Abdominal Aortic Aneurysm Flashcards

1
Q

Define Abdominal Aortic Aneurysm

A

The dilation of the abdominal aorta which can lead to a life-threatening rupture

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2
Q

What is the basic pathophysiology of abdominal aortic aneurysm?

A
  • It is the dilation of the abdominal aorta wherein the diameter exceeds greater than 50% of the vessel diameter (>3cm)
  • It is the degradation of all 3 layers of the vessels (intima, media and adventitia)
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3
Q

What is a true aneurysm?

A

Degradation of all 3 layers

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4
Q

What is a pseudoaneurysm?

A

degradation of less than 3 layers

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5
Q

What is dilation usually?

A

3cm+

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6
Q

What length of dilation means there is an increased risk of rupturing and a surgical emergency?

A

5.5cm+

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7
Q

What is inflammatory AAA?

A
  • a type of AAA that affects younger patients
  • associated with smoking, atherosclerosis and vasculitis
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8
Q

What is thoracic AAA?

A
  • typically a result of Marfan Syndrome or Ehler-Danlos Syndrome(connective tissue disorders) and atherogenesis
  • This is another rare type of AAA
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9
Q

What are the symptoms of AAA?

A

Typically asymptomatic until rupture

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10
Q

What are the rupture symptoms of AAA?

A

Pulsatile and expansile abdominal mass
Hypotension and tachycardia (Haemodynamically unstable)
Sudden epigastric pain radiating to the back or groin
Loss of consciousness

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11
Q

What is the % and prognosis for anterior and posterior AAA ruptures?

A
  • 20% of AAAs rupture anteriorly, with a poor prognosis
  • 80% rupture posteriorly with a better prognosis
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12
Q

What is the mortality rate in untreated ruptured AAA?

A

100%

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13
Q

What are the signs of AAA?

A
  • Grey-Turner’s Sign: Flank Bruising
  • Cullen’s Sign: Pre-umbilical Bruising

However, acute pancreatitis is also linked to these signs.

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14
Q

What are the risk factors for AAA?

A

Smoking
Age
Diabetes
Hypertension
Marfan Syndrome/Ehler Danlos Syndrome
Male
Family History

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15
Q

How do you diagnose AAA?

A
  • Abdominal Ultrasound is usually used for establishing an AAA diagnosis
  • It is fast, cheap and reliable as well as highly specific and sensitive
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16
Q

What are the categories for treatment of AAA?

A
  • Asymptomatic and under 5.5cm dilation
  • Asymptomatic and over 5.5cm dilation
  • Symptomatic AAA
  • Ruptured AAA
17
Q

What is the treatment for Asymptomatic and under 5.5cm dilation?

A

Monitor and offer advice to manage risk

18
Q

What is the treatment for Asymptomatic and over 5.5cm dilation?

A
  • Elective surgery
  • Either open surgery or EVAR (Endovascular Aortic Repair, a stent)
19
Q

What is the treatment for symptomatic AAA?

A

URGENT Surgical Repair (Open or EVAR)

20
Q

What is the treatment for ruptured AAA?

A

Stabilise ABCDE, Fluids, Urgent Surgical Repair

21
Q

Which is preferred treatment, open surgery or EVAR?

A

Open surgery is preferred over EVAR unless they are over 70