AAA

Question 1

Define abdominal aortic aneurysm

Answer 1

DEFINITION: a localised enlargement of the abdominal aorta such that the diameter is > 3 cm or > 50% larger than normal diameter.

NOTE: normal diameter of the aorta = 2 cm

Question 2

What is the aetiology for AAA?

Answer 2

There are NO specific identifiable causes

Question 3

Risk factors for AAA?

Answer 3

Severe atherosclerotic damage to aortic wall

Family history

Smoking

Male

Age

Hypertension - biggest cintributor 80%

Hyperlipidaemia

Connective tissue disorders: Marfan’s syndrome - important, Ehlers-Danlos syndrome

Inflammatory disorders: Behcet’s disease, Takayasu’s arteritis

Question 4

Recognise the presenting symptoms of AAA?

Answer 4

Unruptured;
NO SYMPTOMS
Usually an incidental finding
May have pain in the back, abdomen, loin or groin

RUPTURED;
Pain in the abdomen, back or loin  
Pain may be sudden or severe  
Syncope 
Shock  

NOTE: degree of shock depends on site of rupture and whether it is contained

Question 5

Recognise the signs of AAA on physical examination

Answer 5

Pulsatile and laterally expansile mass on bimanual palpation of the abdominal aorta

Abdominal bruit

Retroperitoneal haemorrhage can cause Grey-Turner’s sign

Question 6

Appropriate investigations for AAA?

Answer 6

Ex; pt may bee hyper/hypotensive

1. Bloods ;
   - FBC, clotting screen, renal function and liver function
   - Cross-match if surgery is planned
2. Scans
   - Ultrasound - can detect aneurysm but CANNOT tell whether it is leaking or not
3. CT with contrast - gold? can show whether an aneurysm has ruptured. exposure: neck to iliac arteries
4. MRI angiography

Question 7

rx of AAA?

Answer 7

type a 1+2: BP control, emergency surgery

type b: “, elective surgery

Annually if the AAA measures 3.0 to 4.4 cm
Every 3 months if the AAA measures 4.5 to 5.4 cm.
However, repair may be considered if the AAA measures >4 cm and is growing rapidly (>1 cm in 1 year).[33] In some countries, repair may be considered for women if their AAA measures ≥5 cm.[4]

Question 8

complications?

Answer 8

paraplegia from ischaemia in intercostal vessels

Question 9

most common type?

Answer 9

type a 1+2 make up 95%