATION
3. NON HEALING ULCER:

 ANY ULCER WHICH DOES NOT SHOW SIGNS OF HEALING

 Eg: TROPHIC
ULCER, TUBERCULAR ULCER,
CARCINOMATOUS ULCER, ETC SHOWING THEIR
CHARACTERISTICS
4. CALLOUS ULCER:

 A CHRONIC ULCER.
 FLOOR HAS PALE, UNHEALTHY WHITISH GRANULATION
TISSUE AND SCANTY SEROUS DISCHARGE
 BASE IS INDURATED, NON TENDER
 ULCER HAS NO TENDENCY TO HEAL
 PIGMENTATION MAY BE SEEN IN THE SURROUNDING
AREA
CLASSIFICATION(PATHOLOGICAL):

1. CARCINOMATOUS ULCER
2. RODENT ULCER
3. MELANOTIC ULCER
CLASSIFICATION(NON-SPECIFIC):

 TRAUMATIC
 ARTERIAL ULCERS
 VENOUS ULCERS
 NEUROPATHIC ULCERS;
- DIABETES, HANSEN’S DISEASE,
- TABES DORSALIS, SPINAL INJURY,ETC
 TROPHIC ULCER
 INFECTIVE ULCER
 TROPICAL ULCER
 ULCERS DUE TO FROSTBITE, CHILLBLAINS
HISTORY TAKING OF AN ULCER:
 AGE: SOME ULCERS ARE MORE IN CERTAIN AGE GROUP
 OCCUPATION:
 PLACE:
 CHIEF COMPLAINTS:
 HISTORY OF PRESENTING ILLNESS:
- MODE OF ONSET
- PROGRESSION
- DURATION
- PAIN
- H/O FEVER, DISCHARGE
 ASSOCIATED SYMPTOMS
 PAST HISTORY, PERSONAL HISTORY, FAMILY HISTORY.
THANK YOU

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