Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology > Abdominal aortic aneurysm > Flashcards

Abdominal aortic aneurysm Flashcards

1
Q

What is an aneurysm?

A

Dilation of a vessel by more than 50% of its normal diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the normal diameter of a vessel?

A

1.2-2cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the minimum diameter before it is termed an aneurysm?

A

over 3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a true aneurysm?

A

An aneurysm in which all three layers of the vessel wall are intact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a false aneurysm?

A

An aneurysm in which there is a breach in the vessel wall (the surrounding structures act as the vessel wall)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can cause false aneurysms?

A

trauma ie needles (medical or non medical), fractures etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

is an abdominal aortic aneurysm a true or false aneurysm?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the three types of aneurysm?

A

saccular, fusiform and mycotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which type of aneurysm has the highest chance of rupture?

A

saccular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What accounts for the vast majority of aneurysms?

A

fusiform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a mycotic aneurysm?

A

It is not a generic problem with the artery wall but an infection. The infection weakens the wall and the aneurysm expands rapidly. It involves all three layers of the artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What increases your likelihood of getting an Abdominal aortic aneurysm?

A

-age (older), gender (male), smoking, hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the main way a rupture occurs in an AAA?

A

Dilation of the aneurysm causes stress. Increase in size also causes increase in speed of growth. The bigger the aneurysms get, the more stressed and therefore the more likely the aneurysms are of rupturing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes aneurysms?

A

damage to the vessel wall mostly caused by atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Are aneurysms genetic?

A

They can run in families most often on the male side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what percentage of AAA patients have a popliteal aneurysm?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A ruptured AAA is the … most common cause f males in the UK?

A

7th

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the ratio of male and females sufferers of AAAs?

A

9males :1 female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What percentage of AAAs are asymptomatic?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How are asymptomatic AAAs identified?

A

imaging for other pathology or screening tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the symptoms that can occur alongside AAAs?

A
  • pain
  • trashing
  • rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is meant by trashing?

A

clot in lumen from aneurysm which can break off which can go into peripheral vessels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the presentation of an AAA?

A
  • sudden onset epigastric/central pain
  • may radiate through to back
  • may mimic renal colic
  • collapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the presentation of AAA on examination in symptomatic AAA rupture?

A

-may look well
-hypo/hypertensive
-pulsatile, expansile mass +/- tender
-transmitted pulse
-peripheral pulses
(can sometimes see pulse coming out side of body caused by aneurysm rupture)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the outcomes for AAA rupture?

A
  • 75% will not make it to hospital
  • ones that rupture in the peritoneal sack dont usually survie
  • 50% operative mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When should you intervene in a symptomatic AAA?

A

when there is :

  • pain
  • trashing
  • rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When should you intervene in an asymptomatic AAA?

A
  • an AAA of more than 5.5cm in diameter

- rapid expansion of aneurysm (more than 0.5cm in 6 months or more than 1cm in 1 year)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the risk of an aneurysm rupturing at less than 5.5cm?

A

less than 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What imaging should you do for an AAA?

A
  • Duplex ultrasound

- CT angiogram

30
Q

What is the use of a Duplex ultrasound?

A
  • sued in asymptomatic AAA and for surveillance
  • it identifies the size of the aneurysm as well as the involvement of the iliac arteries
  • does not determine the location of the aneurysm
31
Q

Why is a CT angiogram scan useful?

A

Will determine if there is a rupture, allows size, shape, artery involvement to be determined as well as planning of treatment
-A CT angiogram is a CT scan with contrast

32
Q

What are the methods of treatment for AAA?

A
  • open repair

- endovascular aneurysm repair (EVAR)

33
Q

What is the principle of an open repair of an AAA?

A
  • laparotomy
  • clamp aorta and iliacs
  • open aneurysm
  • graft inserted
  • aneurysm is then closed back over the graft as the graft would damage the bowl if it came into contact with it

(open abdomen, fire the piece of aorta above and below the aneurysm and then clamp it to stop it bleeding. Dacron (Polyester) graft with two different conformations: tube or bifurcated depending on suite of aneurysm.)

34
Q

What percentage of AAAs are treated this way?

A

25%

35
Q

What drug is used in open repair?

A

Heparin to thin the blood to try and reduce the clot

36
Q

What are the principles of an EVAR?

A
  • want to exclude the AAA from inside the vessel

- the tube is inserted via the peripheral artery guided by an Xray

37
Q

What are the advantages of an EVAR over open repair?

A
  • less invasive
  • only need 2 1cm cuts in the groin
  • preferred by patients
38
Q

What are the disadvantages of an EVAR?

A
  • lifelong scans needed

- 15-25% of patients will need an adjustment to their EVAR over the rest of their lives

39
Q

What is acute limb ischemia?

A

sudden loss of blood supply to a limb

40
Q

What causes acute limb ischemia?

A

occlusion of native artery or bypass graft

41
Q

What are the causes of sudden occlusion?

A
  • embolism (clot commonly comes from heart)
  • atheroembolism (narrowing of vessel can cause clots or some of the plaque can come off and embolise)
  • arterial dissection (tear of the intima can cause narrowing of the arteries)
  • trauma (dislocating knew can cause dissection of artery behind the knee)
  • extrinsic compression
42
Q

What are the clinical features of acute limb ischemia?

A
  • pain (excruciating)
  • pallor (white)
  • pulseless
  • perishingly cold
  • paraesthesia
  • paralysis
  • no prior history of claudication
  • known cause of embolism ‘
  • full complement of pulses in other leg
43
Q

What is the pain like in acute limb ischemia?

A
  • severe, sudden onset, resistant to analgesia

- can have leg muscle tenderness with tight compartment which indicates muscle necrosis

44
Q

What is the pallor like in acute limb ischemia?

A
  • white initially
  • then mottled (purple blue) as capillaries fill with stagnent deoxygenated blood
  • then non blanching mottling
45
Q

What is meant by blanching?

A

touch it and it goes white then comes back to colour

46
Q

What are the effect of acute limb ischemia after 0-4 hours?

A
  • white foot
  • painful
  • sensorimotor deficit
  • Salvageable
47
Q

What are the effect of acute limb ischemia after 4-12 hours?

A
  • mottled
  • blanches on pressure
  • partially reversible
48
Q

What are the effect of acute limb ischemia after 12 hours?

A
  • fixed mottling
  • non blanching
  • compartments tender/red
  • paralysis
  • Non salvageable
49
Q

After 12 hours should you perfuse the leg?

A

No, there is a lot of dead tissue and if you perfused the limb you would simply be washing the toxins into the rest of the body and most likely kill the patient

50
Q

What is the management plan for Acute limb ischemia?

A
  • ABC (resuscitate and investigate)
  • FBC, U/Es, CK, Coag +/- troponin
  • ECG (check for MI or dysrhythmia)
  • CXR (check for underlying malignancy

-Give anticoagulants but not too much as need anaesthetics

51
Q

If the limb is salvageable what are the options?

A

-embolectomy +/-
-fasciotomies +/-
thrombolysis

52
Q

If the limb is not salvageable what are the options?

A

-palliation or amputation

53
Q

What is the risk of dying in hospital due to an embolus?

A

30% risk of dying in hospital if have embolus due to underlying cause of embolus

54
Q

Why might an intra operative angiogram be needed in an embolectomy?

A

Underlying artery disease (especially in elderly patients) so the embolectomy catheter not passing down artery so need intra operative angiogram

55
Q

How is an embolectomy carried out?

A
  • tie off the two ends of the artery
  • small incision to the artery
  • insert the balloon catheter
  • blow it up
  • pull out the clot
  • pull out the clot from the artery
56
Q

What is diabetic foot sepsis?

A

tissue ulceration, necrosis and gangrene caused by diabetes related complications

57
Q

What are the diabetic foot problems that can cause susceptibility to diabetic foot sepsis?

A
  • diabetic neuropathy (cant feel trauma)
  • peripheral vascular disease (lack of blood)
  • infection
58
Q

What is the most significant problem with diabetes?

A

Foot problems in diabetics account for more hospital admissions than any other long term complication of diabetes

59
Q

What are the chances of losing the second leg after losing one leg in diabetes?

A

50% chance of losing their other leg within the first 5 years of the 1st

60
Q

What is the main risk factor for limb loss?

A

diabetes

61
Q

What can diabetic foot sepsis result from?

A
  • simple puncture wound
  • infection from the nail plate or inter-digital space
  • from a neuro-ischemic ulcer
62
Q

Why is diabetic foot sepsis a problem?

A
  • within the foot the intrinsic muscles of the digits are confined within rigid compartments
  • infection tracks in the soft tissues into these rigid compartments
  • the build up of pus cannot escape
63
Q

What can the build up of pus cause?

A

increase pressure in the compartments leading to impaired capillary blood flow and further ischemia and further tissue damage

64
Q

What are the 5 foot compartments from superficial to deep?

A
  • interosseous compartments
  • lateral compartments
  • medial compartments
  • calcaneal compartments
  • central compartments
65
Q

What are some systemic clinical findings of diabetic foot sepsis?

A
  • pyrexia
  • tachycardia
  • tachypnoea
  • confusion
  • Kussmauls breathing (very acidotic, they try to blow CO2 out to raise pH)
66
Q

What are the local clinical findings of diabetic foot sepsis?

A
  • swollen affected digit
  • swollen forefoot
  • tenderness
  • ulcer with pus extruding
  • erythema, may track up limb
  • patches of rapidly developing necrosis
  • crepitus in soft tissues of the foot
67
Q

What is crepitus in the foot caused by?

A

Crepitus is a sign of gas, the gas is from the bugs

68
Q

What antibiotics would you be using?

A

Those to treat:

  • gram +ve cocci
  • gram -Ve bacilli
  • anaerobes
69
Q

How do you treat diabetic foot sepsis?

A
  • rapid surgical debridement of infected tissue

- wound open to encourage drainage

70
Q

What surgical interventions can be done for diabetic foot sepsis?

A
  • Remove all infection from site should take 15 mins

- Then come back to do a definitive procedure such as a Guillotine amputation

71
Q

What is the aftercare for diabetic foot problems?

A

-adequate footwear and education on foot care

Cardiology (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions