ULCER

BY
 SAI ROOPA (125)
 SANDHIYA (126)
DEFINITION

Break in the continuity of the covering epithelium

- skin or mucous membrane
It may either follow molecular death of the surface epithelium or its traumatic removal
CLASSIFICATION OF ULCER

ULCER

CLINICALLY PATHOLOGICALLY

1. Spreading ulcer 1. Non specific ulcer

2. Healing ulcer 2. Specific ulcer
3. Callous or chronic ulcer 3. Malignant ulcer
 CLINICAL CLASSIFICATION
Spreading ulcer
 Surrounding skin is inflamed
 Floor is covered with profuse
and offensive slough without
evidence of granulation tissue
Healing ulcer
 Floor with with red healthy
granulation tissue
 Edge with granulation and
margin bluish
 Presence of discharge
Chronic ulcer
 Floor with with pale granulation
tissue
 Discharge- scanty or absent
PATHOLOGICALLY

 Non specific ulcer

• Specific ulcers
1. Traumatic – electrical burn
2. Arterial – atherosclerosis
3. Venous – varicose ulcer
4. Associated with malnutrition –DM • Malignant ulcers
5. Associated with certain other
disease- gout
6. Neurogenic – bed sores
HISTORY TAKING
HISTORY TAKING

• Mode of onset
• Duration
• Pain
• Discharge
• Associated disease
HISTORY

MODE OF ONSET

1. TRAUMATIC

Heal by themselves if traumatic agent is removed

But the ulcer take a turn towards chronicity if traumatic
agent persists

2. SPONTANEOUSLY

Suspect TB or malignant tumor

Malignant ulcer- Marjolin’s ulcer may develop on scar
of burn
HISTORY

DURATION
- Acute or chronic
- Incubation period => interval between the exposure and the onset of ulcer

PAIN
- with or without pain
- only those ulcers associated with inflammation will be painful
- ulcers from malignant disease are absolutely painless
HISTORY

DISCHARGE

- Presence or absence of discharge

- amount and smell
- if discharge is present
• Serum
• Pus
• Blood

ASSOCIATED DISEASE

- Nervous disease such as tabes dorsalis may result an ulcer

- Generalized TB or diabetes also may lead to ulcer
EXAMINATION
PHYSICAL EXAMINATION

GENERAL SURGERY

In case ulcer, one should not give all attention to ulcer only
Due consideration must given to general examination of the patient
Ulcer may be well be a sequel of malnutrition , general atherosclerosis , syphilis.
LOCAL EXAMINATION

INSPECTION
1. SIZE AND SHAPE

SHAPE AND SIZE OF ULCER DISEASE

ovalcoalescenceirregular Tuberculous ulcers
cresentic border
Circular or semilunar Syphilitic ulcer
vertically oval Varicose ulcers

To record exactly the size and shape of an ulcer, a sterile gauze may be pressed on the
ulcer to get its measurement

2. NUMBER

More than one ulcer in TB , varicose ulcers etc,.

LOCAL EXAMINATION

POSITION

POSITION DISEASE
Medial malleolus of lower limb Varicose ulcers
Neck, axilla or groin Tuberculosis ulcer
Face , fingers and hand Lupus (form of cutaneous TB)

Malignant tumor occur anywhere but more common on lips , tongue ,breast, penis and anus

EDGE……
LOCAL EXAMINATION

EDGE VS MARGIN

Junction b/w normal

epithelium and ulcer

Area b/w margin and floor of ulcer

LOCAL EXAMINATION

EDGE
Sloping edge
- venous ulcer
Undetermined edge
- TB
- spread faster
Raised and pearly white
beaded edge
- Rodent ulcer
Punched out edge - become necrotic ulcer
- deep trophic ulcer
- do not spread
Rolled out edge
- characteristic of
squamous cell carcinoma
LOCAL EXAMINATION

FLOOR

- red granulation  healthy and healing

- pale and smooth granulation  slow healing ulcer
- black mass  malignant melanoma

Surrounding area

- glossy , red, oedematous  acutely inflamed

- scar or wrinkling  old case of TB
PALPATION
• Tenderness
neoplastic ulcers are never tender
• Edge and margin
• Base
slight induration in chronic ulcer but marked induration of base is the most important feature of
squamous cell carcinoma
• Depth
• Bleed on touch?
important feature of malignant ulcer
• Surrounding structure
increased temperature and tenderness => inflammatory origin
THANK YOU