Assesment of Abdominal Pain and management of AAA

Question 1

What is seen in rebound tenderness?

Answer 1

You push in on the painful area then let go.

Question 2

what are causes of central abdo pain?

Answer 2

Early appendicitis, small bowel obstruction. acute gastritis, ruptured AAA, mesenteric thrombosis

Question 3

what are causes of epigastric pain?

Answer 3

Oesophagitis, acute pancreatitis, AAA

Question 4

what are causes of right upper quadrant pain?

Answer 4

Gallbladder disease
Acute pancreatitis
Pneumonia
Subphrenic abscess

Question 5

what are causes of left upper quadrant pain?

Answer 5

Pneumonia
Acute pancreatitis
Spontaneous Splenic rupture
Subphrenic abscess

Question 6

what are causes of suprapubic pain?

Answer 6

Acute urinary retention
UTI's
Cystitis
Ectopic pregnancy
Diverticulitis

Question 7

what are causes of right iliac fossa pain?

Answer 7

Acute appendicitis, mesenteric adenitis, diverticulitis, ureteric colic, meckels diverticulum, ectopic pregnancy, crohns

Question 8

A cause of right iliac fossa pain is salpingitis what is this?

Answer 8

Inflammation of the fallopian tubes

Question 9

what are causes of loin pain?

Answer 9

Muscle strain, UTI, renal stone, AAA

Question 10

what are causes of left iliac fossa pain?

Answer 10

Diverticulitis, Constipation, IBS, PID, ectopic

Question 11

what is the definition of an aneurysm?

Answer 11

An arterial aneurysm is defined by an increased vessel diameter of 50% or more than that of the non dilated adjacent vessel

Question 12

What is the normal threshold for repair of an AAA?

Answer 12

5.5cm

Question 13

What are risk factors for AAA?

Answer 13

• age over 75
• family history
• gender (male)
• smoking
• hypertension
• Caucasian
• hyperlipidaemia
• genetics

Question 14

what are the four stages in the pathogenesis of AAA?

Answer 14

Trigger
Cellular migration
Inflammatory Infiltrate
Collagen degradation

Question 15

What are triggers of AAA?

Answer 15

a genetic predisposition

local haemodynamic stress

Question 16

What happens in cellular migration in the formation of AAA?

Answer 16

Macrophages
Neutrophils
T and B cells

Question 17

whats happens in the inflammatory infiltrate stage of AAA formation??

Answer 17

Increased chemokines and free radicals

Increased MMP activity

Question 18

What happens in the collagen degradation stage of AAA?

Answer 18

Weakening of the tunica media

Aneurysmal dilatation

Question 19

what did the UK small aneurysm trial 1998 find?

Answer 19

No difference in survival if operating on AAA under 5.5cm but a lower threshold in women

Question 20

what did the MASS trial find?

Answer 20

Reduction in AAA related death in males that are screened

Question 21

what are the symptoms for an AAA?

Answer 21

Often none

Abdominal, back and loin pain

Question 22

what are clinical signs of AAA?

Answer 22

pulsatile, expansile abdominal mass

Associated femoral and popliteal aneurysms

Question 23

what are the prognosis differences for anterior and posterior ruptured AAA?

Answer 23

Posterior has a better prognosis as it ruptures into the retroperitoneum
Anterior has breached the peritoneum so can bleed longer

Question 24

what is the immediate management for a ruptured AAA?

Answer 24

• supplemental oxygen
• cross match bloods
• imaging

Question 25

what are disadvantages of open repair for AAA?

Answer 25

Double end clamping means end organ damage

Massive blood loss

Question 26

What is EVAR?

Answer 26

new treatment for ruptured AAA repair; endovascular aneurysm repair that avoids aortic clamping and laparotomy.