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    Ulcer Sinus Fistul A

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    Anil Basnet
    This document defines an ulcer, sinus, and fistula and describes their causes, classifications, clinical features, investigations, and treatment. An ulcer is a break in epithelial continuity caused by tissue death. A sinus is a blind track lined by granulation tissue leading from an epithelial surface into tissues. A fistula is an abnormal communication between epithelial structures. The causes, classifications, features, and management of each are described in detail. Proper investigation and treatment including antibiotics, rest, excision, and drainage are emphasized.

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    Ulcer Sinus Fistul A

    Uploaded by

    Anil Basnet
    50 views47 pages
    This document defines an ulcer, sinus, and fistula and describes their causes, classifications, clinical features, investigations, and treatment. An ulcer is a break in epithelial continuity caused by tissue death. A sinus is a blind track lined by granulation tissue leading from an epithelial surface into tissues. A fistula is an abnormal communication between epithelial structures. The causes, classifications, features, and management of each are described in detail. Proper investigation and treatment including antibiotics, rest, excision, and drainage are emphasized.

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    ulcersinusfistula

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    This document defines an ulcer, sinus, and fistula and describes their causes, classifications, clinical features, investigations, and treatment. An ulcer is a break in epithelial continuity caused by tissue death. A sinus is a blind track lined by granulation tissue leading from an epithelial surface into tissues. A fistula is an abnormal communication between epithelial structures. The causes, classifications, features, and management of each are described in detail. Proper investigation and treatment including antibiotics, rest, excision, and drainage are emphasized.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    50 views47 pages

    Ulcer Sinus Fistul A

    Uploaded by

    Anil Basnet
    This document defines an ulcer, sinus, and fistula and describes their causes, classifications, clinical features, investigations, and treatment. An ulcer is a break in epithelial continuity caused by tissue death. A sinus is a blind track lined by granulation tissue leading from an epithelial surface into tissues. A fistula is an abnormal communication between epithelial structures. The causes, classifications, features, and management of each are described in detail. Proper investigation and treatment including antibiotics, rest, excision, and drainage are emphasized.

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    You are on page 1of 47

    ULCER

    SINUS
    FISTUL
    A
    Definition

    A break in the epithelial continuity

    Discontinuity of the skin or mucous membrane


    which occurs due to the microscopic death of
    the tissues
    Aetiology
    Venous Disease (Varicose Veins)
    Arterial Disease ; Large vessel (Atherosclerosis) or Small
    vessel (Diabetes)
    Arteritis : Autoimmune (Rheumatoid Arthritis, Lupus)
    Trauma
    Chronic Infection : TB/Syphilis
    Neoplastic : Squamous or BCC, Sarcoma
    Wagner’s Grading of ulcers

     Grade 0 - Preulcerative lesion/healed ulcer


     Grade 1 - Superficial ulcer
     Grade 2 - Ulcer deeper to Subcutaneous tissue exposing
    soft tissue or bone
     Grade 3 - Abscess formation or osteomyelitis
     Grade 4 - Gangrene of part of tissues/limb/foot
     Grade 5 - Gangrene of entire one area/foot
    Classification
    A. Clinical
    B. Pathological
    A.
    Clinical
    Spreading : (Edge - Inflamed & Edematous)
    Healing : (Edge is sloping with healthy red
    granulation tissue & serous discharge)
    Callous : (Floor contains pale unhealthy
    granulation tissue with indurated edge)
    B.Pathological
    1. Nonspecific
    2. Specific
    3. Malignant
    1. Non
    specific
    Traumatic Ulcer
    Arterial Ulcer
    Venous Ulcer
    Neurogenic Ulcer
    Infective Ulcer
    1. Non specific
    contd.
    Diabetic Ulcer
    Tropical Ulcer
    Cryopathic Ulcer
    Martorell’s Ulcer
    Bazin’s Ulcer
    • Traumatic ulcer

    1. Mechanical- Dental ulcer on tongue ( jagged tooth )


    2. Physical- Electrical burn
    3. Chemical- Application of caustics

     Acute, Superficial, Painful, Tender


    • Arterial Ulcer

    • Caused due to peripheral vascular


    disease
    • LL : Atherosclerosis & TAO
    • UL : Cervical Rib, Raynauds
    • Chief complaint : Severe Pain
    • Toes, Feet, Legs & UL Digits
    • Venous ulcers

    Medial aspect of lower 3rd of lower limb


    Ankle ( Gaiters Zone ) : Chronic Venous HTN
    Ulcers are Painless
    Varicose Veins or Post Phlebitic limb ( PTS )
    • Trophic Ulcer

    • Pressure Sore or Decubitus Ulcer


    • Punched out edge with slough on the floor
    • Ex: Bed Sores & Perforating ulcers
    • Develop as a result of Prolonged Pressure
    • Sites : Ischial Tuberosity > Greater Trochanter > Sacrum
    > Heel > Malleolus > Occiput
    • Tropical ulcer

    • Tropical regions : Africa, India, S.America


    • Trauma or Insect Bite
    • Fusobacterium fusiformis & Borrelia
    vincentii
    • Abrasions, Redness, Papules & Pustules
    • Severe Pain
    • Diabetic Ulcer

    It may be caused due to


    • Diabetic Neuropathy
    • Diabetic Microangiopathy
    • Increased Glucose : Increased Infection
    • Foot ( Plantar ), Leg, Back, Scrotum,
    Perineum
    • Ischemia, Septicemia, Osteomyelitis,
    2.
    Specific
    Tuberculosis
    Syphilis
    Actinomycosis
    Meleney’s ulcer
    3.
    Malignant
    Squamous cell ca
    Basal cell ca
    Malignant melanoma
    Examination
    Inspection
    Palpation
    Examination of lymph nodes
    Vascular insufficiency
    Nerve lesions
    DISCHARGE FROM THE ULCER
    Serous discharge Healing ulcer

    Purulent discharge Spreading ulcer

    Bloody discharge Malignant ulcer

    Discharge with bony Osteomyelitis


    spicules
    Greenish discharge Pseudomoas
    infection
    EDG
    E
    DEF: This is between the floor of the ulcer and the margin.
    The margin is the junction between the normal epithelium and
    the ulcer.
    A. Sloping edge
    All healing ulcers like
    traumatic ulcers, venous
    Ulcers
    B. Punched out Gummatous
    edge ulcers and trophic
    ulcers.
    C. Undermined
    Tuberculous
    edge
    ulcers
    D. Raised edge
    Rodent ulcers
    (beaded
    or basal cell
    edge)
    carcinoma .
    E. Everted edge
    Squamouscell
    (Rolled out)
    carcinoma.
    MANAGEMEN
    T
    Investigations
    1) Complete blood picture: Hb%, TC, DC, ESR, PS
    2) Urine and blood examination to rule out diabetes
    3) Chest X-ray - PA. view to rule out P.TB
    4) Pus for culture/sensitivity
    5) Lower limb angiography in cases of arterial
    diseases
    6) X-ray of the part to see for Osteomyelitis
    7) Biopsy: Non-healing/malignant ulcers
    Treatment
    Address cause
    Correct deficiencies
    Control pain, infection
    Debridement, dressing
    Closure of defect
    DEFINITION

    SINUS:
     Blind track lined by granulation tissue leading
    from epithelial surface down into the tissues.

     Latin: Hollow (or) a bay


    CAU
    SES
    CONGENITA ACQUIRED
    L
    Preauricular TB sinus
    sinus Pilonidal sinus
    Median mental sinus
    Actinomycosis
    FISTULA:

    Abnormal communication between lumen of two epithelial lining structures

    Internal fistula: between two lumen of two hollow viscus

    External fistula: between lumen of one hollow viscus to the exterior


    Latin : flute (or) a pipe (or) a tube
    .
    CAU
    SES
    CONGENITAL ACQUIRED
     Branchial fistula I. Traumatic
     Tracheo-esophageal II. Inflammatory
     Umbilical III. Malignancy
     Congenital AV IV. Iatrogenic
    fistula
     Thyroglossal fistula
    FISTULA

    EXTERNAL INTERNAL
     Orocutaneous  Tracheo-esophageal
     Enterocutaneo  Colovesical
    us  Rectovesical
     Appendicular  AVF
     Thyroglossal  Cholecystoduodenal
     Branchial
    .
    Causes for persistence of sinus (or)
    fistula
     Presence of a foreign body. e.g., suture material
     Presence of necrotic tissue underneath.
    e.g.,sequestrum
     Insufficient (or) non-dependent
    drainage. e.g., TB sinus
     Distal obstruction. e.g., faecal (or) biliary
    fistula
     Persistent drainage like urine/faeces/CSF
     Lack of rest
    [
    c
    CLINICAL FEATURES

    Usually asymptomatic but when infected manifest


    as-
    • Recurrent/ persistent discharge.
    • Pain.
    • Constitutional symptoms if any deep seated
    origin.
    INVESTIGATIONS
     CBP- Hb, TLC, DLC, ESR.
     Discharge for C/S , AFB, cytology, Gram staining.
     X-RAY of the part to rule out OM, foreign body.
     X-RAY KUB and USG abdomen in cases of lumbar
    fistula to rule out staghorn calculi.
     MRI
     BIOPSY from edge of sinus
     CT Sinusogram
     FISTULOGRAPHY/ SINUSOGRAPHY:

    • For knowing the exact extent/origin of sinus


    (or)fistula.
    • Water soluble or ultrafluid lipoidal iodine dye is used.
    • Lipoidal iodine is poppy seed oil containing
    40% iodine.
    TREATMENT
    BASIC PRINCIPLES:

     Antibiotics
     Adequate rest
     Adequate excision
     Adequate drainage.
     After excision specimen SHOULD be sent for
    HPE.

     Treating the cause.


    e.g., ATT for TB
    sinus.
    removal of any foreign body.
    sequestrectomy for OM.
    FISTULA-IN-ANO
    Chronic abnormal communication usually lined to
    some degree by granulation tissue, which runs
    outwards from anorectal lumen (internal opening) to
    skin of perineum or the buttocks (external opening)

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