Examination of an ulcer
Posted 12 September 2004 - 05:15 PM (#1)
So far as the local physical examination of the ulcer is concerned, start the examination by palpating the dependent lymph nodes associated with the ulcer. this essential step is best carried out at the onset of the examination in case it is in advertently omitted.
With regard to the actual ulcer, ascertain:
1. The situation of the ulcer.
e.g. Rodent ulcer at the side of the nose and beneath the eye.
Carcinoma of the tongue at the side of the tongue.
Gummatous ulcer often occurs at the juncton of the hard and soft palates.
Some indication of the nature of the ulcer may be obtained from its situation alone..
2. Is the ulcer single of multiple?
3. Note the size of the ulcer.
4. Examine the shape of the ulcer.
Ulcers may be round, oval, crescentic, serpiginous, irrigular, punched-out, etc.
5. Note the base of the ulcer.
It may be indurated, soft, or fixed to deeper structures which is indicative of malignancy.
6. The floor of the ulcer may be covered by:
a. Granulations. These may be red, pale, or flabby and may or may not bleed.
c. Covered with slough, membrane, scab, etc.
d. It may be adherent to soft parts or bone.
e. It may be fungating as seen in some varieties of malignant disease.
7. The edge of the ulcer may be:
a. Undermined. e.g. tubercular ulcer.
b. Punched out. e.g. gummatous ulcer.
c. Rolled. e.g. rodent ulcer.
d. Rolled, raised, and averted. e.g. malignant ulcers.
8. The condition of the part surrounding the ulcers must be examined. They may be inflamed, healthy, edematous, pigmented, or in some instances have impaired sensation.
9. If there is a discharge form the ulcer, its color, and smell should be noted and a bacteriological smear taken for culture.
10. Is the ulcer painful?
Inflammatory and traumatic ulcers are usually painful while tuberculosis ulcers in the mouth are often extremely painful, but in the early stages most malignant ulcers are painless. However, when the malignant ulcer becomes established and increased in size it may cause extreme discomfort.
11. The general condition of the patient must always be considered.
Patients become very cachetic when a malignant ulcer involves the gastrointestinal tract. Tubercular ulcer of the mouth may be associated with pulmonary tuberculosism, while sever ulceration on the oral cavity may occur in diabetes, leukemia, uremia, granulocytosis, scurvy, syphilis, etc.
P.S: Be carful about handling ulcers you do not understand with ungloved fingers. Always wash your hands well after examining an ulcerated mouth.