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| {{Infobox_Disease |
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| Name = {{PAGENAME}} |
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| Image = Am ulcer.gif|
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| Caption = Endoscopic images of a [[Duodenum|duodenal]] ulcer.|
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| {{SI}}
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| {{CMG}} | | {{CMG}} |
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| | {{SK}} ulceration |
| | An ulcer is a discontinuity or break in a bodily membrane that impedes the organ of which that membrane is a part from continuing its normal functions. Common forms of ulcers recognized in medicine include: |
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| | | * [[Skin ulcer|Ulcer (dermatology)]], a discontinuity of the skin or a break in the skin |
| '''Ulcers''' are healing wounds that develop on the skin, mucous membranes, or eye. Although they have many causes, they are marked by:
| | * [[Pressure ulcer]]s, also known as bedsores |
| # Loss of integrity of the area
| | * [[Genital ulcer]], an ulcer located on the genital area |
| # Secondary infection of the site by [[bacteria]], [[fungus]] or [[virus]]
| | * [[Ulcerative dermatitis]], a skin disorder associated with bacterial growth often initiated by self-trauma |
| # Generalized [[Weakness (medical)|weakness]] of the patient
| | * [[Corneal ulcer]], an inflammatory or infective condition of the cornea |
| # Delayed [[healing]]
| | * [[Coronary artery ulceration]] |
| | | * [[Mouth ulcer]], an open sore inside the mouth |
| Ulcer comes from the [[Latin]] words ''ulcus'' meaning gel or oozy liquid. | | * [[Aphthous ulcer]], a specific type of oral ulcer also known as a canker sore |
| | | * [[Peptic ulcer]], a discontinuity of the gastrointestinal mucosa (stomach ulcer) |
| ==Skin ulcer classification schemes==
| | * [[Venous ulcer]], a wound thought to occur due to improper functioning of valves in the veins |
| | | * [[Stress ulcer]], located anywhere within the stomach and proximal duodenum |
| 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.
| | * Ulcerative sarcoidosis, a cutaneous condition affecting people with [[sarcoidosis]] |
| | | * Ulcerative lichen planus, a rare variant of [[lichen planus]] |
| ===Raghavendra manual classification===
| | * [[Ulcerative colitis]], a form of [[inflammatory bowel disease]] (IBD). |
| * '''Stage 1:''' *The skin is red. The underlying tissue is soft. The redness disappears with minor pressure.
| | * Ulcerative disposition, a disorder or discomfort that causes severe abdominal distress, often associated with [[chronic gastritis]] |
| * '''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.
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| * '''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.
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| * '''Stage 5:''' Continuing loss of fat and necrosis of muscle below.
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| * '''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.
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| '''This staging system for rating ulcers, is designed to rate the severity of pressure ulcers
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| * '''Stage 1''' - There is [[erythema]] of intact skin which does not blanch with pressure. It may be the heralding lesion of skin ulceration.
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| * '''Stage 2''' - There is partial skin loss involving the [[Epidermis (skin)|epidermis]], [[dermis]], or both. The ulcer is superficial and presents as an [[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.
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| * '''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 tracts associated with ulcers at this stage. | |
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| ===Wagner's classification===
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| This classification system is intended to rate the severity of diabetic foot ulcerations
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| * '''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.
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| * '''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.
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| * '''Grade 1-C''' - As above but with vascular compromise.
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| * '''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.
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| * '''Grade 2-C''' - As above 2B, but including [[ischemic]] | |
| * '''Grade 2-D''' - As above 2C, but including infection
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| * '''Grade 3-A''' - A wound which probes to bone but shows no signs of local infection nor systemic infection.
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| * '''Grade 3-B''' - A wound which probes to bone and is infected.
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| * '''Grade 3-C''' - A wound which probes to bone, is infected, and is ischemic.
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| * '''Grade 3-D''' - A wound which probes to bone characterized by active infection, ischemic tissues, and exposed bone.
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| * '''Grade 4''' - [[Gangrene]] of the forefoot
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| * '''Grade 5''' - [[Gangrene]] of the entire foot | |
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| ==Other locations==
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| # '''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.
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| # '''Sacrum and ischium'''
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| # '''[[Mouth ulcer]]'''
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| # '''[[Peptic ulcer]]s:''' This includes ulcers of the [[esophagus]], [[stomach]], large and small [[intestine]]
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| # '''Genitalia:''' May be [[penis|penile]], [[vulva]]r or labial. Most often are due to [[sexually transmitted diseases]]
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| # '''Eyes:''' [[corneal ulcer]]s are the most common type. Conjunctival ulcers also occur.
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| ==Pathology of ulceration==
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| ===Causes===
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| The most common causes (not in order) are:
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| * [[Infection|Bacterial infection]]
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| * [[Infection|Viral infection]]
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| * [[Mycosis|Fungal infection]]
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| * [[Cancer]] - both 'primary' and 'secondary'
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| * [[Venous stasis]] | |
| * [[Arterial Insufficiency]]
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| * [[Diabetes]]
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| * [[Rheumatoid Arthritis]]
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| * [[Amyloidosis]]
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| * Loss of mobility
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| * [[Hypertension]]
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| * [[Gastroesophageal reflux disease]] <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| ===Types===
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| Some specific types of ulcers are:
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| *[[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]]-->
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| *Hunner's ulcer (of the [[Urinary bladder|bladder]] caused by Interstitial Cystitis)
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| *[[Ulcerative colitis]] (of the colon) | |
| *[[Curling's ulcer]]
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| *[[Cushing ulcer]]
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| *Arterial insufficiency ulcer
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| *[[Venous ulcer|Venous insufficiency ulcer]]
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| *Diabetic foot ulcer
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| *Corneal ulcer
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| *Vascular ulcer
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| ==References==
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| <references/>
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| {{Symptoms and signs}}
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| [[Category:Anatomical pathology]]
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| [[Category:Dermatology]]
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| [[Category:Symptoms]]
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| [[ar:قرحة]]
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| [[es:úlcera]]
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| [[fr:Ulcère]]
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| [[da:Ulcus]]
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| [[de:Ulcus]]
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| [[id:Borok]]
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| [[it:Ulcera]]
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| [[ja:潰瘍]]
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| [[he:אולקוס]]
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| [[la:Ulcus]]
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| [[lt:Opa]]
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| [[nl:Zweer]]
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| [[pl:Wrzód]]
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| [[pt:Úlcera]]
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| [[ru:Язва (заболевание)]]
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| [[sv:Sår]] | |
| [[simple:ulcer]]
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| {{WH}}
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| {{WS}}
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