AAA

Question 1

Define AAA

Answer 1

Localised bulge/swelling (diameter at least 1.5x normal diameter, where normal diameter = 2cm) of abdo aorta
Has the potential to rupture and cause internal haemorrhage

Question 2

Name some risk factors for AAA

Answer 2

FH
Male
65+
smoking
HTN

Question 3

What is the mortality rate of AAA

Answer 3

Pretty high - 70-95%

Question 4

Is an AAA commoner in males or females?

Answer 4

4 times more common in males

Question 5

Which ethic groups are more likely to get an AAA?

Answer 5

Caucasian - UK rates of AAA in men is 4.7%

in Asian men it’s 0.45%

Question 6

What symptoms are associated with AAA

Answer 6

Often asymptomatic but sometimes

• pulsating sensation in tummy
• constant abdo/low back pain

Question 7

What symptoms are associated with a ruptured AAA

Answer 7

Severe abdo/low back pain
Cold, clammy, sweaty, dizzy
SOB
Syncope

Question 8

What signs of AAA can be seen on examination

Answer 8

Grey Turner sign
Bruits (if renal/visceral arterial stenosis)
Palpable, pulsatile abdo mass that might pulse w/heart
Tachycardia
Hypotensive

Question 9

What investigations would you do for AAA and what results would you expect?

Answer 9

Abdo USS - measures size of aneurysm

CT - retroperitoneal fluid

Question 10

How would you manage AAA

Answer 10

Repair if it’s over 5.5cm with endovascular repair (EVAR) which is keyhole surgery where a stent is placed in the aorta
Or you can surgically graft the aorta with a plastic tube

Question 11

Which layers of the aorta are affected by AAA

Answer 11

Tunica media

Tunica intima

Question 12

Name some of the changes that occur in the t. media and intima forming AAA

Answer 12

Foam cells accumulate lipids
Extracellular free cholesterol crystals
Calcifications
Thrombosis
Ulceration
Proteolytic degradation of t.media

Question 13

What differentials could you suggest?

Answer 13

Kidney stones

Muscle related back pain