Abdominal Aortic Aneurysm

Question 1

What must you do in cases of women with abdominal pain?

Answer 1

PREGNANCY TEST (Beta HCG)

Question 2

What questions do you have to ask about Abdominalpain?

Answer 2

Site: chest, back, abdomen, flank, buttock, groin

Onset: gradual or sudden

Character: sharp, pulsating, dull

Radiations

Associated symptoms: upper GI sx (ulcers, dysphasia, odynophagia), nausea and vomiting, haematemesis, anorexia, bloating, altered bowel habit, jaundice

Time course: improving, colicky, worsening

Exacerbating/ relieving factors

Severity: on a scale of 1 to 10

Question 3

Abdominal Aortic Aneurysm

Diameter: What is considered an aneurysm?

What are the indications for repair?

Answer 3

Aneurysm = diameter over 3cm

Indications for repair (open repair or endovascular aneurysm repair) :

• over 5.5cm
• rapid expansion (over 5mm in 6 months or over 10mm in 12 months)

Question 4

Abdominal Aortic Aneurysm

Where is the most common site for AAA?

Answer 4

Most common location: between inferior mesenteric artery and renal artery

Question 5

Abdominal Aortic Aneurysm

Screening

Who? How? What do you do with the results?

Answer 5

Offered to men over the age of 65 in UK using abdominal ultrasound scan

Results:
Small = 3 to 4.4 cm = repeat ultrasound every year
Medium = 4.5 to 5.4cm = repeat ultrasound every 3 months
Larger = over 5.5cm = surgery (open repair or endovascular aneurysm repair)

Question 6

Abdominal Aortic Aneurysm

Clinical Features

Risk Factors

Answer 6

Shock (hypotensive - pale)

PULSATILE abdominal mass (Whilst expansive is normal)

Mild/Severe abdominal pain (can radiate to back, flank or groin)

RF: old men, smoking, hypertension, connective tissue disease (Ehlers Danlos Type 1, Marfans)

Question 7

Abdominal Aortic Aneurysm

Medical Management

Answer 7

Stopping smoking

Exercise

Beta blockers - also has positive cardiovascular effects

Statins reduce aneurysm expansion rates