aneurysms

Question 1

aneurysm

Answer 1

localized dilation or outpouching of vessel wall -> true
often coincide with uncontrolled htn: cause BV dilation, wall weakens and bursts

Question 2

patho

Answer 2

htn causes constant P which weakens arterial wall, increased development of bulges in arterial walls (aneurysms), aneurysms cause turbulent blood flow and are susceptible to rupture, bruits (swish) may be heard over
most common spots: aorta and cerebral arteries

Question 3

rf

Answer 3

causes that damage BV
atherosclerosis, htn, diseases of BV, trauma, tobacco use, age (>65)
hereditary component

Question 4

types

Answer 4

can view with agiogram
aortic (abd, thoracic, dissecting)
cerebral
false (pseudoaneurysm)
saccular, berry, fusiform

Question 5

saccular

Answer 5

balloon shaped, wide neck, only 1 part of circumference, 1 side

Question 6

saccular: berry

Answer 6

subtype of saccular
small neck, at bifurcaition -> commonly the circle of willis
dx by angiography, hx and cm

Question 7

saccular: berry - tm

Answer 7

medical control of htn and vasospasms, sx drain, clipping (clip across pouch), coiling (prevent outpouch, fill in?)
can be fatal if rupture in brain

Question 8

circle of willis

Answer 8

connect anterior and posterior circulation at base of brain, articles that branch off here supply a lot of blood to brain

Question 9

fusiform

Answer 9

entire circumference of vessel, gradual/progressive dilation, potentially extensive involvement
monitor, intervention may not be required until it reaches certain size
usually r/t diffuse anterior sclerotic change

Question 10

false (pseudo)

Answer 10

localized dissection or tear in inner artery wall (not all 3 layers), type of hematoma, complication of vascular interventional procedures (leakage btw graft and natural artery)
may heal on own or require intervention

Question 11

abd aortic aneurysm

Answer 11

AAA
auscultate bruit
pulsatile mass during insepction or light palpation -> no deep palpation until AAA ruled out d/t r/o rupture
cm depend on location -> may have none
complication -> rupture!, largest vessel, lots of P, bleed out V quickly

Question 12

dissecting aneurysm (aortic)

Answer 12

layers of wall of artery separated and blood enters region
can be medical emergency, can rupture
aneurysm can increase r/o aortic dissection -> weak wall can continue to tear -> dissection
dx via CT or MRA (MRI with angiogram)
emergency pharm: BB (decrease HR and BP to decrease tearing) and nitrates but sx most important

Question 13

dissecting aneurysm (aortic) - cm

Answer 13

differ from aneurysm which may have no cm
sudden severe, tearing pain -> chest!, neck, back, jaw, abd
early = increased bp
late = bp may be unobtainable, syncope, hemiplagia (cant feel L or R side), paralysis of LE
CV collapse -> shock -> death
need sx intervention, minutes count!