S7C63 - Aneurysms of the Aorta an Major Arteries

Question 1

Aneurysm

Answer 1

= dilation of arterial wall to >1.5 x its normal diameter

-AAA = >3cm in diameter, consider repair if >5cm diameter

Question 2

AAA

Answer 2

• usually >60yo
• M>F
• Sx: syncope, flank/back pain, abdo pain, GIB, extremity ischemia, shock, death
• syncope followed by abdo/back pain **very concerning

Dx:
-u/s has >90% sensitivity

Tx:

• limited resuscitaiton until definitive repair of ruptured AAA can occur, be careful with fluids
• if hypertensive and AAA is unruptured, may consider a short-acting BB, no good guidelines

Question 3

Thoracic Ao Aneurysms

Answer 3

-rarely survive if they rupture

Question 4

Extremity/visceral aneurysms

Answer 4

• popliteal - risk for thrombosis or embolis to leg, rarely rupture
• femoral/iliac artery aneurysm
• hepatic artery aneurysm: shock if it ruptures, quincke triad (jaundice, colic, upper GIB)
• subclavian - dysphagia, stridor, c/p, hourseness, upper extremity fatigue/numbness/tingling, limb ischemia
• anastomotic aneurysms: aortoenteric fistula, severe LGIB in pt with hx of AAA repair should make one suspicious
• iliac: pain in groin, scrotum, lower abdo, sciatica, vulvar/groin hematoma if it ruptures
• renal: 40-60yo, HTN with flank pain, hematuria, shock if ruptured
• splenic: elderly, female, HTN, liver dz, multiparous, sx of rapid onset of epigastric or LUQ pain then diffuse pain with rupture and shock