Marjolin’s Ulcer
NAME : XXXXXXXXXX AGE : 45 years SEX : Male
ADDRESS : XXXXXXXXXX
OCCUPATION : Farmer – while staying in Punjab
RELIGION & NATIONALITY : Sikhism
REGISTRATION NO. : XXXX
DATE OF CASE TAKING : 9th June , XXXX
PRESENTING COMPLAINTS :
- Wound at the anterior aspect of right upper arm since 1 year .
- Weakness and weariness 1 year .
HISTORY OF PRESENT COMPLAINTS
Patient was apparently well 1 year back when he accidentally burnt his right upper arm following which he developed a wound in that region which has not healed till date . He is also feeling weakness since then .
Location – Anterior aspect of right upper arm
Sensation – Burning pain
Aggravation – Pressure , Rest
PAST HISTORY
Any major illness in past – No history of any major illness in the past
Vaccinations – On time in childhood
Drugs used / addicted to – No drug addictions
Any other history – History of frequent gum abscess and nasal polyp
No history of operations , allergy or skin diseases
FAMILY HISTORY
Father – Alive — Hypertensive
Mother – Alive and healthy
Paternal Grandparents – Died of natural death
Maternal Grandparents – Died of natural death
Siblings – 1 Elder brother – Alive and healthy
PERSONAL HISTORY
Developmental landmarks – On time
Habits / Addictions – Nothing specific
Diet – Vegetarian
Marital status – Married
Occupation – Farming
Intra-uterine history – Congenial at home and workplace
Happy going type . Likes to be in company
Likes to share his views and feelings with family members .
PHYSICAL GENERALS
Thermal reaction – Chilly patient
Appetite – Decreased ( 1-2 chappatis / meal )
Thirst – Thirst for small quantities of water
Cravings – Sweet , Cabbage
Aversions – Nothing specific
Intolerance – Nothing specific
Urine
Frequency D 2-3 N 0
Smell – Non-offensive
Pain, burning – No pain or burning
Flow – Streaml ine flow
Colour – Colourless
Stools
Frequency D 1 N 0
Smell – Non-offensive
Pain, burning – No pain or burning
Sleep – Always sleepy . Yawning even during sleep .
Dreams – Nothing significant
Perspiration
Location – On exposed parts
Amount – Scanty
Smell – Non-offensive
Staining – Non-staining
Seasonal variation – Only in summers
MENTAL GENERALS
- Restlessness
- Weariness – Difficult physical and mental labour
- No hope of recovery
- Disgust for medicines
GENERAL PHYSICAL EXAMINATION
Built – Ectomorphic
Nutrition – Average
Pallor – Absent
Icterus – Absent
Cyanosis – Absent
Pigmentation – Dark brown colour on the affected site
Clubbing – Absent
Edema – Absent
Tongue – Dry , with dryness of mouth
Pulse – 84/ minute
Blood Pressure – 118 / 80 mm Hg
Respiratory Rate – 14 / minute
Lymph glands – Non-palpable
LOCAL EXAMINATION
EXAMINATION OF WOUND
Inspection
- Dark red-brown colour
- Everted edges
- Circular margin
- Necrotic central area
Palpation
- Base – not hard
- Tenderness – absent
- Temperature of affected site – normal to touch
SYSTEMEIC EXAMINATIONS
ABDOMINAL EXAMINATION
Inspection
- Flat abdomen
- No visible lump or swelling
- No visible veins
- No visible peristaltic movements
- Umbilicus – centrally placed and inverted
Palpation
- Superficial – Rigidity and tenderness – absent
- Deep – Liver , spleen , kidney – non-palpable
Percussion
- Percussion node – tympanic
- Shifting dullness – absent
- Fluid thrill – absent
Auscultation
- Normal bowel sounds heard
RESPIRATORY SYSTEM EXAMINATION
Inspection
- Shape – Bilaterally symmetrical
- Respiratory rate – 14 / minute
- Type of breathing – Abdomino-thoracic
- Veins – Not visible
- Apex beat – Not visible
Palpation
- Position of trachea – central
- Tenderness – absent
- Vocal fremitus – equivocal
Percussion
- Resonant chest
Auscultation
- Bronchial and vesicular sounds heard in respective areas
- No adventitious sounds heard
- Vocal resonance – Equivocal
CARDIO-VASCULAR SYSTEM EXAMINATION
Inspection
- Abnormal prominence of veins of chest wall – not visible
- Pulsations – not visible
- Dyspnoea – not visible
- Apex beat – not visible
Palpation
- Tenderness – absent
- Apex beat – left 5th intercostal space
- Thrills – non-palpable
Percussion
- Resonant chest
Auscultation
- Pulse – 84 / minute
- Blood pressure – 118 / 80 mm Hg
- Heart sounds 1 & 2 heard
- Added sounds – absent
- Splitting of heart sounds – absent
NERVOUS SYSTEM EXAMINATION
Sensory Function
- Recognition of size and shape – proper
- Tactile sensation , pain & temperature sensation – normal
- Co-ordination – normal
- Appreciation of vibrations – normal
Motor Function
- Muscle tone and muscle movements – normal
- Muscle strength and nutrition – normal
- Abnormal , involuntary movements – absent
Reflex Function
- Superficial reflex
- Abdominal reflex – normal
- Scapular reflex – normal
- Corneal reflex – normal
- Planter reflex – normal
- Deep reflex
- Knee jerk – normal
- Ankle jerk – normal
- Biceps jerk – normal
- Triceps jerk – normal
- Supinator jerk – normal
- Jaw jerk – normal
Functioning of cranial nerves – normal
DIFFERENTIAL DIAGNOSIS
- Squamous cell carcinoma
- Basal cell carcinoma
- Pyogenic granuloma
- Marjolin’s ulcer
INVESTIGATIONS ADVISED
- Biopsy of wound tissue
- Blood tests – Hb , TLC , DLC , ESR .
CONFIRMED DIAGNOSIS
Marjolin’s Ulcer
MANAGEMENT
- Regular cleaning of wound .
- Usage of sterile bandages for covering the ulcer .
- Avoid frequent touching of the ulcer .
REMEDY INDICATED
RX
Silicea 200 / TID / 1 day
SL 30 / TDS / 7 days
JUSTIFICATION
- Aggravation – Pressure .
- Weariness .
- Sleepiness always ; yawning during sleep .
- Ailment from burns .
- Nasal polyp .
- History of abscess of gums .
- admin |
- December 4, 2021
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