abdominal vascular emergency Flashcards
most feared complication of abdominal aortic aneurysm ?
rupture
what is thee presentation of abdominal aortic aneurysm ?
acute abdominal pain
back pain
hypotension n
what is the treatment for AAA rupture ?
resuscitation and allow for permissive hypotension
Urgent CTA followed by
immediate surgical intervention
what can AAA rupture be confused with upon presentation ?
renal or ureteric colic
what are the two types of mesenteric vascular diseases ?
acute mesenteric ischemia
chronic mesenteric ischemia
where do most emboli lodge in cases of acute mesenteric ischemia ?
superior mesenteric artery
what are the causes of non occlusive mesenteric ischemia ?
usually due to hypotension secondary to CHF, MI orr sepsiss
what are the causes of mesenteric venous thrombosis?
hypercoagulability
portal hypertension
infection
paraneoplastic
pancreatitis
decompression sickness
what is the presentation of acute mesenteric ischemia ?
1- abrupt severe abdominal pain
2- urgent need to have a bowel movement
3- fever
4- nausea and vomitingw
what are the expected lab findings in acute mesenteric ischemia ?
raised WCC and lactate
what is the presentation of chronic mesenteric ischemia ?
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
what is the investigation of choice for chronic mesenteric ischemia ?
CTA
what is the treatment for mesenteric ischemia ?
revascularization
resection of the non viable bowel
what is the difference in presentation between patients with contained hematomas and patient with free intraperitoneal haemorrhage ?
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
what does the term black bowel refer to ?
occlusion of the proximal superior mesenteric artery
what are the 4 zones associated with major abdominal vascular injuries ?
zone 1: midline retroperitoneum
zone 2: upper lateral retroperitoneum
zone 3: pelvic retroperitoneum or the portal retrohepatic area
what are the predictors of expansion in AAA ?
hypertension
COPD
what are the indications for repair of an AAA?
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
what type of repair is preferred in high risk patients with an AAA?
EVAR
which type of mesenteric ischemia may present with bloody diarrhea ?
non occlusive and mesenteric venous ischemia
what is the treatment for embolic, thrombotic, non occlusive and venous mesenteric ischemia ?
embolic - embolectomy
thrombotic - thrombolectomy
non occlusive - volume resus and then nitroglycerin
venous - administration of heparin
what is the treatment for chronic mesenteric ischemia ?
PTA and stent , bypass if that fails
