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Big Surgery > Abdominal aortic aneurysm > Flashcards

Abdominal aortic aneurysm Flashcards

1
Q

What age does AAA usually occur in?

A

-60-70 years

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2
Q

What is the definition of AAA?

A
  • Localised dilation of all 3 layers(intima,media and adventitia) to more than 50% of its original size
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3
Q

What are the causes/risk factors for AAA?

A
  1. Old age
  2. Family history
  3. Smoking hx
  4. Hypercholesteraemia and arterial hypertension
  5. Atherosclerosis
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4
Q

What is the pathophysiology of AAA?

A
  • inflammation and degeneration of connective tissue by proteloytic enzymes
  • mechanical stress(high blood pressure )can cause further dilation and rupture
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5
Q

Where does the AAA usually develop?

A
  • infrarenal-95%

- juxtrarenal-5%

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6
Q

What are the clinical features of a patient with AAA?

A

-Back pain
-mostly asymptomatic
-trash feet(gangrenous foot)
-

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7
Q

How do we diagnose AAA?

A
  • Ultrasound-best initial and confirmatory test

- CT-determines AAA rupture

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8
Q

What is the treatment for an AAA?

A
  • Cessation of smoking

- decreased BP to <120/80

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9
Q

How many times do we need to monitor the patient according to the aortic diameter?

A
  1. <3 cm- no ultrasound
  2. 3-4 cm do a yearly ultrasound
  3. 4-4.5 cm- ultrasound every 6 months
  4. 4.5-5.5 cm ultrasound every 3 months
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10
Q

When do we consider elective surgery?

A
  • aneurysm >5.5cm

- expanding more than 1 cm per year

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11
Q

When do we we consider emergency surgery?

A
  • leaking or ruptured AAA

- Acutely symptomatic

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12
Q

What are the surgical procedures we can do?

A
  • EVAR which is preferred over

- open(tube graft and y-prosthesis)

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13
Q

What are the complications of an AAA?

A

-Rupture

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14
Q

What does EVAR stand for?

A

Endovascular aneurysm repair

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15
Q

What is the clinical features for a ruptured AAA?

A
  • Throbbing abdominal pain that radiates towards the flank, the back, the buttocks, legs and groin
  • nausea and vomiting
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16
Q

What is the treatment for a ruptured AAA?

A
  • emergency open surgery
  • sometimes endoscopic surgery
  • high mortality rate(90%) if it occurs outside the hospital
17
Q

What is the possible differential diagnosis for upper abdominal pain with surgery

A
  • Pale: ruptured AAA, ruptured hepatoma, ruptured spleen in trauma
  • Not pale: sepsis, pancreatitis, pyenephrosis
18
Q

Why should we not intubate these patients?

A

-neuromuscular blocking agents will reduce the tamponade effect and cause haemorrhage

19
Q

What kind of graft is used?

A

-a synthetic graft called Dacron

20
Q

What is the most common complication post-operatively?

A

Renal insufficiency

21
Q

How can we stop the complication of renal insufficiency?

A

-by giving furosemide or mannitol pre-operatively

22
Q

What are the peri-operative complications of doing EVAR?

A
  1. Stroke because of hypotension
  2. Myocardial infarction
  3. renal insufficiency
  4. colon ischaemia
  5. haemmorrhage
  6. Infection of the graft
  7. Gangrene foot when an embolism travels from a thrombus
23
Q

What is a late complication of EVAR?

A
  • late infection

- aortoenteric fistula

24
Q

How can you tell the difference between a saccular and fusiform aneurysm?

A

Fusiform is symmetrical and saccular is asymmetric and bulges out

25
Q

What are the 4 ways to classify aortic aneurysms?

A
  1. pathology
  2. anatomy
  3. morphology
  4. etiology
26
Q

What is the etiology of aneurysms?

A
  1. inflammatory: Takayasus
  2. degenerative (most common)
  3. Infections-HIV, TB, Infective endocraditis, salmonella, staphdissecti aureus
  4. Traumatic-false anurysms
  5. Anastomatic- false anurysms
  6. dissection-thoraco-abdominal aneurysm
27
Q

What is the gold standard special investigation for aneurysms?

A
  1. CT scan because you can see the thrombosis, angiogram only shows the dilatation
28
Q

How do degenerative aneurysms present?

A
  1. The present with older white males that smoked
  2. Usually fusiform in shape
  3. Infra-renal, aortic. popliteal and thoracic aneurysms
29
Q

How do HIV related anurysms present?

A

They are multiple an saccular

30
Q

How do we classify aneurysms anatomically?

A
  1. Aortic- by the umbilicus
  2. Supra-renal- under ribs
  3. infra renal-below costal margin
  4. popliteal
  5. carotid
  6. visceral
31
Q

What are the possible complications of aneurysms?

A
  1. rupture
  2. embolus
  3. compression
  4. infection
32
Q

How do people with symptomatic anurysms present?

A

abdominal or back pain or pain above the enurysm

Needs urgent medical care immediatey

33
Q

Into which organs can an abdominal aneurysm rupture?

A
  1. retroperitoneal space
  2. IVC
  3. GIT-duodenum
  4. Ureter
  5. left renal vein
34
Q

What are the 3 managment options?

A
  1. conservative
  2. surgical
  3. EVAR
35
Q

What are the indications for conservative management?

A
  1. If the aneurysm is < 5,5cm
  2. The patient is not fit for surgery
  3. Thepatient is asymptomatic
    If <4 cm then yearly ultrasound must be done
    If 4-5,5cm then 6 monthly ultrasound should be done
36
Q

What are indications for surgery?

A
  1. High rupture risk: >5,5cm

2. Healthy individuals

37
Q

What are the complications of EVAR?

A
  1. limb occlusion
  2. migration
  3. dilatation
  4. endoleaks
38
Q

What is different about the management of popliteal aneurysms?

A

We bypass instead of putting in a stent

Big Surgery (21 decks)

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