Aortic Aneurysm

Question 1

What is an aortic aneurysm?

Answer 1

full-thickness dilation of a segment of blood vessel (more than 50% normal diameter and weakness in blood vessel wall)

Question 2

What is the most common type of aortic aneurysm?

Answer 2

AAA

Question 3

What is an AAA?

Answer 3

a localised enlargement of the abdominal aorta where the diameter is >3cm or >50% larger than normal diameter

Question 4

What are RF for aortic aneurysms?

Answer 4

1. Large diameter
2. Rapid expansion
3. Current smoking
4. Recent MI
5. History of sepsis
6. Male
7. Connective tissue disorder
8. Old age
9. Inflammatory disorder
10. Hypertension

Question 5

What is an unruptured AAA?

Answer 5

> 3cm across

Question 6

What is patho of AAA?

Answer 6

Cause is degeneration of elastic lamella and smooth muscle loss and genetics

Question 7

What should be done if 5.5cm or expanding more than 1cm a year or symptomatic aneurysms?

Answer 7

elective surgery and stenting EVAR

Question 8

What are symptoms of a proximal AAA?

Answer 8

upper abdominal pain or back pain

Question 9

What are symptoms of a distal AAA?

Answer 9

lower abdominal or pelvic pain

Question 10

What are the symptoms of an unruptured aneurysm?

Answer 10

1. indolent onset of pain + vague and nonspecific

2. pain in back, abdomen or groin

Question 11

What are symptoms of a ruptrued aneurysm?

Answer 11

sudden onset severe pain

Question 12

What is the classic triad for an aortic aneurysm?

Answer 12

1. Acute pain
2. Pulsatile abdominal mass
3. Hypotension

Question 13

What are signs of haemodynamic compensation?

Answer 13

1. Tachycardia
2. Peripheral cyanosis
3. Mottling

Question 14

What are vague symptoms in aortic aneurysm?

Answer 14

1. Pain in back, flank, pelvis or hip (lower back and abdomen)
2. Nausea and vomiting
3. Syncope

Question 15

What are causes of an aortic aneurysm?

Answer 15

1. Trauma
2. Atheroma
3. Infection
4. Connective tissue disorder
5. Inflammatory

Question 16

What are the common sites for an aortic aneurysm?

Answer 16

1. Aorta
2. Iliac
3. Femoral
4. Poplitieal arteries

Question 17

What are the signs for all AAA?

Answer 17

1. Pulsatile, laterally expansile mass on palpation
2. Abdominal bruit
3. Grey-Turners sign (ruptured)

Question 18

What happens if rupture into peritoneal cavity?

Answer 18

sudden cardiovascular collapse and death

Question 19

What happens if rupture into retroperitoneal space?

Answer 19

may stabilize temporarily, massive haemorrhaging and then shock and death

Question 20

What is the diagnosis for AA?

Answer 20

• dilation with transverse diameter exceeding 3cm

- Incidental finding + one time screening

Question 21

What imaging is done for AAA?

Answer 21

1. ECG
2. Abdominal US
3. CT angiogram
4. Magnetic resonance angiogram

Question 22

What would abdominal US show?

Answer 22

Gold standard: can detect presence of AAA but not if ruptured yet

Question 23

What would CT angiogram show?

Answer 23

can detect whether AAA has ruptured

Question 24

What would magnetic resonance angiogram show?

Answer 24

detect whether AAA has rupture: if patient has contrast allergy or renal impairment

Question 25

What bloods are done in AA?

Answer 25

1. Amylase
2. Hb
3. Crossmatch
4. FBC
5. Clotting screen
6. U+Es
7. LFTs

Question 26

What is the management for AAA?

Answer 26

1. IV access, keep systolic over 100
2. Prophylactic antibiotics
3. Surgery for clamping aorta above leak and inserting dacron graft

Question 27

Is there screening for AAA?

Answer 27

All males over 65 screened in UK for AAA

Question 28

What is the prognosis for AAA?

Answer 28

Ruptured AAA: morality in treated is 41% and untreated around 100%

Question 29

What are true anurysms?

Answer 29

-saccular
-fusiform
(goes into intima)

Question 30

Where do most AAA occur?

Answer 30

90% below renal arteries