Aortic Aneurysm

Question 1

What does AAA stand for?

Answer 1

• Abdominal aortic aneurysm

Question 2

When is a swelling of the aorta categorised as an AAA?

Answer 2

• When maximal external diameter exceeds 3cm OR- When there is a 50% increase in vessel diameter above the norm

Question 3

What does a fusiform aneurysm mean?

Answer 3

• Spindle shaped (symmetrical)

Question 4

What does a saccular aneurysm mean?

Answer 4

• Pouch shaped (asymmetrical)

Question 5

What percentage of AAA’s are infra-renal?

Answer 5

• 95%

Question 6

What are true aneurysms?

Answer 6

• Aneurysms that consist of all 3 tunica layers bulging

Question 7

What are false aneurysms?

Answer 7

• When the blood is contained by the thin adventitia layer OR- Contained by surrounding soft tissue in a haemotoma

Question 8

What conditions can cause AAA’s earlier in life?

Answer 8

• Marfans - Ehlers danlos syndrome

Question 9

What is an asymptomatic AAA?

Answer 9

• When it is discovered on examination and has no other symptoms

Question 10

What is an emergency AAA?

Answer 10

• Impending/actual rupture - High mortality

Question 11

What is an unusual presenting AAA?

Answer 11

• Aortic occlusion- Distal embolism- Uretic occlusion - Aortocaval fistula - Aortoenteric fistula - Duodenal obstruction All traced back to the AAA

Question 12

Besides occasional asymptomatic ones, what are the common symptoms of an established AAA?

Answer 12

• Dyspnoea - Dysphagia - Hoarseness - Sharp chest pain radiating to back between shoulder blades- Dissection

Question 13

What are the signs of an AAA?

Answer 13

• Low BP - Heart failure

Question 14

What are the symptoms of an emergency AAA?

Answer 14

• Sudden onset of severe central/lumbar pain - Dull back ache later - Hypoveolaemic shock

Question 15

What is hypovolaemic shock?

Answer 15

-Blood/fluid loss leading to organ failure

Question 16

Who is most susceptible to an AAA?

Answer 16

• Elderly - Male - Smoker w/ wo/ COPD- HBP - Peripheral vascular disease - Ischaemic HD

Question 17

What new symptom in those over 60 should be assumed as result of AAA?

Answer 17

• New onset renal colic pain

Question 18

What genetic aspects are important in calculating patient risk of AAA?

Answer 18

• 1st degree male relatives with it

Question 19

What non-genetic causes are linked to AAA development?

Answer 19

• Weakening of vessel wall - Hypertension

Question 20

What congenital issues can lead to AAA?

Answer 20

• Bicuspid aortic valve - Marfan’s syndrome - Coarctation

Question 21

What can a biscupid aortic valve cause?

Answer 21

• Stenosis or regurgitation - Is associated with coarctation and then aneurysm

Question 22

What are the 3 developmental coarctations that can cause shunt if not closed?

Answer 22

• Ductus arteriosus - Foramen ovale - Ductus venosus

Question 23

How does the ductus arteriosus cause coarctation of the aorta?

Answer 23

• When it closes the smooth muscles contracts on the aorta resulting in coarctation

Question 24

What are the signs of coarctation of the aorta?

Answer 24

• Cold legs - Poor leg pulses - Radiofemoral delay - Heart failure - Failure to thrive - Hypertension

Question 25

On presentation and suspected AAA what are the pre operative investigations?

Answer 25

• Routine bloods - ECG - Echocardiogram- Cardiac perfusion scan - CXR - Pulmonary function tests - CT of abdomen

Question 26

What is the management and treatment of a ruptured AAA?

Answer 26

• First diagnosis - CXR - Ultrasound CT scan if CXR obscured - Coagulation screen - FBC - U’s and E’s- Explorative

Question 27

What are U’s and E’s?

Answer 27

• Urea and electrolytes

Question 28

Following a rupture, what risk factor treatment should be implemented?

Answer 28

• Aspirin/clopidogrel - Statin - Anti-hypertensives- Smoking cessation