Aneurysms

Question 1

AAA Definition

Answer 1

When there is a permanent dilation of the artery to twice the normal diameter. Bigger than 3cm.
– urgent referral if its bigger than 5.5cm

– normal 1.5cm in women and 1.7cm in men

Defined as true or false

True- the arterial wall forms the wall of the aneurysm
False- goes through all 3 layers, where the surrounding tissues form the wall of the aneurysm

Question 2

AAA Causes

Answer 2

Almost all are caused by aortic atherosclerosis

Can be caused by high blood pressure

Blood vessel diseases where the blood vessels become inflamed

Can also be caused by infection or trauma

Salmonella infection
– salmonella bacteria travels to the intestine where they begin life cycle, in severe cases bacteria break through into the bloodstream and can be deadly

Syphylis

marfans syndrome (as it weakens the connective tissue)

Question 3

Epidemiology

Answer 3

Incidence reported to be 3-8%

Mortality of a ruptured AAA is around 50%

Incidence increases with age

Men 5x more likely

Age- peak incidence age 75 (starts usually in 50s)

Question 4

Pathophysiology

Answer 4

Proteolytic enzymes weaken the media of the aorta, leading to aneurysmal change

Increased level of matrix metalloproteinases have been found in aneurysmal aortas. These enzymes are known to degrade elastin.

Question 5

Risk factors

Answer 5

Men affected significantly more and at a younger age

Increased age

Smoking

Hypertension

Family history

Existing cardiovascular disease

connective tissue disease (Marfan’s syndrome)

1st degree relative (25% of cases)

Popilteal arteries co existence with AAA’s (25-50% of cases)

Question 6

Clinical presentation

Answer 6

Unruptured aneurysms are most often asymptomatic but may cause lower back or abdominal pain. Most are discovered incidentally on abdominal examination or imagine.

Ruptured AAA:
– medical emergency and present with severe epigastric or abdominal pain that may radiate to the back or the groin and shock.
– causes life-threatening bleeding into the abdominal cavity
—- should be instantly referred if suspected AAA rupture and should go straight into surgery, if the patient is haemodynamically unstable.

– hypotension, tachycardia, profound anaemia and sudden death may also be caused
– collapse
– loss of consciousness
– risk of rupture increase with the diameter:
—- 5% for a 5cm aneurysm
—- 40% for an 8cm aneurysm

Unruptured AAA’s:
– most often asymptomatic
– if enlarged may notice:
—- deep constant pain in the belly or side of the belly
—- back pain
—- a pulse near the belly button
—- can be felt as a pulsatile and expansile mass when palpating umbilical area with both hands

– syncope (30%)
– vomiting (22%)
—- if abdominal pain, back pain, vomiting and syncope are progressive, should alert for an imminent rupture

– possible lower limb intermittent claudication

– may mimic symptoms of:
—- renal colic, diverticulitis and severe abdominal or testicular pain

Signs:
– may have ‘trash fee’- dusky discolouration of the digits, secondary to emboli from aortic thrombus

Extras:
– people who have popliteal artery aneurysms (25-50% of them) have AAA’s

Question 7

Classification of AAA

Answer 7

Normal- >3cm
Small aneurysm- 3-4.4cm
Medium aneurysm- 4.5-5.4cm
Large aneurysm- >5.5cm

Question 8

Other common arteries aneurysms occur in

Answer 8

Iliac artery, popliteal artery, femoral arteries and thoracic aorta

Question 9

Types of aneurysms

Answer 9

Atherosclerotic

Dissecting

Berry- small red one that’s the most common aneurysm in the brain

Capillary micro aneurysm

Syphylitic

Mycotic

Question 10

DDX

Answer 10

IBD
IBS
GORD