B & C 3) Hamid Akbari is a 64-year-old man with a history of diabetes mellitus comes to your office with anulcer on his left leg below the knee for the last two weeks. He has had ulcerations of the skin of hislegs intermittently for several years that all resolved with local care and generally have not beenpainful. He said that this time his ulcer has been painful for the last two weeks and he feels weak andtired since he develops this ulcer.In physical exam, the ulcer area is erythematous, warm and tender. His temperature is 37.40c (99.3oF).a. Based on Hamid's clinical history and physical finding, what would be your diagnosis? What additionalinformation/assessments may help to confirm your diagnosis?The patient's diagnosis is diabetic ulcer. Some information that helps me confirm this wouldbe his ulcerations with inflammation that began to occur along with his history of DM.Ulcers are a common condition seen in diabetic patients.HSC4558 Pathophysiology IIAssignment 4 CGroup #Date:Names:b. Explain the pathogenesis of Hamid's condition. What is the most common cause of his condition?High blood sugar for a prolonged period of time can cause local inflammation usually in thelower body areas, which can then turn into ulcerations.c.What would be the complications of Hamid's condition?It could become easily infection and even loss of the foot or leg.d. What is your treatment plan?Offloading the wound, daily saline, as well as debridement when necessary and antibiotictherapy.

On the basis of history probable diagnosis is Diabetic foot with ulceration. Ans.B) Pathogenesis of the diabetic ulcer Due to hyperglycemia i.e increased blood sugar levels in the body the glucose starts accumulating in microvessels. There is conversion of glucose to sorbitol which increases vascular permeability and leads to leakage of blood in tissue. Glycosylated blood decreases oxygen utilisation. Ans.C) Complications of the diabetic ulcer can be as: Deep seated ulcer can occur. Cellulitis. Gangrene foot leads to amputation. Osteomyelitis Septicaemia due to increase chances of infection in open wound. These complications occurs as because diabetic ulcers are neurotrophic(unaware of placing feet) in nature as the person doesn't have any sensation due to peripheral neuropathy.