Dr.Emad Sunday, September 04, 2016
Diabetic Foot (ulcer)
1
middle age male patient with uncontrolled D.M and diabetic foot and ulcer and
amputation has been done for him
االسئلة اللي كانت
Did D.M was controlled or not?
no because he changed to insulin in the hospital and he develped ulcer
How you manage this case?
Hx
(history of DM ,duration ,on insulin or oral hypoglycemic drugs, controlled or not)
Ex :
Inspection;(Site:; ulcer in DM is present at the pressure (Head of 1st metatarsal bone)
and you should acurrately the site)
Shape: round ,oval or irregular
Skin surrounding: (indurated or not)
edge :trophic
floor:; contain granulation tissue,…… ...
Palpation
سكميرلاب ةروكذملا تلاغشلا لك
Tests and Investigation :
FBS ; 70-110
RBS ;120-180
ESR : elevated but not so high
CBC ; leukocytosis
Urine test for glucose and ketone bodies
RFT : urea and creatinine
Electrolyte : k and Na
Doppler U/S: to see blood flow and saturation
CXR: to see if there is Heart failure
ECG
_C reactive protein
_LVT ممكن تتخربط
ال
liver enzymes ولكن بلlate stage لا نكمم واrenal
f.يؤدي الliver f.
_x ray for the foot ( osteomyelitis)
_doppler ultrasound (ischemia)
_US for the kidney (renal artery stenosis, neuropathy)
_chest x ray,ECG (cardiomegaly, HF)
_angiography if doppler not usefulاذه نلآ invasive ريخلآل ونيلخن
*If ESR very high we suspect malignancy (SSC, BCC).
-start with hx of diabetes is it
control or not??usually diabetic
foot occur in neglected patient
(uncontrolled), type1 or type 2
??duration?family hx?
-associated other medical disease
e.g hypertension stroke, ischemic
heart disease.(complication عادة
تبدي بعد ال
5
سنوات
-Then hx of the ulcer
duration? how it start? coldness?
sensation?
-In examination
most commonly at the area of
head of metatarsal bone then the
heel(area of pressure )
Examination general & local.
من الdressing وكا اذا فرعن ردقن pus
لا وا
* wet gangrene( diabetes), dry
with (ischemia)
Dr.Emad Sunday, September 04, 2016
Diabetic Foot (ulcer)
2
Tx :-Admission to hospital
-Control of DM via insulin from date of admission till complete control and then convert to
oral hypoglycemic drugs
-Continuous taking care of ulcer ,debridement and follow up
-Broad spectrum antibiotics such as gentamicin+ampicillin plus flagyl till the culture appear
and then give according to it If all the previous measures are failed then we will do
amputation
*Charcot foot(in diabetes) is characterized by varying degrees of bone and joint
disorganization secondary to underlying neuropathy, the hallmark deformity associated
with this condition is midfoot collapse, described as a “rocker-bottom” foot
Causes of ulcer
1) microangiopathy&
macroangiopathy
2) ischemia
3) neuropathy
4) minor trauma
**Site of ulcer : accurate discreption give it " in relation to fixed bony mark"
**Type of Insulin given in hospital is soluble insulin ,after control change to lantus as
follow
1/3 soluble at morning
2/3 lantus at evening.
**Examination of ulcer Should be According to this check-list for OSCE (just before the
last page)
https://www.muhadharaty.com/lecture/9735/OSCE-steps/الرابعة-ةلحرملا-بلاط