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STEP 2 Cardio + Renal > Aortic aneurysm (AAA and TAA) 09-x (1) > Flashcards

Aortic aneurysm (AAA and TAA) 09-x (1) Flashcards

1
Q

AAA. 7 risk factors?

A

Age >60 years
Cigarette smoking
Male sex

History of atherosclerosis or connective tissue disease
HTN
Family history of AAA
white race

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2
Q

AAA. whats about initial symptoms?

A

Patients are typically asymptomatic until the aorta rapidly expands or ruptures:

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3
Q

AAA. Aorta rapidly expands. Symptoms? 2

A

Rapid expansion:

Dull abdominal/back pain
Distal embolization

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4
Q

AAA. Aorta ruptures. when delayed HD instability?

A

If the bleeding is in retroperitoneum

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5
Q

AAA. Aorta ruptures. when rapid onset HD instability?

A

Rapid onset hemodynamic instability and shock if bleeding is in peritoneum:

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6
Q

AAA. Aorta ruptures. Rapid onset. 5 symptoms?

A
  • Severe abdominal/back pain (left costovertebral angle tenderness may be present)
  • Pulsatile abdominal mass at the umbilicus
  • Umbilical or flank hematoma
  • Shock
  • Peripheral pulses are decreased
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7
Q

AAA. Management? 4

A

Smoking cessation
Elective repair for size > 5,5 cm (asymptomatic)
Urgent repair for symptomatic and HD stable patients
Emergency repair for symptomatic and HD unstable patients

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8
Q

AAA. management for HD stable?

A

Urgent repair for symptomatic and HD stable patients

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9
Q

AAA. management for HD unstable?

A

Emergency repair for symptomatic and HD unstable patients

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10
Q

AAA. management for asymptomatic?

A

Elective repair for size > 5,5 cm (asymptomatic)

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11
Q

AAA. what increases risk of rupture?

A

a. Large aneurysm diameter (>5.5 cm)
b. Aortic expansion rate >0.5 cm in 6 months or >1 cm in 1 year
c. Current ongoing smoking. It increases risk probably because of degeneration of connective tissue in the aortic wall
d. Female gender
e. Hypertension. It has a weak association with AAA (in contrast to thoracic aortic aneurysm where hypertension has the greatest overall risk for dissection)

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12
Q

AAA. what increases risk of rupture. size?

A

Large aneurysm diameter (>5.5 cm)

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13
Q

AAA. what increases risk of rupture. expansion rate?

A

Aortic expansion rate >0.5 cm in 6 months or >1 cm in 1 year

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14
Q

AAA. what increases risk of rupture. smoking, why?

A

Current ongoing smoking. It increases risk probably because of degeneration of connective tissue in the aortic wall

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15
Q

AAA. whats about DM?

A

AAA progression and development in patients with diabetes is lower than in those without diabetes.

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16
Q

AAA. complication?

A

Aortocaval fistula

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17
Q

AAA. complication Aortocaval fistula. heart?

A

Leads to venous congestion and high-output cardiac failure

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18
Q

AAA. complication Aortocaval fistula. kidney?

A

Can also lead to venous congestion of bladder, leading to hematuria that is misdiagnosed as nephrolithiasis

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19
Q

AAA. CT findings? 2

A

Pulsatile abdominal mass, prevertebral aortic calcifications

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20
Q

AAA. HD stable diagnosis?

A

CT scan

21
Q

AAA. Treatment - surgical. indications for operative or endovascular repair?

A
  1. Aneurysm size >5.5 cm
  2. Rapid rate of aneurysm expansion i.e. more that 0,5 cm in 6months or >1 cm in year
  3. Presence of symptoms (abdominal, back, or flank pain; limb ischemia) regardless of aneurysm
22
Q

AAA. HD unstable diagnosis? 2

A

Known history of aneurysm –> surgery
No prior history of aneurysm –> focused abdominal ultrasound

23
Q

AAA. Treatment - surgical. what aneurysm size?

A

Aneurysm size >5.5 cm

24
Q

AAA. Treatment - surgical. what aneurysm expansion?

A

Rapid rate of aneurysm expansion i.e. more that 0,5 cm in 6months or >1 cm in year

25
Q

AAA. Treatment - surgical. what symptoms says we need surgery?

A

Presence of symptoms (abdominal, back, or flank pain; limb ischemia) regardless of aneurysm size

26
Q

AAA. Screening? sex, age, risk factor?

A

MALES, age 65-75

If they have ANY prior history of smoking (ie, any lifetime exposure of >100 cigarettes)

27
Q

AAA. Screening method?

A

One-time abdominal duplex ultrasound (duplex = UG + doppler (colorful)).

28
Q

AAA. screening - in what other population also may be done?

A

Screening may also be done in patients with age 65-75 with no smoking history if they have other significant risk factors (eg, first-degree family history of AAA rupture)

29
Q

AAA unstable. Algorithm. Symptoms suggesting unstable AAA?

A

Abdominal/flank/groin pain
Pulsatile mass
flank ecchymosis
limb ischemia

—–> ITS HD INSTABILITY

NOTE: abdominal bruit is RENAL ARTERY STENOSIS OR FIBROMUSCULAR DYSPLASIA.

30
Q

AAA unstable. Algorithm.
HD stable –> whats next?

A

CT of abdomen

31
Q

AAA unstable. Algorithm.
HD stable –> CT aneurisma detected –> whats next? if yes and no

A

Yes - medical optimization or repair

No - explore other diagnoses

32
Q

AAA unstable. Algorithm.
HD unstable –> whats next?

A

evaluate if patients has KNOWN AAA.

33
Q

AAA unstable. Algorithm.
HD unstable –> has known AAA –>?

A

Emergency repair

34
Q

AAA unstable. Algorithm.
HD unstable –> does not have known AAA –>?

A

Obtain focused abdominal UG

35
Q

AAA unstable. Algorithm.
HD unstable –> does not have known AAA –> aneurysm detected on UG –> ?
and what to do if not detected?

A

Emergency repair

Not detected –> explore other diagnoses

36
Q

TAA. which part of aorta usually involves?

A

Most TAAs (60%) involve ascending aorta (between the aortic valve and the brachiocephalic artery)

A minority of aneurysms involve the descending aorta (distal to the left subclavian artery)

37
Q

TAA. what is ascending aorta?

A

between the aortic valve and the brachiocephalic artery

38
Q

TAA. what is descending aorta?

A

distal to the left subclavian artery

39
Q

TAA. most common etiology? what risk factors?
what mechanism?

A

Age-related degenerative changes (more common).
Risk factors including dyslipidemia, hypertension, tobacco use, and family history.

Leads to disruption of aortic wall medial layer with loss of elasticity  aortic dilation

40
Q

TAA. connective tissue?

A

Connective tissue disease (eg, Marfan or Ehlers-Danlos syndrome)

41
Q

TAA. infection?

A

Endarteritis of vasa vasorum due to tertiary syphilis

42
Q

TAA. initial symptoms?

A

Mostly asymptomatic until discovery is made incidentally

43
Q

TAA what pain?

A

Vague chest/back pain

44
Q

TAA. compression? 4

A

Hoarseness (left recurrent laryngeal nerve or vagus nerve)

hemidiaphragmatic paralysis (phrenic nerve),

dysphagia (esophagus),

respiratory manifestations, including wheeze, cough, hemoptysis, and dyspnea (tracheobronchial obstruction).

45
Q

TAA. rupture symptoms?

A

Rupture: severe pain, hemodynamic instability

46
Q

TAA. diagnostic methods? 2

A

Chest X-ray: Widened mediastinum; Enlarged aortic knob; tracheal deviation

CT scan with contrast (diagnostic)

47
Q

TAA differential?

A

Differentials:

Hilar/mediastinal lymphadenopathy. Enlarged lymph nodes appear as opacities that are discrete from the heart borders

Xray - hilar limphadenopathy on both sides + mediastinal widening.

48
Q

TAA: x ray - what seen?3

A

Widened mediastinum; Enlarged aortic knob; tracheal deviation

49
Q

TAA. instrumental diagnostic?

A

CT scan with contrast (diagnostic)

STEP 2 Cardio + Renal (35 decks)

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