Signs and symptoms

Question 1

What are the common causes of severe abdominal pain of sudden onset?

Answer 1

• Perforated viscus e.g. perforated gastric/duodenal ulcer
• Acute pancreatitis
• Biliary colic or acute cholangitis
• Acute mesenteric occlusion (e.g. embolus)
• Ruptured or leaking AAA

Question 2

What are the signs of acute ischaemia in PVD? 6 Ps

Answer 2

• Pale
• Perishing cold
• Pulseless
• Painful
• Parasthetic - muscle tenderness (4-6 hrs, threatened)
• Paralysed - numb, mottled (6-8 hrs, non-viable limb)

Question 3

How does chronic ischaemia in PVD present?

Answer 3

• Fontaine I: asymptomatic
• II: claudication
• III: rest pain
• IV: tissue loss

Question 4

What are the typical symptoms for PVD?

Answer 4

• Claudication - aching muscles on effort, worse on hills/with weight/at speed, settles swiftly at rest
• Rest pain - icy, burning, constant aching pain in foot, worse on elevation or at night, needs opiates
• Tissue loss - ulcers, necrosis, gangrene

Question 5

What are the triad of symptoms for rupture of an aneurysm?

Answer 5

• Collapse
• Hypotension
• Lower back or flank pain

Question 6

What are the symptoms of aortic dissection?

Answer 6

• Sudden, severe central chest pain (can radiate to back)
• Sweating
• Nausea
• SOB
• Weakness
• Syncope

Question 7

What are the signs of hypovolaemia?

Answer 7

• Narrowing of pulse pressure but maintenance of systolic BP initially
• Signs of organ hypoperfusion: oliguria, skin, cognitive changes, metabolic acidosis

Question 8

What are the symptoms of local compression?

Answer 8

• Early satiety
• Nausea/vomiting
• Urinary symptoms

Question 9

What are the symptoms of thromboembolic disease from site of aneurysm?

Answer 9

• Embolic phenomena affecting the toes (blue toe syndrome)
• Occasionally acute ischaemia

Question 10

What are the symptoms of expansion?

Answer 10

Back, flank, abdomen or groin (femoral nerve compression) pain

Question 11

What are the symptoms of expansion with imminent rupture?

Answer 11

• Sudden, severe and constant low back, flank, abdominal or groin pain
• Syncope

Question 12

What are the signs of aortic dissection?

Answer 12

• Difference in BP between both arms >20mmHg
• Acute aortic regurgitation caused by dilation of aortic root (early diastolic murmur)
• Cardiac tamponade (hypotension, JVP, muffled heart sounds)
• Acute occlusion of arteries arising from aorta causing organ ischaemia