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TCD Cases > Abdominal Aortic Anuerysm > Flashcards

Abdominal Aortic Anuerysm Flashcards

1
Q

Define a true aneurysm

A

Wall of the artery makes up the wall of the aneurysm

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2
Q

Name the 4 most frequently involved arteries

A
  1. Abdominal aorta
  2. Iliac
  3. Popliteal
  4. Femoral
  5. Thoracic aorta
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3
Q

What are the most important differentials for acute onset severe abdominal pain? (5)

A
  1. Perforated viscus (e.g. gastric or duodenal ulcer)
  2. Acute pancreatitis
  3. Biliary colic or acute cholangitis
  4. Acute mesenteric occlusion
  5. Ruptured or leaking abdominal aortic aneurysm
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4
Q

What is the clinical difference between transmitted and expansile abdominal pulsations?

A
  • An expansile pulsation will cause your finger to moved outwards
  • Transmitted pulsation will cause your fingers to move upwards
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5
Q

Name the 3 major branches of the abdominal aorta that supply the GI tract

A
  1. Coeliac trunk
  2. Superior mesenteric
  3. Inferior mesenteric
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6
Q

Recall the main branches of the abdomonal aortia: ‘ In Case My Students Really Love Games I’m Monopoly’

A
  1. Inferior phrenic
  2. Coeliac trunk
  3. Middle suprarenal
  4. Renal
  5. Lumbar
  6. Gonadal
  7. Inferior mesenteric
  8. Median sacral
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7
Q

What bleeding volume is required in order to qualify as a major haemorrhage?

A

Ongoing bleeding of 150ml/min and clinical signs of shock

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8
Q

What is the most common cause for activation of the major haemorrhage pathway?

A

Obstetric haemorrhage

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9
Q

Which bloods are required as part of the management of a major haemorrhage? (8)

A
  1. FBC
  2. U and E
  3. LFT
  4. Calcium
  5. PT
  6. APTT
  7. Fibrinogen
  8. Crossmatch
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10
Q

What is contained within pack 1 of the major haemorrhage packs?

A
  • 4 units of red cells

- 4 units of FFP

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11
Q

What is contained within pack 2 of the major haemorrhage packs?

A
  • 4 units of red cells
  • 4 units FFP
  • 1 dose platelets
  • 2 packs cryoprecipitate
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12
Q

When managing ongoing bleeding what ranges should one aim to achieve for fibrinogen, PT and APPT respectively?

A

Fibrinogen >1.5g/L
PT ratio <1.5
APTT ratio <1.5

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13
Q

What are the 6 Ps associated with acute Ischaemia?

A
  1. Pale
  2. Perishing cold
  3. Pulseless
  4. Painful
  5. Paraesthetic
  6. Paralysed
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14
Q

Recall the Fontaine classification of chronic Ischaemia

A

Fontaine 1 - asymptomatic
Fontaine 2 - claudication
Fontaine 3 - pain at rest
Fontaine 4 - tissue loss

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15
Q

Give 3 signs and symptoms associated with peripheral vascular disease?

A
  1. Claudication
  2. Rest pain
  3. Tissue loss - I.e. ulceration, necrosis, gangrene
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16
Q

What is the expected incidence of MI’s in patients with sifncjsnt peripheral vascular disease?

A

30% chance of MI in the next 5 years

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17
Q

What is the the absolute indication for carotid endarterectomy?

A

> 70 stenosis of internal carotid artery

18
Q

Recall the NNT for symptomatic and symptomatic carotid stenosis

A

Asymptomatic - 50

Symptomatic - 15

19
Q

Suggest 3 potential causes of obstructive shock

A
  1. Cardiac tamponade
  2. Tension pneumothorax
  3. Pulmonary embolism
20
Q

Define ectasia

A

Arterial dilation of up to 50%

21
Q

Which components of stroke volume is increased by giving inotropic support?

A

Contractility

22
Q

What are the 5 main aetiologies of an aneurysm?

A
  1. Atherosclerotic damage
  2. Mycotic
  3. Inflammatory
  4. Connective tissue disorders
  5. False I.e. pseudoaneurysm
23
Q

What are the 2 main aneurysmal shapes?

A
  1. Fusiform

2. Saccular

24
Q

What receptor type does clopidogrel act upon?

A

Adenosine diphosphate receptors of platelets

25
Q

Suggest 5 recognised complications of long stays in ICU

A
  1. Muscle weakness and wasting
  2. Nutritional deficiencies
  3. Sleep disorders
  4. Inability to swallow effectively + micro aspiration of food
  5. Recurrent chest infections
26
Q

In terms of transverse diameter, how is a large AAA defined?

A

> 5.5cm

27
Q

Recall the triad of presenting symptoms associated with aneurysm rupture

A
  1. Collapse
  2. Hypotension
  3. Lower back/ flank pain
28
Q

When managing ongoing bleeding what ranges should one aim to achieve for fibrinogen, PT and APPT respectively?

A

Fibrinogen >1.5g/L
PT ratio <1.5
APTT ratio <1.5

29
Q

Recall the 3 components of stroke volume

A
  1. Preload
  2. Contractility
  3. Afterload
30
Q

What are the 4 main categories of shock?

A
  1. Hypovolaemic
  2. Cardiogenic
  3. Distributive
  4. Obstructive
31
Q

Briefly outline the mechanism of each of the 4 main categories of shock

A
  1. Hypovolaemic - Reduced intravascular volume
  2. Distributive - Vasodilation and malperfusion
  3. Cardiogenic - Intrinsic cardiac (pump) failure
  4. Obstructive - Failure of circulatory flow
32
Q

Give 4 clinical examples that may precipitation hypovolaemic shock

A
  1. Haemorrhage
  2. Burns
  3. GI losses
  4. Significant dehydration
33
Q

Suggest 3 categories of distributive shock

A
  1. SIRS related e.g. Sepsis, pancreatitis, trauma or burns
  2. Neurogenic i.e. spinal cord injury
  3. Anaphylaxis
34
Q

Suggest 3 clinical aetiologies of cardiogenic shock

A
  1. MI/ ischaemia
  2. Arrhythmia
  3. Acute valve pathology
35
Q

Suggest 3 potential causes of obstructive shock

A
  1. Cardiac tamponade
  2. Tension pneumothorax
  3. Pulmonary embolism
36
Q

Which component of stroke volume is increased by administering IV fluids?

A

Preload

37
Q

Which components of stroke volume is increased by giving inotropic support?

A

Contractility

38
Q

Name 2 connective tissue disorders that predispose an individual to an aortic aneurysm

A
  1. Marfan syndrome

2. Ehler’s-Danlos syndrome

39
Q

90% of aortic dissections occur within which section of the vessel?

A

Within 10cm of the aortic valve i.e. aortic root

40
Q

What receptor type does clopidogrel act upon?

A

Adenosine diphosphate receptors of platelets

41
Q

Suggest 5 recognised complications of long stays in ICU

A
  1. Muscle weakness and wasting
  2. Nutritional deficiencies
  3. Sleep disorders
  4. Inability to swallow effectively + micro aspiration of food
  5. Recurrent chest infections
42
Q

Suggest 5 possible complications of a massive blood transfusion

A
  1. Hypocalcaemia
  2. TRALI
  3. Haemolytic reactions - immediate and delayed
  4. Hypothermia
  5. Dilutional coagulopathy

TCD Cases (25 decks)

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