Description ulcer
Description ulcer
Description ulcer DM should at least include;
* Size,
* Depth,
* Smells,
* Form
* Locations.
This assessment is used to assess the progress of therapy.
In the background gastric ulcer neuropathy is usually dry, fissure, warm skin, callus, normal skin color and usually on the plantar location, lesions often a punch out. While lesions are due sianotik ischemia, gangrene, skin cold and linked locations are at finger. Ulcers form should be described as; edge, base, there is / no pus, exudate, edema, callus, ulcer depth need to be assessed with the help of a sterile probe. Probes can help to
determine the sine, knowing ulcer involving tendons, bones .2 Based on research Reiber,
location is the most common ulcer dorsal surface of fingers and plantar (52%), plantar region (metatarsals and heel: 37%)
and the dorsum (11%).
Neuropathy Due ulcer
If the ulcer had occurred several months and is asymptomatic it is necessary to suspect that the ulcer motivated by factors neuropathy.
In gastric ulcer in the form of neuropathy characters punched out lesions in areas hiperkeratotik, location not most of the plantar pedis, dry skin, warm and normal skin color, the callus (ship).
As for determining factors as the cause of the neuropathy can be used ulcer examination
foot joint reflex, sensory examination, examination with a tuning fork, or with test monofilament.
Test monofilament is a very simple examination and sensitive enough to diagnose patients who have ulcer risk for impaired sensory peripheral neuropathy. The test results said to be normal if the patient can not feel the touch of nylon monofilament. Part of monofilament examination was performed on the plantar side (metatarsal area, and in the heel and between the metatarsals and heel) and the dorsal side.
Evaluation of Vascular Status
Peripheral arterial disease in patients with DM it happened 4 times more often than non-DM patients. Other risk factors other than DM which facilitates the occurrence of Occlusive peripheral arterial disease are smoking, hypertension and hyperlipidemia. Peripheral arteries is frequently disrupted tibial artery and peroneal arteries, especially the area between the knee and leg joints.
The existence of lower limb arterial obstruction is marked by complaints of pain when walking and decreases at rest (claudication), the skin was blue, cold, ulcers and gangrene. Ischemic causes disruption of the distribution of oxygen and nutrients so hard to heal ulcers. Clinically the occlusion can be assessed through pulse palpability popliteal artery, tibial and dorsalis pedis.
To determine vascular patensi can be used several non-invasive tests such as; (ankle brachial index / ABI), transcutaneous oxygen tension (TcP02), color Doppler ultrasound or use of invasive tests such as digital subtraction angiography (DSA), magnetic resonance angiography (MRA) or angigraphy computed tomography (CTA). Ankle brachial index (ABI) is a non-invasive tests to detect peripheral vascular obstruction at the bottom.
ABI examination is inexpensive, easy to do and have a fairly good sensitivity as a marker of arterial insufficiency. ABI examination performed as we measure blood pressure using a blood pressure cuff, then the pressure from the artery is detected by Doppler probe (replacement stethoscope).
In normal circumstances the systolic pressure in the lower leg (ankle) is equal to or slightly higher than the systolic blood pressure of the upper arm (brachial). In circumstances where an artery stenosis in the lower leg will be a decline in pressure. ABI is calculated based on the ratio of ankle systolic pressure divided by brachial systolic pressure.
In normal conditions, the normal price of the ABI is> 0.9, ABI mild ischemia occurs 0,71-0,90, 0,41-0,70 ABI vascular obstruction has occurred is, ABI has occurred 0,00-0,40 vascular obstruction berat.15 If the diagnosis of peripheral vascular obstructive disease is still in doubt, or if the planned action will be the examination of revascularization digital subtraction angiography, CTA or MRA should be done. Gold standard for the diagnosis and evaluation of peripheral vascular obstruction is the DSA. DSA examinations should be done if endovascular interventions into treatment options.
Ulcer classification DM
After anamnesis and physical examination, lesions on the feet should be judged on the basis of the classification system that can assist in treatment decisions and determine the prognosis of recovery or the risk of amputation.
There are several classification systems for assessing gradations of lesions, one of the many beliefs are based on the classification of ulcer DM University of Texas Classification System. This classification system is not only assessing lesion inside the lesion factor, but also to assess the presence or absence of infection and ischemic factors. More severe lesions and the greater the risk of amputation performed when the nature of the lesion further down and to the right
Infection Status
Infection is a major threat leg amputation in diabetic patients.
Superficial infections in the skin if not immediately above can be developed through tissue under the skin, such as muscles, tendons, joints and bones, or even a systemic infection.
Not all ulcers were infected. Suspected of infection should be found when the local inflammation, purulent fluid, sinus or krepitasi. Enforcing an infection in people with DM is not easy. Inflammatory response in people with DM decreased because of decreased function lekosit, neuropathy and vascular disorders. Fever, chills and lekositosis not found in 2 / 3 of patients with limb-threatening infections. Deciding there was / is not an infection and the degree of infection are important in ulcer management of DM. Key element in the clinical classification of ulcer infection PEDIS guarantee abbreviated DM (perfusion, extent / size, depth / tissue loss, infection, and sensation).
Dikatagorikan infection as 1st degree (without infection), 2nd degree (mild infection: skin tissue and involves subkutis), degree 3 (infection were: going cellulitis or infection is more widespread in) and degree 4 (severe infections: sepsis encountered there). In practical terms the degree of infection can be divided into two, namely a non-threatening infections kaki/non- limb-threatening infections (degrees 1 and 2), and infections that threaten the foot / limb-threatening infections (degrees 3 and 4).
In infected leg ulcers and diabetic foot infection (without ulcer) have done a culture and sensitivity bacteria. Preferred method of doing the aspirations of pus culture / liquid.
But culture is the standard of debridemen necrotic tissue. Germs in diabetic foot infections are polimikrobial. Staphylococcus and Streptococcus are the dominant pathogens.
Nearly 2 / 3 of patients with diabetic foot ulcer complications, osteomyelitis provide. Undetected osteomyelitis would complicate the healing ulcer. Therefore, every place ulcer should be considered the possibility of osteomyelitis.
The diagnosis of osteomyelitis is not easily enforced. Clinically when the ulcer had lasted> 2 weeks, and the ulcer area and ulcer location on the prominent bone of osteomyelitis should be suspected. Specificity and sensitivity of bone X-ray examination is only 66% and 60%, especially when the review is done 10-21 days before the picture of bone abnormalities is unclear. In case of disruption of this bone is often difficult to distinguish between images artropati osteomyelitis or neuropathy.
Radiological examination should be done because in addition can detect osteomyelitis can also provide information regarding osteolisis, fractures and dislocations, gas gangrene, foot deformities. Test probes to bone using a sterile metal probe can help enforce osteomyelitis because it has a positive predictive value of 89%.
To further ensure osteomyelitis MRI examination is very helpful because it has a sensitivity and specificity of more than 90%. However, osteomyelitis remains a definite diagnosis based on examination of bone culture.
Leave a Comment
RECOMENDED,The Best book for nursing