Po249 By Pressure Sores And Defects On Feet Gp´s Have To Search For Differential Diagnosis Too

Katarina Dostalova1, Lucia Kukuckova2, Lucia Mahelova3, Stefania Moricova1 e Jan Luha4
1Department of preventive and clinical medicine, Faculty of Public Health, Slovak Medical University, Bratislava,; 2Slovak Society of General Practice, Long Term Ill Department, University Hospital, Bratislava; 3Department of Occupational Medicine and Toxicology, University Hospital, Bratislava,; 4Department of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava
Pressure sores are a serious complication which general practitioners (GP´s) have to face in everyday practice. It is important in differential diagnostic process of decubitus to think about peripheral disease (PAD). Pressure sores in patients with PAD are a result of ischaemia, but it may combined and potentiated by other risk factors. We present two case reports of patients hospitalized at the Department of long term ill and afterwards discharged to the care of GP´s. 84 year old female has been transferred from the Surgical clinic with decubitus stage 3 on her left feet (area of V. metatarsal bone) originated in nursing home. The measurement of ankle brachial pressure index (ABPI) confirmed severe stenosis of left leg arteries. Colour duplex sonography of arterial system displayed hemodynamically significant stenosis and obliterations in arteria tibialis posterior area bilateral. Second patient is an 90 year old female transferred form the Geriatrics clinic with a defect on her right ankle. ABPI measurement showed a combined damage- hemodynamically significant stenosis of right limb, mediocalcinosis on the left one. We verified by CDS obliteration of a. femoralis superficialis and a. tibialis posterior dextra and haemodynamically significant stenosis of a. poplitea dextra. The findings suggest a critical limb ischaemia. Presented cases turn our attention to the fact that PAD can participate as an aetiological factor of developing pressure sores. GP´s have to take time to evaluate patients medical history (claudication, rest pain, feeling of cold feet, smoking, diabetes mellitus,...), perform clinical examination (palpation of pulse, skin colour, skin temperature,..) which leads GP´s to consider PAD as the final diagnosis. Diagnosis can be confirmed with high sensitivity and specificity by Doppler measurement of ABPI which is very simple and cheap method. In these patients, especially if they are immobile, the GP has to manage preventive measures (positioning, physiotherapy, pharmacological prevention,..) to avoid developing decubitus which can be first sign of critical limb ischaemia (CLI). CLI in immobile patients may become a very difficult even an unsolvable problem. GP is the one who has to take the leadership in the care team consisting of relatives, nurses in nursing homes, physiotherapists.
peripheral arterial disease, ankle brachial pressure index, pressure ulcers