Ulcer and sinus

• What is an ulcer?

  It is a discontinuity of the epithelial surface.
• What characterizes an ulcer?

  Destruction of surface epithelium and a granulation base.
• What are the parts of an ulcer?

  1. Margin: regular or irregular, color.
  2. Edge: sloping (healing), undermined (tuberculous), punched out (ischemic, trophic, diabetic), everted and rolled out (malignant).
  3. Floor: visible discharge, slough, or granulation tissue.
  4. Base: the underlying support (bone or soft tissue).
• What does the margin of an ulcer refer to?

  The margin refers to the outer boundary of the ulcer, which can be regular or irregular in shape.
• How can the edge of an ulcer indicate its type?

  Different edge characteristics can suggest specific conditions, such as sloping for healing or punched out for ischemic ulcers.

  
• What are the classifications of ulcers based on pathology?

  Specific, non-specific, and malignant ulcers.
• Name a specific ulcer.

  Tuberculosis ulcer.
• What is a malignant ulcer?

  An ulcer associated with cancers such as squamous cell carcinoma, basal cell carcinoma, or malignant melanoma.
• What are the steps in the management of an ulcer?

  1. History taking.
  2. Examination: inspection, palpation, regional lymph nodes, neurovascular examination, systemic examination.
  3. Investigation: CBC, ESR, RBS, LFT, RFT, PUS for culture & sensitivity, AFB staining, X-ray, duplex U/S, angiography, biopsy.
  4. Treatment: address underlying cause, analgesics, control infection, closure of defect.
• What is a sinus in medical terms?

  A blind ending tract connecting a cavity lined by granulation tissue to the epithelial surface.

  
• What are the congenital causes of a sinus?

  Remnants of persistent embryological ducts, such as preauricular sinus.
• What are some acquired causes of a sinus?

  TB sinus, actinomycosis sinus, osteomyelitis, retained foreign body, inadequate surgical drainage, malignancy.
• What investigations are used for diagnosing a sinus?

  1. CBC, ESR, RBS, LFT, RFT.
  2. X-ray, ultrasound.
  3. Sinogram.
  4. CT, MRI.
  5. Biopsy.
• What is a fistula?

  An abnormal tract communicating between two epithelial surfaces, lined by granulation tissue.
• What are congenital causes of a fistula?

  Thyroglossal fistula, tracheoesophageal fistula, arteriovenous fistula, umbilical fistula.
• What are some acquired causes of a fistula?

  Inflammatory conditions like Crohn's disease, TB, diverticulitis, post-abscess, traumatic causes, and malignancy.
• What investigations are used for diagnosing a fistula?

  1. CBC, ESR, RBS, LFT, RFT.
  2. X-ray, ultrasound.
  3. Fistulogram.
  4. MRI fistulogram.
  5. Biopsy.
• What are the treatment options for a fistula?

  1. Treatment of the underlying cause.
  2. Surgical excision of the fistula.
  3. Laser ablation.
• What are the treatment options for an ulcer?

  1. Treat the underlying cause.
  2. Analgesic drugs.
  3. Control the infection: drainage, debridement, dressing, proper antibiotics.
  4. Closure of the defect.
• What is an ulcer?

  It is a discontinuity of the epithelial surface.

  
• What characterizes an ulcer?

  Destruction of surface epithelium and a granulation base.

  
• What are the parts of an ulcer?

  1. Margin: regular or irregular, color.
  2. Edge: sloping (healing), undermined (tuberculous), punched out (ischemic, trophic, diabetic), everted and rolled out (malignant).
  3. Floor: visible discharge, slough, or granulation tissue.
  4. Base: the underlying support (bone or soft tissue).

  
• What are the types of ulcer classification based on pathology?

  Specific, non-specific, and malignant ulcers.
• What are examples of specific ulcers?

  Tuberculosis, syphilis, and actinomycosis.
• What are examples of non-specific ulcers?

  Traumatic, arterial, venous, diabetic, and trophic ulcers.
• What are examples of malignant ulcers?

  Squamous cell carcinoma, basal cell carcinoma, and malignant melanoma.
• What is involved in the management of ulcers?

  • History taking
  • Examination: inspection, palpation, regional lymph nodes, neurovascular examination, systemic examination
  • Investigations: CBC, ESR, RBS, LFT, RFT, PUS for culture & sensitivity, AFB staining, X-ray, duplex U/S, angiography, biopsy
• What is the first step in treating an ulcer?

  Treat the underlying cause.
• What are the methods to control infection in ulcer management?

  Drainage of abscess, debridement, dressing with hydrogen peroxide and EUSOL, and proper antibiotics.
• What is a sinus?

  It is a blind ending tract connecting a cavity lined by granulation tissue to the epithelial surface.

  
• What are the causes of a sinus?

  Congenital remnants and acquired conditions like T.B sinus, retained foreign body, and malignancy.
• What investigations are used for diagnosing a sinus?

  • CBC, ESR, RBS, LFT, RFT
  • X-ray, ultrasound
  • Sinogram
  • CT, MRI
  • Biopsy
• What is the treatment for a sinus?

  Treat or remove the underlying cause and perform surgical excision or laser therapy.
• What is a fistula?

  It is an abnormal tract communicating between two epithelial surfaces.

  
• What differentiates a sinus from a fistula?

  A sinus is a blind ending tract, while a fistula connects two epithelial surfaces.

  
• What are the causes of a fistula?

  Congenital factors and acquired conditions like inflammatory diseases, trauma, and malignancy.
• What investigations are used for diagnosing a fistula?

  • CBC, ESR, RBS, LFT, RFT
  • X-ray, ultrasound
  • Fistulogram
  • MRI fistulogram
  • Biopsy
• What is the treatment for a fistula?

  Treat the underlying cause and perform surgical excision or laser ablation.