Pathology

Question 0

What does it mean if the SMA goes straight up instead of its normal parallel to the aorta?

Answer 0

Could have a lymphatic mass; they cluster around the great vessels

Question 1

When scanning the aorta, which sections are focused on?

Answer 1

Long & transverse

Prox, mid, distal

Question 2

Most are ______ aneurysms and involve all ______ layers.

Answer 2

True; three

Question 3

What percent of AAA are infrarenal?

Answer 3

95%

Question 4

What does infrarenal mean?

Answer 4

Below the renal arteries

Question 5

How do you measure the aorta in long?

Answer 5

Anteroposterior (AP)

Question 6

What is common in larger aneurysms?

Answer 6

Mural thrombus

Question 7

Tortuosity and folding in an aneurysm is called what?

Answer 7

Atherosclerosis; plaque build up

Question 8

What results when there is an infection in the aorta?

Answer 8

Mycotic aneurysm (mycosis)

Question 9

At what size is surgery on an aneurysm considered?

Answer 9

Greater than 5 cm

Question 10

What results when trauma occurs to the aorta?

Answer 10

Aortic pseudoaneurysm

Question 11

What is an AAA?

Answer 11

Permanent localized abnormal dilation of any vessel

Question 12

What is aortic ectasia?

Answer 12

Characterized by aortic root dilation associated with HTN and aging
Resulting in aortic regurgitation

Question 13

At what size is an abnormality considered a AAA?

Answer 13

Increase in diameter of greater than 1.5 times the normal

Question 14

What is the normal diameter of the aorta?

Answer 14

Less than 3 cm
Tapers as you go distal
Dependent on age, gender, blood pressure

Question 15

How are AAA usually found?

Answer 15

Physical exam by palpating a pulsatile mass or by an ABD bruit

Question 16

Where are most AAA found?

Answer 16

Infrarenal; below the renal arteries

Question 17

What are 11 AAA risk factors?

Answer 17

Over age 60 Smoke
HTN Vascular disease
COPD Family history
Diabetes Congenital
Trauma/inflammation Syphilis
Plaque build up - atherosclerosis

Question 18

What is Marfan’s syndrome?

Answer 18

Autosomal dominant connective tissue disorder

May be diagnosed at birth or not recognized till later in life

Question 19

What causes AAA?

Answer 19

Inflammation of media and adventitia
Increased pressure
Abnormal volume load

Question 20

For AAA, what are examples of inflammation of media and adventitia?

Answer 20

Rheumatic fever, polychondritis, ankylosing spondylitis

Question 21

For AAA, what are examples of increased pressure?

Answer 21

Systematic hypertension, aortic valve stenosis

Question 22

For AAA, what are examples of abnormal volume load?

Answer 22

Serve aortic regurgitation

Question 23

What are clinical symptoms of AAA?

Answer 23

Asymptomatic
Symptoms resulting from a rupture or vessel expansion - pain
ABD bruit
Palpable mass
Drop in hematocrit

Question 24

What does "drop in hematocrit" mean?

Answer 24

Something is bleeding

Question 25

If a AAA is smaller than 4 cm, what does the doctor do?

Answer 25

A follow up every 6 months

Question 26

If a AAA is greater than 4 cm, what does the doctor do?

Answer 26

Possibly a surgical intervention

Question 27

If a AAA is greater than 6 cm, what is this considered?

Answer 27

High risk

Question 28

AAA growth rate depends on what?

Answer 28

Initial size Cardiac disease Blood pressure lowing meds

Question 29

What relationship must you determine when you see an aneurysm?

Answer 29

The relationship to the renal arteries

Question 30

How is a true aneurysm classified?

Answer 30

Forms when the tensile strength of the wall decreases | Greater than 3 cm AP

Question 31

What are the 2 appearances of an aneurysm?

Answer 31

Saccular - balloons off aorta - sudden Fusiform - gradual enlargement - most common

Question 32

Psuedoaneuryms are found where?

Answer 32

In the groin area

Question 33

When dealing with a psuedoaneurysm, what is pulsatile hematoma?

Answer 33

Leakage of blood into the soft tissue abutting the punctured artery

Question 34

When could a psuedoaneurysm occur?

Answer 34

Status post a cardiac cath or angiography

Question 35

How might you fix a psuedoaneurysm?

Answer 35

Surgical repair Compression technique Thrombin injection - clotting

Question 36

Other than an AAA, what else could be wrong with the aorta?

Answer 36

Could have a dissection or flap

Question 37

What are 4 symptoms of an aortic dissection?

Answer 37

Intense chest pain HTN ABD pain Neurological symptoms

Question 38

What happens when there is an aortic dissection?

Answer 38

Hemorrhage between layers due to separation of the layers

Question 39

What is a type of aortic dissection?

Answer 39

DeBakey Model -different type depending on location of flap

Question 40

What are 5 physical symptoms of an AAA rupture?

Answer 40

``` Excruciating pain Shock Organ displacement Compression Greater than 6 cm ```

Question 41

What are 5 clinical symptoms of a ruptured AAA?

Answer 41

``` Intense back pain Decrease in hematocrit Hypotension Nausea Vomiting ```

Question 42

If an AAA ruptures, what will be done?

Answer 42

Emergency surgery CT is usually the method of choice not US

Question 43

How will an AAA be fixed during surgery?

Answer 43

Stent graft repair

Question 44

What might a psuedo pulsatile ABD mass be?

Answer 44

``` Tumor Fibroid uterus Horseshoe kidneys Para aortic nodes Pancreatic cancer ```

Question 45

What are arteriovenous fistulas?

Answer 45

Acquired secondary to trauma Communication between an artery and vein

Question 46

What are clinical signs of an arteriovenous fistula?

Answer 46

Pain Pulsatile mass Massive swelling of lower extremities Dilated IVC

Question 47

What are some IVC abnormalities?

Answer 47

Congenital - double IVC, infrahepatic interruption of the IVC

Question 48

What will a dilation of the IVC cause?

Answer 48

Right ventricular failure

Question 49

2 types of IVC tumors are?

Answer 49

Renal cell cancer Wilm's tumor

Question 50

What is IVC thrombosis?

Answer 50

Pulmonary emboli from lower extremities | Insert a filter to fix

Question 51

What are symptoms of renal vein obstruction?

Answer 51

``` Dehydration in infants Adult kidneys look abnormal Flank pain Hematuria Proteinuria ```

Question 52

What are symptoms of renal vein thrombosis?

Answer 52

``` Related to thrombosis in IVC Pain Hematuria Nephromegaly Decreased flow ```

Question 53

Renal artery stenosis will cause?

Answer 53

Hypertension Use Doppler