Ulcer
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CERminator
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{{unreferenced|date=May 2008}}
{{otheruses|Ulceration (disambiguation)}}
[[Image:Am ulcer.gif|thumb|right|250px|Endoscopic images of a [[Duodenum|duodenal]] ulcer.]]
'''Ulcers''' are healing wounds that develop on the skin, mucous membranes, or eye. Although they have many causes, they are marked by:
# Loss of integrity of the area
# Secondary infection of the site by [[bacteria]], [[fungus]] or [[virus]]
# Generalized [[Weakness (medical)|weakness]] of the patient
# Delayed [[healing]]
==Etymology==
The word ulcer is first attested from ca. 1400 CE, deriving from [[Old French]] ''ulcere'', which came from [[Latin]] ''ulcus'' "ulcer", ultimately from the [[Proto-Indo-European]] base *elk-es- "wound".<ref>[http://www.etymonline.com/index.php?term=ulcer Online Etymology Dictionary's entry on ''ulcer''.]</ref>
==Skin ulcer classification schemes==
The [[skin]] is the largest organ of the human body. Classification systems are used to communicate the severity and depth of an ulcer. It is an easy way to communicate changes for the better, or worse.
===Raghavendra manual classification===
* '''Stage 1:''' The skin is red. The underlying tissue is soft. The redness disappears with minor pressure.
* '''Stage 2:''' There is redness, [[swelling (medical)|swelling]] and hardening of the skin around the area. Sometimes there is blistering. Sometimes there is loss of the superficial skin.
* '''Stage 3:''' The skin becomes [[necrosis|necrotic]]. There may be exposure of the [[fat]] beneath the skin. The skin may be lost through all its layers.
* '''Stage 4:''' There is more loss of fat and more necrosis of the skin through to the [[muscle]] beneath.
* '''Stage 5:''' Continuing loss of fat and necrosis of muscle below.
* '''Stage 6:''' [[Bone]] destruction begins with irritation of the bone, erosion of the bone cortex progressing to [[osteomyelitis]]. There may be [[sepsis]] of a joint, pathologic fracture or generalized body infection, septicemia.
'''This staging system for rating ulcers, is designed to rate the severity of pressure ulcers
* '''Stage 1''' - There is [[erythema]] of intact skin which does not blanch with pressure. It may be the heralding lesion of skin ulceration.
* '''Stage 2''' - There is partial skin loss involving the [[Epidermis (skin)|epidermis]], [[dermis]], or both. The ulcer is superficial and presents as an [[Abrasion (medical)|abrasion]], [[blister]], or wound with a shallow center.
* '''Stage 3''' - This is an entire thickness skin loss. It may involve damage to or necrosis of subcutaneous tissue that may extend down to, but not through, the underlying fascia. The ulcer presents as a deep crater with or without undermining of adjacent intact tissues.
* '''Stage 4''' - Here there is entire thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. [[Tendon]]s, and [[joints]] may also be exposed or involved. There may be undermining and/or [[sinus tract]]s associated with ulcers at this stage.
===Wagner's classification===
This classification system is intended to rate the severity of diabetic foot ulcerations
* '''Grade 0''' - Skin with prior healed ulcer [[scar]]s, areas of pressure which are sometimes called pre-ulcerative lesion or the presence of bony deformity which puts pressure on an unguarded point.
* '''Grade 1-A''' - The wound is superficial in nature, with partial or full-thickness skin involvement but does not include tendon, capsule or bone.
* '''Grade 1-B''' - As above, the wound is superficial in nature, with partial or full thickness skin involvement but not including tendon, capsule nor bone; however the wound is infected. The definition of this wound implies superficial infection without involvement of underlying structures. If the wound shows signs of significant [[purulence]] or fluctuation, further exploration to expose a higher grade classification of infection is in order.
* '''Grade 1-C''' - As above but with vascular compromise.
* '''Grade 1-D''' - As above but [[ischemic]]. Because ischemia is a type of vascular compromise, the distinction between these two grades is often difficult to make.
* '''Grade 2-A''' - Penetration through the [[subcutaneous tissue]] exposing tendon or [[ligament]], but not bone.
* '''Grade 2-B''' - Penetration through the deep tissues including tendon or ligament and even [[joint capsule]] but not bone.
* '''Grade 2-C''' - As above 2B, but including [[ischemic]]
* '''Grade 2-D''' - As above 2C, but including infection
* '''Grade 3-A''' - A wound which probes to bone but shows no signs of local infection nor systemic infection.
* '''Grade 3-B''' - A wound which probes to bone and is infected.
* '''Grade 3-C''' - A wound which probes to bone, is infected, and is ischemic.
* '''Grade 3-D''' - A wound which probes to bone characterized by active infection, ischemic tissues, and exposed bone.
* '''Grade 4''' - [[Gangrene]] of the forefoot
* '''Grade 5''' - [[Gangrene]] of the entire foot
==Other locations==
# '''Inferior members''': most ulcers of the foot and leg are caused by underlying [[vascular insufficiency]]. The skin breaks down or fails to heal because of repeated [[Physical trauma|trauma]]. Pressure of the [[nail (anatomy)|nail]] can cause [[subungual]] ulceration. These are most frequently seen in [[diabetes|diabetics]] who have a very low potential to heal from injury.
# '''Sacrum and ischium'''
# '''[[Mouth ulcer]]'''
# '''[[Peptic ulcer]]s:''' This includes ulcers of the [[esophagus]], [[stomach]], large and small [[intestine]]
# '''Genitalia:''' May be [[penis|penile]], [[vulva]]r or labial. Most often are due to [[sexually transmitted diseases]]
# '''Eyes:''' [[corneal ulcer]]s are the most common type. Conjunctival ulcers also occur.
==Pathology of ulceration==
===Causes===
The most common causes (not in order) are:
* [[Infection|Bacterial infection]]
* [[Infection|Viral infection]]
* [[Mycosis|Fungal infection]]
* [[Cancer]] - both 'primary' and 'secondary'
* [[Venous stasis]]
* [[Arterial Insufficiency]]
* [[Diabetes]]
* [[Rheumatoid Arthritis]]
* [[Amyloidosis]]
* [[Loss of mobility]]
* [[Hypertension]]
* [[Gastroesophageal reflux disease]]
===Types===
Some specific types of ulcers are:
*[[Peptic ulcer]] (of the [[stomach]], esophageal cardium or [[duodenum]])
*[[Mouth ulcer]]
*[[Pressure ulcer]] (decubitus)
*[[Crural ulcer]] (due to [[venous insufficiency]] or other causes) <!--see German page [[Ulcus cruris]]-->
*[[Hunner's ulcer]] (of the [[Urinary bladder|bladder]] caused by Interstitial Cystitis)
*[[Ulcerative colitis]] (of the colon)
*[[Curling's ulcer]]
*[[Cushing ulcer]]
*Arterial insufficiency ulcer
*[[Venous ulcer|Venous insufficiency ulcer]]
*Diabetic foot ulcer
*Corneal ulcer
*Vascular ulcer
==References==
<references/>
[[Category:Anatomical pathology]]
[[Category:Dermatology]]
[[Category:Symptoms]]
[[ar:قرحة]]
[[bs:Ulkus]]
[[es:úlcera]]
[[fr:Ulcère]]
[[da:Ulcus]]
[[de:Ulcus]]
[[id:Borok]]
[[it:Ulcera]]
[[ja:潰瘍]]
[[he:אולקוס]]
[[la:Ulcus]]
[[lt:Opa]]
[[nl:Zweer]]
[[pl:Wrzód]]
[[pt:Úlcera]]
[[ru:Язва (заболевание)]]
[[sv:Sår]]
[[simple:ulcer]]