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Cardiovascular (Annie) > Peripheral Vascular Disease III - Abdominal Aortic Aneurysm (AAA) > Flashcards

Peripheral Vascular Disease III - Abdominal Aortic Aneurysm (AAA) Flashcards

1
Q

what is an aneurysm?

A

dilation of a vessel by more and 50% of its normal diameter

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2
Q

what is the normal aortic diameter?

A

1.2-2.0cm

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3
Q

what are the 2 types of aneurysm?

A

1) true aneurysm

2) false aneurysm

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4
Q

in true aneurysm, describe the vessel wall?

A

= the vessel wall is intact (all 3 layers)

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5
Q

in false aneurysm, describe the vessel wall?

A

= there is a breach in the vessel wall (surrounding structures act as vessel wall)

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6
Q

what are the 3 shapes of an aneurysm?

A

1) saccular
2) fusiform
3) mycotic

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7
Q

how do mycotic aneurysms arise?

A
  • arises secondary to an infectious process, involving all 3 layers of the artery
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8
Q

related to pathogenesis, what happens in abdominal aortic aneurysm?

A

= medial degeneration

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9
Q

what happens in medial degeneration?

A
  • regulation of elastin/collagen in aortic wall
  • aneurysmal dialtion
  • increase in aortic wall stress
  • progressive dilation
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10
Q

who is at the greatest risk of developing abdominal aortic aneurysm?

A

1) increases with age
2) make gender
3) smoking
4) hypertension
5) diabetes
6) raised cholesterol

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11
Q

what commonly happens in people with AAA?

A

popliteal aneurysms

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12
Q

what do the majority of AAA present with?

people who present with this, what are they at risk or?

A

asymptomatic

Risk of = rupture

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13
Q

if people with AAA present with symptoms, what are they?

In people who present with symptoms, what can you exclude?

A

1) pain
- can mimic renal colic

2) trashing
= bits of plaque break off and travel through aorta

3) rupture

You can exclude rupture.

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14
Q

what sort of pain is AAA rupture?

A

sudden onset of epigastric, central pain.

- may radiate through back

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15
Q

what may rupture of AAA mimic?

A

mimic renal colic

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16
Q

what does rupture of AAA result in?

A

collapse

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17
Q

on examination, what might you find in a patient with ruptured AAA?

A
  • may look well
  • hypo/hypertension
  • pulsatile, expansile mass +/- tender
  • transmitter pulse
  • peripheral pulses
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18
Q

what are the 2 types of rupture?

A

1) retroperitoneal, contained rupture

2) free intra-peritoneal rupture = fatal

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19
Q

how can you image AAA?

A
  • duplex ultrasound

= asymptomatic/surveillance

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20
Q

in the duplex ultrasound, what are you looking at?

A

AP diameter and involvement of iliac arteries

= it only tells you there is an AAA or not and its AP diameter

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21
Q

what other imaging can you do for AAA?

A

CT scan

22
Q

what are you looking at in a CT scan?

A

= arterial phase

  • IV contrast
  • commence when contrast is in arterial system
23
Q

what is the only imaging method to identify ruptured AAA?

A

CT scan

24
Q

what are the 2 ways of managing an AAA?

A

1) open repair

2) endo-vascular aneurysm repair (EVAR)

25
Q

to repair an AAA, what 4 things can open repair involve?

A

1) laparotomy
2) clamp aorta + iliac
3) Dacron graft
4) tube vs bifurcated graft

26
Q

what is the other way of managing an AAA?

A

endo-vascular aneurysm repair

27
Q

what happens in endo-vascular aneurysm repair?

A
  • exclude AAA from inside the vessel
  • inserted via peripheral artery
  • X-ray guided
  • modular components
28
Q

what are the 3 types of acute limb threat?

A

1) acute limb iscahemia
2) acute or chronic limb iscahemia
3) diabetic foot sepsis

29
Q

what is acute limb ischaemia?

A

sudden loss of blood supply to a limb

30
Q

what causes acute limb ischaemia?

A

= occlusion of native artery or bypass graft

31
Q

what causes sudden occlusion in acute limb ischaemia?

A

1) embolism
2) athero-embolism
3) arterial dissection
4) trauma
5) extrinsic compression

32
Q

what are the 6 features of acute limb ischaemia?

What 2 important features are important to gather in a history for people at risk of acute limb ischaemia?

A

1) pain (due to lack of blood supply to nerves)
2) pallor
3) pulseless
4) perishingly cold
5) paraesthesia = pins & needles/altered sensation
6) paralysis

  • no prior history of claudication
  • known cause for embolism
33
Q

describe the pain suffered in acute limb iscahemia.

A
  • severe, sudden onset, resistant to analgesia
34
Q

what happens with the calf muscles in acute limb ischaemia?

A
  • calf/muscles tenderness with tight compartment indicates muscle necrosis often irreversible iscahemia
35
Q

describe the pallor of the limb involved in acute limb ischaemia.

A

Initially
= limb white with empty veins

Later
= capillaries fill with stagnated de-oxygenated blood giving a mottled appearance

  • Arteries distal to occlusion fill with propagated thrombus with rupture of capillaries
36
Q

is blanching mottling salvageable?

is non-blachnig mottling reversible?

A

yes - if prompt re-vascualrisation

no - it is irreversible ischaemia

37
Q

why does paraesthesia/parlysis occur in acute limb ischaemia?

A
  • sensorimotor deficit are indicative of muscle & nerve ischaemia
38
Q

what time feature is acute limb iscahemia salvable?

A

0-4hours

  • white foot
  • painful
  • sensorimotor deficit
39
Q

what time feature is acute limb iscahemia partially reversible?

A

4-12hours

  • mottled
  • blanches on pressure
40
Q

what time feature is acute limb iscahemia non-salvageable?

A

> 12hours

  • fixed mottling
  • non-blanching
  • compartments render/red
  • paralysis
41
Q

how do you manage acute limb ischaemia?

A

1) ABC – resuscitate and investigate
2) FBC, U/Es, CK, Coag +/- Troponin
3) ECG – MI, dysrhythmia
4) CXR – underlying malignancy

5) anti-coagulants
= stops propagation of thrombus
- may improve perfusion

6) arterial imaging

42
Q

if limb is salvageable, what do you do?

A

= embolectomy +/- fascioteomies +/- thrombolysis

43
Q

what 3 things does diabetic foot sepsis encompass?

A

1) diabetic neuropathy
2) peripheral vascular disease
3) infection

44
Q

what does this triad in diabetic foot sepsis lead to?

A
  • tissue ulceration
  • necrosis
  • gangrene
45
Q

what causes diabetic foot sepsis?

A
  • simple puncture wound
  • infection from nail plate or inter-digital space
  • from neuro-iscahemic ulcer (occurs on areas of increased pressure)
46
Q

why is diabetic foot sepsis a problem?

A

= within the foot the intrinsic muscles of digits are confine within rigid compartments
- bounded by planter fascia, metatarsal bones and interosseous fascia

  • infection tracks in soft tissues into this rigid compartment
47
Q

what happens if the build up of pus cannot escape?

A
  • pressure builds up in rigid compartment leading to impairment of capillary blood flow & further iscahemia & further tissue damage

= can rapidly progress to sepsis & limb loss

48
Q

what 5 systemic things happen as a result of diabetic foot sepsis?

A
  • pyrexia
  • tachycardia
  • tachypnoeic
  • confused
  • kussmauls breathing
49
Q

what 7 local features happens as a result of diabetic foot sepsis?

A
  • swollen affected foot
  • swollen forefoot
  • tenderness
  • ulcer with pus extruding
  • erythema, may track up limb
  • patches of developing necrosis
  • crepitus in soft tissue of foot
  • pedal pulse may or may not be present
50
Q

how would you manage diabetic foot sepsis?

A

1) antibiotics
- gram +ve cocci (S. aureus + streptococcus sp)
- gram -ve bacilli (E. coli, klebsiella sp, enterobacter, proteus sp and pseudomonas sp.)
- anaerobes (bacteroides)

2) rapid surgical debridement of infected tissue
3) remove all infected tissue
4) wound open to encourage drainage

Cardiovascular (Annie) (36 decks)

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