Abdominal Aortic Anuerysm Flashcards
Define a true aneurysm
Wall of the artery makes up the wall of the aneurysm
Name the 4 most frequently involved arteries
- Abdominal aorta
- Iliac
- Popliteal
- Femoral
- Thoracic aorta
What are the most important differentials for acute onset severe abdominal pain? (5)
- Perforated viscus (e.g. gastric or duodenal ulcer)
- Acute pancreatitis
- Biliary colic or acute cholangitis
- Acute mesenteric occlusion
- Ruptured or leaking abdominal aortic aneurysm
What is the clinical difference between transmitted and expansile abdominal pulsations?
- An expansile pulsation will cause your finger to moved outwards
- Transmitted pulsation will cause your fingers to move upwards
Name the 3 major branches of the abdominal aorta that supply the GI tract
- Coeliac trunk
- Superior mesenteric
- Inferior mesenteric
Recall the main branches of the abdomonal aortia: ‘ In Case My Students Really Love Games I’m Monopoly’
- Inferior phrenic
- Coeliac trunk
- Middle suprarenal
- Renal
- Lumbar
- Gonadal
- Inferior mesenteric
- Median sacral
What bleeding volume is required in order to qualify as a major haemorrhage?
Ongoing bleeding of 150ml/min and clinical signs of shock
What is the most common cause for activation of the major haemorrhage pathway?
Obstetric haemorrhage
Which bloods are required as part of the management of a major haemorrhage? (8)
- FBC
- U and E
- LFT
- Calcium
- PT
- APTT
- Fibrinogen
- Crossmatch
What is contained within pack 1 of the major haemorrhage packs?
- 4 units of red cells
- 4 units of FFP
What is contained within pack 2 of the major haemorrhage packs?
- 4 units of red cells
- 4 units FFP
- 1 dose platelets
- 2 packs cryoprecipitate
When managing ongoing bleeding what ranges should one aim to achieve for fibrinogen, PT and APPT respectively?
Fibrinogen >1.5g/L
PT ratio <1.5
APTT ratio <1.5
What are the 6 Ps associated with acute Ischaemia?
- Pale
- Perishing cold
- Pulseless
- Painful
- Paraesthetic
- Paralysed
Recall the Fontaine classification of chronic Ischaemia
Fontaine 1 - asymptomatic
Fontaine 2 - claudication
Fontaine 3 - pain at rest
Fontaine 4 - tissue loss
Give 3 signs and symptoms associated with peripheral vascular disease?
- Claudication
- Rest pain
- Tissue loss - I.e. ulceration, necrosis, gangrene
What is the expected incidence of MI’s in patients with sifncjsnt peripheral vascular disease?
30% chance of MI in the next 5 years
What is the the absolute indication for carotid endarterectomy?
> 70 stenosis of internal carotid artery
Recall the NNT for symptomatic and symptomatic carotid stenosis
Asymptomatic - 50
Symptomatic - 15
Suggest 3 potential causes of obstructive shock
- Cardiac tamponade
- Tension pneumothorax
- Pulmonary embolism
Define ectasia
Arterial dilation of up to 50%
Which components of stroke volume is increased by giving inotropic support?
Contractility
What are the 5 main aetiologies of an aneurysm?
- Atherosclerotic damage
- Mycotic
- Inflammatory
- Connective tissue disorders
- False I.e. pseudoaneurysm
What are the 2 main aneurysmal shapes?
- Fusiform
2. Saccular
What receptor type does clopidogrel act upon?
Adenosine diphosphate receptors of platelets
Suggest 5 recognised complications of long stays in ICU
- Muscle weakness and wasting
- Nutritional deficiencies
- Sleep disorders
- Inability to swallow effectively + micro aspiration of food
- Recurrent chest infections
In terms of transverse diameter, how is a large AAA defined?
> 5.5cm
Recall the triad of presenting symptoms associated with aneurysm rupture
- Collapse
- Hypotension
- Lower back/ flank pain
When managing ongoing bleeding what ranges should one aim to achieve for fibrinogen, PT and APPT respectively?
Fibrinogen >1.5g/L
PT ratio <1.5
APTT ratio <1.5
Recall the 3 components of stroke volume
- Preload
- Contractility
- Afterload
What are the 4 main categories of shock?
- Hypovolaemic
- Cardiogenic
- Distributive
- Obstructive
Briefly outline the mechanism of each of the 4 main categories of shock
- Hypovolaemic - Reduced intravascular volume
- Distributive - Vasodilation and malperfusion
- Cardiogenic - Intrinsic cardiac (pump) failure
- Obstructive - Failure of circulatory flow
Give 4 clinical examples that may precipitation hypovolaemic shock
- Haemorrhage
- Burns
- GI losses
- Significant dehydration
Suggest 3 categories of distributive shock
- SIRS related e.g. Sepsis, pancreatitis, trauma or burns
- Neurogenic i.e. spinal cord injury
- Anaphylaxis
Suggest 3 clinical aetiologies of cardiogenic shock
- MI/ ischaemia
- Arrhythmia
- Acute valve pathology
Suggest 3 potential causes of obstructive shock
- Cardiac tamponade
- Tension pneumothorax
- Pulmonary embolism
Which component of stroke volume is increased by administering IV fluids?
Preload
Which components of stroke volume is increased by giving inotropic support?
Contractility
Name 2 connective tissue disorders that predispose an individual to an aortic aneurysm
- Marfan syndrome
2. Ehler’s-Danlos syndrome
90% of aortic dissections occur within which section of the vessel?
Within 10cm of the aortic valve i.e. aortic root
What receptor type does clopidogrel act upon?
Adenosine diphosphate receptors of platelets
Suggest 5 recognised complications of long stays in ICU
- Muscle weakness and wasting
- Nutritional deficiencies
- Sleep disorders
- Inability to swallow effectively + micro aspiration of food
- Recurrent chest infections
Suggest 5 possible complications of a massive blood transfusion
- Hypocalcaemia
- TRALI
- Haemolytic reactions - immediate and delayed
- Hypothermia
- Dilutional coagulopathy
