Abdominal Aortic Aneurysm

Question 1

Define

Answer 1

Pathological widening of the aorta more than 1.5 times the expected AP diameter for that segment, given the patient’s BODY SIZE and gender.

Question 2

Aetiology

Answer 2

Smoking - most important risk factor
Atherosclerosis - most important risk factor
-> releases matrix metalloproteinases which diminish integrity of wall
Hyperlipidemia
High cholestrol

Marfans/EDS and other connective tissue disorders

Diabetes = protective, possibly
Inflammatory disorders

Question 3

Epidemiology

Answer 3

Male (4-6 times greater)>female

More common in older age (50+)

Question 4

Symptoms of unruptured AAA

Answer 4

Asymptomatic

If pain, it is the groin, loin (flanks)

Question 5

Symptoms of ruptured AAA

Answer 5

Sudden and severe pain in abdo or lower back
Syncope & hypotension & LOC
Pulsatile abdo mass

Question 6

Signs

Answer 6

Bimanual palpation reveals: 
Pulsatile mass 
Laterally expansile mass 
Abdo bruit 
Grey-Turner's sign

Question 7

What is the Grey-turner’s sign?

Answer 7

Bruising around the flanks

Question 8

When would you see Grey-Turner’s sign with AAA?

Answer 8

If there was retroperitoneal bleeding

Question 9

Where do AAA most commonly originate?

Answer 9

BELOW the renal arteries

Question 10

Investigations

Answer 10

Bloods - FBC, clotting screen, renal function and liver function 
Scans
- ultrasound 
- CT with contrast 
- magnetic resonance angiography

Question 11

Why isn’t an ultrasound enough?

Answer 11

It doesn’t tell you whether the AAA is leaking or not