Abdominal Aortic Aneurysm

Question 1

Triad for !!!Ruptured Aortic Abdominal Aneurysm

Answer 1

pain (Severe, acute)
hypotension
pulsatile abdominal mass

Question 2

What are signs of an aortovenous fistula?

Answer 2

A continuous abdominal bruit and a palpable abdominal thrill are suggestive of an aortovenous fistula.

Question 3

What are signs of an aortoenteric fistula?

Answer 3

Heme-positive or grossly bloody stools can be indicative of an aortoenteric fistula.

Question 4

Describe the pain in an enraptured triple A

Answer 4

Patients may complain of abdominal, back, or flank pain with a stable, intact AAA. However, the pain usually has a gradual onset and a dull quality. Patients may also complain of abdominal mass, fullness, or the sensation of pulsations.

Question 5

Describe the resuscitative strategy in ruptured triple A patients

What should the target blood pressure be?

Answer 5

There is no agreed upon resuscitation strategy for hypotensive patients with ruptured AAAs.

• Hypotensive patients may benefit from a slowing in the rate of hemorrhage and clot formation. On one hand, large volumes of crystalloid solution can cause further bleeding (by dislodging clots) and causing a dilutional coagulopathy. On the other hand, prolonged hypotension can cause myocardial infarction, respiratory failure, renal failure. Therefore a target systolic blood pressure of between 90 and 100 mm Hg is reasonable to prevent these complications.

Question 6

What test is the most sensitive for detecting a triple A?

Answer 6

• Ultrasonography is the ideal study for detection of AAA
• Computed tomography (CT) is extremely accurate in determining whether or not an AAA is present. CT is less operator dependent than ultrasound and is more accurate in detecting extraluminal blood.

Question 7

If the patient is not hypotensive should they still be sent to the OR?

Answer 7

• If the patient is not hypotensive, these patients should not be sent to the operating room. In this case, bedside ultrasound (if available) can be used to confirm the presence of an AAA.
• An unstable patient with AAA requires emergent surgical consultation and transfer to the operating room. Any delay in surgical care will result in an increased mortality.