AAA Flashcards
Describe the abdominal blood supply?
GIT arterial supply: 3 anterior branches of the abdo aorta
1) Celiac trunk -> foregut (mouth to 2nd part duodenum)
2) Superior mesenteric -> midgut (3rd part duodenum to proximal 2/3 transverse colon)
3) Inferior mesenteric -> hindgut (distal 1/3 transverse colon to anal canal)
Describe the celiac trunk?
Location: from abdo aorta at T12
Supplies: foregut (mouth to 2nd part duodenum)
Branches:
• L gastric a -> lesser curvature of stomach
• Splenic a -> spleen, pancreas, also greater curvature of stomach (from L gastroepiploic a and short gastric a.s.)
• Common hepatic a -> hepatic artery proper, R gastric artery and gastroduodenal artery
• Gastroduodenal a -> superior pancreaticoduodenal artery and R gastroepiploic artery
Describe the superior mesenteric artery (SMA)?
Location: from abdo aorta at L1 (below celiac trunk)
Supplies: midgut (3rd part duodenum to proximal 2/3 of transverse colon)
Branches:
• Intestinal arteries (jejunal and ileal arteries)
• Inferior pancreaticoduodenal artery
• Ileocolic artery
• R and middle colic arteries
Describe the inferior mesenteric artery (IMA)?
Location: arises from abdo aorta at L3 Supplies: hindgut (distal 1/3 transverse colon to anal canal) Branches: • L colic a • Sigmoid arteries • Superior rectal artery
Describe the arterial supply of the diaphragm?
Superior and inferior phrenic arteries
Superior aspect: thoracic aorta -> superior phrenic arteries (5) -> pericardiophrenic and musculophrenic arteries
Inferior aspect: thoracic aorta -> inferior phrenic arteries
Describe the arterial supply of the pancreas?
Superior and inferior pancreaticoduodenal a.s.
Coeliac a. -> superior pancreaticoduodenal a
Superior mesenteric a -> inferior pancreaticoduodenal a
Describe the arterial supply of the bile ducts?
- cystic artery
- posterior superior pancreaticoduodenal a
Describe the lymphatic drainage of the pancreas?
pancreaticosplenic LNs and pyloric LNs
- > coeliac LNs (included in pre-aortic LNs)
- > cisterni chyli -> thoracic duct
Describe the lymphatic drainage of the diaphragm?
Phrenic or parastenal LNs
Describe the lymph drainage of the abdomen?
- Pre-aortic LNs-> intestinal trunks -> cisterna chyli -> thoracic duct
- Coeliac LNs collect from: gastric, hepatic, pancreatosplenic LNs
- Superior mesenteric LNs collect from SMA supply
- Inferior mesenteric LNs collect from IMA supply - Para-aortic LNs -> lumbar trunks -> cisterna chyli -> thoracic duct
- Kidneys, suprarenal glands, abdo ureters
- Posterior abdo wall
- Testis, ovary
- Uterus, fallopian tubes
- Lower limbs - Retro-aortic LNs -> cisterna chyli -> thoracic duct
- Posterior abdo wall
Describe the management of an AAA?
Surgical intervention:
- Evaluation: All symptomatic AAA should be considered, asymptomatic AAA not considered until >5.5cm diameter
- Open repair- aneurysmal segment replaced with Dacron prosthetic graft
- Endocascular repair- stent-graft introduced through femoral a.s.
- Concurrent B-blocker -> reduce BP and HR -> reduce risk of rupture
Ruptured AAA management:
- Clinical triad: abdo/back pain, pulsatile abdo mass, hypotension
Immediate resuscitation:
- A/B- airway management: supplemental O2/ intubation
- C- V access, aggressive fluid replacement, group and hold, arterial line
- D- urinary catheter
- Notify anaesthetics, theatre and ICU
List some DDx for severe back pain?
CVS o MI o Angina Respiratory o Pneumonia- pleuritis o PE o Lung ca o TB o Pneumothorax Neoplasia o Pancreatic ca o Vertebral mets and path # o Lung ca o Haematological- MM GIT o GORD o Oesophageal stenosis, spasm, rupture, carcinoma o Pancreatitis o PUD Genitourinary o Renal colic MSK o Muscular injury o Vertebral fracture- osteoporosis, osteolytic lesion o Disc prolapse Infectious- epidural abscess, osteomyelitis
