各種潰瘍的鑒別診斷

1、,How to Distinguish Arterial, Venous and Other Ulcers,Zhijie Xi, MD,Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,WOUND TYPES,?ARTERIAL (ISCHEMIC) ULCERS?VENOUS (VARICOSE, LEG,STASI

2、S) ULCERS?LYMPHEDEMA (CHRONIC DERMAL DISRUPTION) ULCERS?PRESSURE (DECUBITUS) ULCERS?LATE EFFECT OF TRAUMA?UNCONTROLLED INFECTION?AUTOIMMUNE ULCERS (PSORIASIS,LUPUS, ETC),ELEMENTS COMMON TO MOST WOUNDS,VASCULAR COMPR

3、OMISE (ARTERIAL, VENOUS, MICROVASCULAR)?REDUCED TISSUE OXYGEN CONCENTRATION (TCpO2)?METABOLIC COMPROMISE,ARTERIAL ULCERS,Arterial Ulcers,ARTERIAL ULCERS,?Usually have a “punched out” appearance?Full thickness defect?

4、Most often occurs in diabetics?May be the result of embolic “showering” into the toes?Can occur anywhere on the extremities,VENOUS ULCERS,Venous Ulcers,VENOUS ULCERS,?Most often accompany varicose veins?Most often aff

5、ect distal leg and ankle?Are usually painful and heavily exudative?Are often recurrent?Exhibit varying depths, even within the same ulcer?Can become huge,LYMPHEDEMA ULCERS,LYMPHEDEMA ULCERS,?Are invariably foul and d

6、irty?Surrounding skin is indurated?Are heavily exudative?Can expand to encompass the entire lower leg and top of the foot?Are usually infected with multiple organisms and yeasts?Occur most often in association with

7、obesity,PRESSURE ULCERS,PRESSURE ULCERS,?Can occur anywhere following sustained pressure?Can become life threatening?Are often extremely foul and infected,AUTOIMMUNE ULCERS,AUTOIMMUNE ULCERS,?Can mimic other ulcer type

8、s?Are often complicated with arterial/venous insufficiencies?Are common with severe lupus, psoriasis and pemphigoid syndromes?Are frequently recurrent,ULCERS OF MIXED ETIOLOGY,DIABETIC PLANTAR ULCER,BKA PRESSURE ULCER

9、,DIABETIC/ARTERIAL ULCER,VENOUS/ARTERIAL ULCER,ULCERS OF MIXED ETIOLOGY,PRESSURE/VENOUS ULCER,VENOUS/ARTERIAL ULCER,PRESSURE/VENOUS/ARTERIAL,DIABETIC/PRESSURE ULCER,CONCLUSIONS,?Single-etiology ulcers are uncommon?We sh

10、ould suspect arterial involvement in any ulcer that is accompanied by diabetes?Venous leg ulcers often have a pressure component and, in diabetics, an arterial compromise?Any ulcer may be compromised in the presence of