Ulcers Facts: Causes, Symptoms, Risk Factors

Ulcers Facts: Causes, Symptoms, Risk Factors

Define ulcer. Describe different types of ulcer.

Answer. An ulcer is the break in the continuity of the covering epithelium either skin or mucus membrane due to molecular death.

Different Types Of Ulcer

Classification I (Clinical)

• Spreading ulcer: In this edge is inflmed, irregular and edematous.
  • It is an acute painful ulcer, flor consists of profuse purulent discharge and slough.
  • Surrounding area is red and edematous
• Healing ulcer: Edge is sloping with healthy pink/red granulation tissue with scanty/minimal serous discharge on the flor, slough is absent.
  • Surrounding area does not show any signs of inflammation or induration.
  • Base is not indurated. Three zones are seen innermost red zone of healthy granulation tissue, middle bluish zone of growing epithelium, outer white zone of firosis and scar formation.

“The Role Of Imaging Tests In Diagnosing Ulcers”

• Non-healing ulcer: In this ulcer, edge of the ulcer depend on the cause punched out (trophic), undermined (tuberculosis), rolled out (carcinomatous ulcer), beaded (rodent ulcer); flor consists of unhealthy granulation tissue and slough, and serosanguineous/purulent/bloody discharge, regional draining lymph nodes are enlarged but nontender.
• Callous ulcer: This is a chronic non healing ulcer, flor consists of pale, unhealthy, flbby, whitish yellow granulation tissue and thin scanty serous discharge or rarely with copious serosanguinous discharge, with indurated non tender edge, base in indurated, nontender and is often fied.
  • Ulcer does not show any tendency to heal. It lasts for months to years.
  • Induration and pigmentation can be seen.

“What Causes Ulcers In The Body”

Classification II (Based on duration)

• Acute ulcer: Duration less than 2 weeks
• Chronic ulcer: Duration more than 2 weeks

Classification III (Pathological)

Specific ulcers:

• Tuberculous ulcer: Ulcer can be single or multiple;oval or rounded with undermined edge, painless with caseous material on the flor. Ulcer is not deep
• Syphilitic ulcer: It has punched-out edge, deep with wash leather slough in the flor and indurated base.
• Actinomycosis: In this initially an induration develops.
  It softens and bursts via skin as sinuses which discharge pus and have sulfur granules.
• Meleney’s ulcer: It is seen in postoperative wounds in abdomen and chest wall. This is an acute rapidly spreading ulcer with destruction and deep burrowing of subcutaneous tissues.

“Comprehensive Overview Of Ulcer Symptoms”

Malignant ulcers:

• Carcinomatous ulcer: This ulcer arises from prickle cell layer of skin.
  • It has rolled out/everted edge.
  • Floor consists of necrotic content, unhealthy granulation tissue and blood.
  • Ulcer bleeds on touch and is vascular or friable. Induration is felt at base and edge.
  • It is circular or irregular in shape.
• Rodent ulcer: It is seen in basal cell carcinoma. Ulcer shows central area of dry scab with peripheral, raised active and beaded edge.
  • Often flor is pigmented. It erodes in deeper planes such as soft tissue, cartilage and bones
• Melanotic ulcer: It is the ulcerative form of melanoma.
  • Ulcer is pigmented often with halo around. Ulcer is rapidly growing often with satellite nodules.

“Common Symptoms Of Ulcers”

Non-specific ulcers:

• Traumatic ulcers: It occurs after trauma. Ulcer is superfiial, painful and tender.
• Arterial ulcer: This ulcer occurs after trauma and soon become nonhealing.
  • Ulcer is usually deep,destruct deep fascia, exposing tendons, muscles and underlying bone.
  • Ulcer is very painful, tender and often hyperaesthetic
• Venous ulcer: It is common around ankle due to ambulatory chronic venous hypertension.
  • Ulcer is initially painful but once it become chronic, it is painless.
  • It is vertically oval in shape. Floor is covered with pale or often without any granulation tissue.
  • Edge is sloping. Induration and tenderness is seen often at base of an ulcer.
• Trophic ulcer: It is the ulcer due to prolonged pressure.
  • Blood flow to skin stops once external pressure becomes more than 30mm of Hg and this leads to tissue hypoxia, necrosis and ulceration.
• Infective ulcer
  • Tropical ulcer: It is an acute ulcerative lesion of skin seen in tropical countries.
  • Pustule formation occur which bursts in three days with necrobiosis and phagedena causing spreading painful ulcer with an undermined edge, brownish floor and serosanguineous discharge

“Risk Factors For Developing Ulcers”

• Ulcers due to chilblain and frostbite: This is due to exposure of a part to wet cold below freezing point.
  Ulcers here are deep
• Martorell’shypertensiveulcer: Itisseeninhypertensive patients often with atherosclerosis.
  In this necrosis of calf skin occur with sloughing away and formation of deep, punched out ulcers extending to deep fascia.
• Bazin’s ulcer
• Diabetic ulcer: Diabetic ulcer is most common in foot.
  • It can cause abscess, ulcer, osteomyelitis, gangrene,septicemia.
  • Initially, patient undergo toe amputation but later eventually land with below knee or above knee amputation.
• Ulcers due to leukemia, polycythemia, jaundice,collagen diseases, lymphoedema
• Cortisol ulcers: They are due to long time application of cortisol creams to certain skin diseases.