Pathology Flashcards
What does it mean if the SMA goes straight up instead of its normal parallel to the aorta?
Could have a lymphatic mass; they cluster around the great vessels
When scanning the aorta, which sections are focused on?
Long & transverse
Prox, mid, distal
Most are ______ aneurysms and involve all ______ layers.
True; three
What percent of AAA are infrarenal?
95%
What does infrarenal mean?
Below the renal arteries
How do you measure the aorta in long?
Anteroposterior (AP)
What is common in larger aneurysms?
Mural thrombus
Tortuosity and folding in an aneurysm is called what?
Atherosclerosis; plaque build up
What results when there is an infection in the aorta?
Mycotic aneurysm (mycosis)
At what size is surgery on an aneurysm considered?
Greater than 5 cm
What results when trauma occurs to the aorta?
Aortic pseudoaneurysm
What is an AAA?
Permanent localized abnormal dilation of any vessel
What is aortic ectasia?
Characterized by aortic root dilation associated with HTN and aging
Resulting in aortic regurgitation
At what size is an abnormality considered a AAA?
Increase in diameter of greater than 1.5 times the normal
What is the normal diameter of the aorta?
Less than 3 cm
Tapers as you go distal
Dependent on age, gender, blood pressure
How are AAA usually found?
Physical exam by palpating a pulsatile mass or by an ABD bruit
Where are most AAA found?
Infrarenal; below the renal arteries
What are 11 AAA risk factors?
Over age 60 Smoke
HTN Vascular disease
COPD Family history
Diabetes Congenital
Trauma/inflammation Syphilis
Plaque build up - atherosclerosis
What is Marfan’s syndrome?
Autosomal dominant connective tissue disorder
May be diagnosed at birth or not recognized till later in life
What causes AAA?
Inflammation of media and adventitia
Increased pressure
Abnormal volume load
For AAA, what are examples of inflammation of media and adventitia?
Rheumatic fever, polychondritis, ankylosing spondylitis
For AAA, what are examples of increased pressure?
Systematic hypertension, aortic valve stenosis
For AAA, what are examples of abnormal volume load?
Serve aortic regurgitation
What are clinical symptoms of AAA?
Asymptomatic Symptoms resulting from a rupture or vessel expansion - pain ABD bruit Palpable mass Drop in hematocrit
What does “drop in hematocrit” mean?
Something is bleeding
If a AAA is smaller than 4 cm, what does the doctor do?
A follow up every 6 months
If a AAA is greater than 4 cm, what does the doctor do?
Possibly a surgical intervention
If a AAA is greater than 6 cm, what is this considered?
High risk
AAA growth rate depends on what?
Initial size
Cardiac disease
Blood pressure lowing meds
What relationship must you determine when you see an aneurysm?
The relationship to the renal arteries
How is a true aneurysm classified?
Forms when the tensile strength of the wall decreases
Greater than 3 cm AP
What are the 2 appearances of an aneurysm?
Saccular - balloons off aorta - sudden
Fusiform - gradual enlargement - most common
Psuedoaneuryms are found where?
In the groin area
When dealing with a psuedoaneurysm, what is pulsatile hematoma?
Leakage of blood into the soft tissue abutting the punctured artery
When could a psuedoaneurysm occur?
Status post a cardiac cath or angiography
How might you fix a psuedoaneurysm?
Surgical repair
Compression technique
Thrombin injection - clotting
Other than an AAA, what else could be wrong with the aorta?
Could have a dissection or flap
What are 4 symptoms of an aortic dissection?
Intense chest pain
HTN
ABD pain
Neurological symptoms
What happens when there is an aortic dissection?
Hemorrhage between layers due to separation of the layers
What is a type of aortic dissection?
DeBakey Model -different type depending on location of flap
What are 5 physical symptoms of an AAA rupture?
Excruciating pain Shock Organ displacement Compression Greater than 6 cm
What are 5 clinical symptoms of a ruptured AAA?
Intense back pain Decrease in hematocrit Hypotension Nausea Vomiting
If an AAA ruptures, what will be done?
Emergency surgery
CT is usually the method of choice not US
How will an AAA be fixed during surgery?
Stent graft repair
What might a psuedo pulsatile ABD mass be?
Tumor Fibroid uterus Horseshoe kidneys Para aortic nodes Pancreatic cancer
What are arteriovenous fistulas?
Acquired secondary to trauma
Communication between an artery and vein
What are clinical signs of an arteriovenous fistula?
Pain
Pulsatile mass
Massive swelling of lower extremities
Dilated IVC
What are some IVC abnormalities?
Congenital - double IVC, infrahepatic interruption of the IVC
What will a dilation of the IVC cause?
Right ventricular failure
2 types of IVC tumors are?
Renal cell cancer
Wilm’s tumor
What is IVC thrombosis?
Pulmonary emboli from lower extremities
Insert a filter to fix
What are symptoms of renal vein obstruction?
Dehydration in infants Adult kidneys look abnormal Flank pain Hematuria Proteinuria
What are symptoms of renal vein thrombosis?
Related to thrombosis in IVC Pain Hematuria Nephromegaly Decreased flow
Renal artery stenosis will cause?
Hypertension
Use Doppler
