AAA

Question 1

What is an AAA?

Answer 1

Abdominal aortic anerysm

Question 2

What would you find on examination of an AAA?

Answer 2

Palpable pulsatile abdominal mass

Question 3

How would a patient with AAA present?

Answer 3

Abdominal, back or groin pain

Question 4

What is the first line test for an AAA?

Answer 4

Abdominal ultrasound

Question 5

What would you find on an abdominal ultrasound of an AAA?

Answer 5

Aortic dilation roughly 1.5 times the size it should be`in an average person this is about 3cm

Question 6

How would you treat a ruptured AAA?

Answer 6

Standard resuscitation, surgical repair and post-op antibiotics

Question 7

How would you treat a symptomatic AAA that hasn’t ruptured?

Answer 7

Surgical repair (semi-urgent), post-op antibiotics and reduction of CV risk factors

Question 8

How would you treat an AAA that has been incidentally found?

Answer 8

Small AAA - Treat CV risk factors aggressively and monitor

Large AAA - Elective surgical repair (and post-op antibiotics) and aggressive treatment of risk factors

Question 9

What are the risk factors for an AAA?

Answer 9

Cigarettes, FHx, age, connective tissue disease
Males are more likely to have them
Females are more likely to have them rupture

Question 10

Whereabouts in the abdominal aorta are you most likely to find an AAA?

Answer 10

Below the renal arteries

Question 11

What is the pathophysiology of an AAA?

Answer 11

• Degradation of the connective tissues of the aortic wall due to disproportionate activity of proteolytic enzymes (these enzymes are derived from macrophages)
• There is also an inflammatory and immune response with transmural infiltration of macrophages and lymphocytes that can create a cascade of cytokines that promote proteolytic enzymes
• There is also decreased elasticity and collagen degradation