4.5 Examenul clinic in ulceratiile cutanate
4.5 Examenul clinic in ulceratiile cutanate
4.5 Examenul clinic in ulceratiile cutanate
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<strong>Examenul</strong> <strong>cl<strong>in</strong>ic</strong> <strong>in</strong> tumorile <strong>cutanate</strong><br />
• venoasa<br />
• arteriala<br />
• neurologica<br />
• neoplazica<br />
• <strong>in</strong>fectioasa<br />
• altele –<br />
Etiologie<br />
» DZ, alcoolism, neuropatii<br />
» carc<strong>in</strong>om sp<strong>in</strong>o/bazocelular, u.Marjol<strong>in</strong><br />
» pioderma gangrenosum, sifilis<br />
» siclemia<br />
95% d<strong>in</strong> ulcerele de gamba
<strong>Examenul</strong> <strong>cl<strong>in</strong>ic</strong> <strong>in</strong> tumorile <strong>cutanate</strong><br />
• durerea<br />
• <strong>in</strong>suficienta venoasa<br />
Anamneza<br />
» ulcer arterial, <strong>in</strong>fectios, siclemie<br />
• claudicatie <strong>in</strong>termitenta<br />
• traumatisme (m<strong>in</strong>ore)<br />
• RCUH ---- pioderma gangrenosum<br />
• altele<br />
» DZ, b. neurologice, traumatism sp<strong>in</strong>al,<br />
coagulopatii, imobilizare<br />
» fumat, alcoolism, sifilis netratat
<strong>Examenul</strong> <strong>cl<strong>in</strong>ic</strong> <strong>in</strong> tumorile <strong>cutanate</strong><br />
pioderma gangrenosum
<strong>Examenul</strong> <strong>cl<strong>in</strong>ic</strong> <strong>in</strong> tumorile <strong>cutanate</strong><br />
• Localizare<br />
U. venos – gamba, maleola<br />
<strong>in</strong>terna, pe traiectul venei safene<br />
<strong>in</strong>terne<br />
U. de presiune/neuropatice –<br />
proem<strong>in</strong>ente osoase: calcai, capul<br />
metatarsianului I<br />
U. arterial – dorsoplantar<br />
<strong>Examenul</strong> obiectiv
<strong>Examenul</strong> <strong>cl<strong>in</strong>ic</strong> <strong>in</strong> tumorile <strong>cutanate</strong><br />
• Forma<br />
<strong>Examenul</strong> obiectiv
<strong>Examenul</strong> <strong>cl<strong>in</strong>ic</strong> <strong>in</strong> tumorile <strong>cutanate</strong><br />
• Alte modificari<br />
<strong>Examenul</strong> obiectiv<br />
U. venos – varice, s<strong>in</strong>drom posttrombotic, tulburari trofice<br />
U. malign/ <strong>in</strong>fectat – adenopatie <strong>in</strong>gh<strong>in</strong>ala<br />
U. arterial – paloare, abs. pilozitatii, ex. atenta a pulsului
<strong>Examenul</strong> <strong>cl<strong>in</strong>ic</strong> <strong>in</strong> tumorile <strong>cutanate</strong><br />
Algoritm diagnostic
Exam<strong>in</strong>ari para<strong>cl<strong>in</strong>ic</strong>e <strong>in</strong> tumorile <strong>cutanate</strong><br />
• hemograma / test de siclizare<br />
• glicemie, TTGO<br />
• VSH (vasculite)<br />
• VDRL<br />
• culturi si ex. bacteriologic d<strong>in</strong> secretia d<strong>in</strong> plaga<br />
• evaluarea arteriopatiei/ obstructiei venoase<br />
• biopsia leziunii/ marg<strong>in</strong>ilor u. cronic (u. Marjol<strong>in</strong>)
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