Abdominal aortic aneurysm

Question 1

What is the characteristic triad of a ruptured AAA?

Answer 1

Hypotension
Pulsatile abdominal mass
Abdominal/back pain

Question 2

How would you weigh surgical vs. conservative management of AAA?

Answer 2

Assess haemodynamic stability: urinary catheter, arterial catheter, IV access, electrolyte balance, surgical evaluation for repair.

Symptomatic AAA: gauge the size of the enlargement; men >5.5cm, women >5cm then surgical intervention is needed. Symptomatic AAA should be considered for surgery because it will predispose to rupture.

Question 3

Describe the branches and abdominal supply of coeliac trunk (3).

Answer 3

Left gastric artery
Common hepatic artery
Splenic artery

Question 4

What are branches of common hepatic artery?

Answer 4

Right gastric artery
Gastroduodenal artery
Hepatic artery proper

Question 5

What are the branches of gastroduodenal artery?

Answer 5

Right gastroepiploic artery and superior pancreaticoduodenal artery

Question 6

What are the branches of the superior mesenteric artery?

Answer 6

Jejunal artery, ileal artery, ileocolic artery, inferior pancreaticoduodenal artery, right and middle colic arteries

Question 7

What are the branches of the inferior mesenteric artery?

Answer 7

Left colic artery, sigmoidal arteries, superior rectal artery

Question 8

Where do the SMA and IMA anastomose?

Answer 8

They anastamose to form marginal arteries of Drummond and the Riolan’s arcade. They run distal and proximal to the root of mesentery.

Question 9

Which colonic arteries form vasa recta?

Answer 9

Terminal branches of right, left, middle and sigmoid arteries form the vasa recta.

Question 10

What is the blood supply of diaphram?

Answer 10

Five arteries of the intercostals, subcostals and left and right phrenic arteries.

Question 11

What is the blood supply of the pancreas?

Answer 11

Splenic artery (neck, body, tail) 
Superior and inferior pancreaticoduodenal arteries (head)

Question 12

What is the blood supply of the cystic duct?

Answer 12

Gastroduodenal artery, cystic artery and hepatic arteries.

Question 13

What are the main lymphatic drainage pathways?

Answer 13

1. Pre-aortic
2. Para-aortic
3. Retro-aortic

Question 14

What do pre-aortic nodes drain?

Answer 14

Coeliac (gastric, hepatic and pancreaticosplenic)

SMA and IMA

Question 15

What do para-aortic nodes drain?

Answer 15

Kidneys, adrenals, testes, ovaries, fallopian tube, uterus and abdominal ureters, lower limbs

Question 16

What do retro-aortic nodes drain?

Answer 16

Posterior abdominal wall