abdominal vascular emergency

Question 1

most feared complication of abdominal aortic aneurysm ?

Answer 1

rupture

Question 2

what is thee presentation of abdominal aortic aneurysm ?

Answer 2

acute abdominal pain
back pain
hypotension n

Question 3

what is the treatment for AAA rupture ?

Answer 3

resuscitation and allow for permissive hypotension
Urgent CTA followed by
immediate surgical intervention

Question 4

what can AAA rupture be confused with upon presentation ?

Answer 4

renal or ureteric colic

Question 5

what are the two types of mesenteric vascular diseases ?

Answer 5

acute mesenteric ischemia
chronic mesenteric ischemia

Question 6

where do most emboli lodge in cases of acute mesenteric ischemia ?

Answer 6

superior mesenteric artery

Question 7

what are the causes of non occlusive mesenteric ischemia ?

Answer 7

usually due to hypotension secondary to CHF, MI orr sepsiss

Question 8

what are the causes of mesenteric venous thrombosis?

Answer 8

hypercoagulability
portal hypertension
infection
paraneoplastic
pancreatitis
decompression sickness

Question 9

what is the presentation of acute mesenteric ischemia ?

Answer 9

1- abrupt severe abdominal pain
2- urgent need to have a bowel movement
3- fever
4- nausea and vomitingw

Question 10

what are the expected lab findings in acute mesenteric ischemia ?

Answer 10

raised WCC and lactate

Question 11

what is the presentation of chronic mesenteric ischemia ?

Answer 11

1- pain that started 30 minutes after eating
2- pain that worsens over an hour
3- pain that goes away within one to three hours

Question 12

what is the investigation of choice for chronic mesenteric ischemia ?

Answer 12

CTA

Question 13

what is the treatment for mesenteric ischemia ?

Answer 13

revascularization
resection of the non viable bowel

Question 14

what is the difference in presentation between patients with contained hematomas and patient with free intraperitoneal haemorrhage ?

Answer 14

contained hematoma - have transient hypotension and respond to an initial bolus of crystalloid solution

free intraperitoneal hge - do not respond to crystalloid bolus and may have a rigid abdomen on examinatioin

Question 15

what does the term black bowel refer to ?

Answer 15

occlusion of the proximal superior mesenteric artery

Question 16

what are the 4 zones associated with major abdominal vascular injuries ?

Answer 16

zone 1: midline retroperitoneum
zone 2: upper lateral retroperitoneum
zone 3: pelvic retroperitoneum or the portal retrohepatic area

Question 17

what are the predictors of expansion in AAA ?

Answer 17

hypertension
COPD

Question 18

what are the indications for repair of an AAA?

Answer 18

if reached 5.5 ccm or more in males
if reached 5 ccm or more in females plus risk factors
if growing more than 1 cm a year
symptommatic
infected

Question 19

what type of repair is preferred in high risk patients with an AAA?

Answer 19

EVAR

Question 20

which type of mesenteric ischemia may present with bloody diarrhea ?

Answer 20

non occlusive and mesenteric venous ischemia

Question 21

what is the treatment for embolic, thrombotic, non occlusive and venous mesenteric ischemia ?

Answer 21

embolic - embolectomy
thrombotic - thrombolectomy
non occlusive - volume resus and then nitroglycerin
venous - administration of heparin

Question 22

what is the treatment for chronic mesenteric ischemia ?

Answer 22

PTA and stent , bypass if that fails