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Cardiovascular > Albert Smith - AAA > Flashcards

Albert Smith - AAA Flashcards

1
Q

What does MEDIICAATION stand for and what does it relate to?

A

When trying to reach a diagnosis

Metabolic
Endocrine
Degenerative
Inflammatory-Infection
Congenital
Age related
Alcohol-Toxic
Injury-trauma
Oncological
Neoplastic
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2
Q

DDx of generalized abdominal pain

A
  1. Perforation
  2. AAA
  3. Acute Pancreatitis
  4. Diabetes mellitus
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3
Q

DDx of central abdominal pain

A
  1. Early appendicitis
  2. Subacute Obstruction
  3. Acute gastritis
  4. Acute pancreatitis
  5. Ruptured AAA
  6. Mesenteric
    thrombosis (Mesenteric venous thrombosis (MVT) is a blood clot in one or more of the major veins that drain blood from the intestine)
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4
Q

DDx of epigastric pain

A
  1. Peptic Ulceration DU /GU / Oesophagitis
  2. Biliary Colic
  3. Acute pancreatitis
  4. AAA
  5. Myocardial Infarction (inferior)
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5
Q

DDx of RUQ pain

A
  1. Gallbladder disease
  2. Duodenal Ulcer
  3. Acute pancreatitis
  4. Pneumonia
  5. Subphrenic abscess
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6
Q

DDx of LUQ pain

A
  1. Gastric Ulcer
  2. Pneumonia
  3. Acute pancreatitis
  4. Spontaneous splenic
    rupture
  5. Subphrenic abscess
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7
Q

DDx of suprapubic pain

A
  1. Acute urinary retention
  2. UTIs
  3. Cystitis
  4. PID
  5. Ectopic pregnancy
  6. Diverticulitis
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8
Q

DDx of RIF pain

A
  1. Acute appendicitis
  2. Mesenteric adenitis (young)
  3. Perf DU
  4. Diverticulitis
  5. PID
    6.Salpingitis
  6. Ureteric colic
  7. Meckel’s diverticulum
  8. Ectopic pregnancy
    • Crohn’s disease
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9
Q

DDx of loin pain

A
  1. Muscle strain
  2. UTIs
  3. Renal stones
  4. Pyelonephritis
  5. AAA
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10
Q

DDx of LIF pain

A
  1. Diverticulitis
  2. Constipation
  3. Irritable Bowel Syndrome
  4. Pelvic Inflammatory
    Disease
  5. Rectal Carcinoma
  6. Ulcerative Colitis
  7. Ectopic pregnancy
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11
Q

Abdominal pain investigation options

A
  1. Pregnancy test
  2. Urine dipstick
  3. Plain film (free air, obstruction, air-fluid, foreign bodies)
  4. Ultrasound (role in trauma)
  5. CT
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12
Q

Mx steps for abdominal pain

A

1.ABC’
2. Supplemental oxygen
3. IV access
4. Fluid administration
5. Antiemetics
6. Analgesics
7. Urinary catheterisation
8. Antibiotics
9. Radiology…
10. Re-evaluation with results (Barium Meal, Blood
tests, Arterial Blood Gasses, ECG, radiology)

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13
Q

Risk factors for AAA

A
  1. ↑ Age
  2. Male sex (x 4-8)
  3. Smoking (x 6)
  4. Family history (x 4)
  5. Vascular disease
  6. Hypertension
  7. Hypercholesterolaemia
  8. • Ethnicity
    • 50% decreased risk in black men
    • 90% decreased risk in Asian men
  9. Genetic disorders: lysil oxidase deficiency
  10. Connective tissue disorders
    • Marfan, Ehlers Danlos
  11. Infective (Mycotic and inflammatory causes)
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14
Q

Protective factors of AAA

A
  1. Blacks and hispanics
  2. Diabetes
  3. Exercise 1 p/w
  4. Fruit, veg and nuts
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15
Q

Disease LOB Marfaans

A

Genetic disorder of connective tissue – tall with long
limbs and long thin fingers
• Autosomal dominant inheritance – Gene FBN1 which
encodes connective protein fibrillin – 1
• Varying penetrance – heart valves, aorta, lungs, eyes,
dura, skeleton, hard palate.
• Fibrillin 1
– A connective protein
– B binds transfroming growth factor beta (TGF-β).
TGF-β has deleterious effects on vascular smooth muscle
development and the integrity of extracellular matrix. Thus
excessive TGF-β weakens the tissues and causes Marfan’s

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16
Q

Disease LOB Ehlers-Danlos syndrome

A

Group of inherited connective tissue disorders
caused by a defect in the synthesis of type V collagen.
• Typically affects joints, skin and blood vessels.
- Symptoms may include loose joints, stretchy skin,, poor wound healing and abnormal scar formation.
- These can be noticed at birth or in early childhood.
- Complications may include aortic dissection, joint dislocations, scoliosis, chronic pain, or early osteoarthritis.

17
Q

Pathophysiology of atherosclerosis

A

See notebook

18
Q

SS of AAA

A
  1. Abdominal pain, back pain, loin pain
  2. Pulsatile, expansile abdominal mass
  3. 25% have associated femoral or popliteal aneurysms
  4. <4cm AAA; clinical examination sensitivity 0.57
  5. > 5cm AAA; clinical examination sensitivity 0.98
19
Q

Risk of AAA rupture per by size

A 
– 4 cm.: 1 % / year
– 5 cm.: 4 %/ year
– 6 cm.: 10 % / year
– 7 cm.: 20 % / year
– 8 cm.: 40% / year
– 10cm.: 100% / year
20
Q

Most frequent misdiagnosis of AAA

A
  1. Renal bleed
  2. GI bleed
  3. Diverticulitis
  4. Back pain
  5. MI
  6. Motor vehicle accident
  7. Sepsis
21
Q

AAA disease LOB

A

See notebook

22
Q

open surgery or EVAR

A

SEE SLIDE 54 OF mX OF aaa LECTURE (PANOS)

23
Q

Disadvantages of open repair

A

Clamping the aorta
• End-organ ischaemia
• Increased SVR (increased pre-load and after-load)
• Reperfusion injury (mediated by inflammatory cytokines)
Massive blood loss
• Transfusion-related coagulopathy

24
Q

Advantages of EVAR

A
  • Avoids laparotomy

* Avoids aortic clamping

25
Q

Disadvantages of EVAR

A
  • Wire trauma/access problems
  • Endoleak
  • Graft migration
  • Graft kinking/occlusion
26
Q

What are the distal branches of the abdominal aorta and what do they supply?

A

Abdo aorta splits into common iliac arteries which split into ext and int. iliac arteries

Int. iliac supplies pelvis
Ext. iliac continues downward to supply the leg and becomes the femoral artery

27
Q

Which parameters indicate that the fluid challenge has been successful (i.e. the patient responds positively to fluid)

A

Heart rate decreases

Mean arterial pressure increases

Arterial pulse pressure increases

Urine output increases

Lactate clearance increases

Cardiac output or stroke volume increase

28
Q

When is it indicated to give blood glucose?

A

if < 3 mmol l-1 give glucose

29
Q

What is the significance of urine output in the sick patient?

A

Urine output is one of the few signs of end-organ
perfusion

In a sick patient catheterisation should be considered to
allow measurement (and documentation) of hourly urine
volume The weight is essential to get an accurate urine
output.

30
Q

What is the difference between cholangitis and cholecyctitis?

A

Cholangitis: infection of the biliary tree, usually arising form a combination of biliary obstruction and presence of bacteria
Cholecystitis: inflammation of the gallbladder, which results from obstruction of the cystic duct by gallstones in 90% of cases

Clinical features:

Cholangitis: Classic triad of fever (>90%), jaundice (65%) and RUQ pain (>40%), although all three occur in <20% of cases.

Cholecystitis: Most have prior history of biliary colic (. Fever, nausea, vomiting often present, RUQ pain/guarding, palpable galbladder in 30% of cases. Jaundice suggests choledocholithasis or Mirizzi’s syndrome (see defs below)

31
Q

What is biliary colic?

A

Biliary colic, also known as a gallbladder attack or gallstone attack, is when pain occurs due to a gallstone temporarily blocking the bile duct. Typically, the pain is in the right upper part of the abdomen, and it can radiate to the shoulder. Pain usually lasts from one to a few hours.

32
Q

Why is the sigmoid colon at highest risk of developing diverticula?

A

Sigmoid colon has the thinnest diameter therefore according the law of La Place it is subject to increase pressure (pressure is inversely proportional to diameter)

33
Q

Difference between diverticulosis and diverticulitits

A

Divertituclosis is outpuching of the colon without inflammation whereas diverticulsis in an inflamed diverticulosis

  • Diverticulosis may involve weaking of the vessel within the outpuching and can lead to painless bleeding however diverticulitis does not lead to bleeding as the vessel wall is scarred
34
Q

Outline a serious potential complication of diverticulosis

A

Vesicocolonic fistula - rupture of the diverticulosis causes a fistula to be formed in nearby strucutre e.g. the bladder

The leads to fecal matter in the urine - nicht gut

35
Q

What are the features of mesenteric adentitis

A
  • Usually preceded by viral or bacterial infection
  • Diffuse abdo pain > RIF pain
  • Can be indistinguishable from appendicitits
  • Children > adults
  • Precded by URT infection
36
Q

What is Meckels Diverticulaum

A

Diverticulum of all layers of the intestinal wall - mucosa, submucosa, muscularis and serosa

As opposed to false diverticula which is just outpuching of the mucosa and submucosa

Congenital remnant of the vetelline

2% population
2 feet from ileocecal valve
2 inches in length
2 x males most likely affect

Cardiovascular (1 decks)

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