Week 10 Flashcards
What is the most common site for an arterial aneurysm? What diameter of the artery is abnormal?
-abdominal aorta
-greater than 3 cm is abnormal
- abdominal aorta between the renal arteries and the bifurcation of the common iliac; L4/L5
Patient demographics related to an abdominal aortic aneurysm
-more common than men
-around 50 years for men and 60 for women
-Caucasians are at greater risk than African and Asian and Hispanics
-History of cigarette smoking (about 90% with AAA have smoked)
-hypertension, peripheral arterial, occlusion disease, CVD
What is an aneurysm? Other information related to abdominal aortic aneurysm.
-an abnormal dilation in an artery, vein, or heart
-vascular wall can become weakened from infection leading to atherosclerosis and then dilation of the vessel
-worst case scenario is the media layer disrupts and now there is blood in between the media and adventitia layers
What is the most common cause for an abdominal aortic aneurysm?
- atherosclerotic changes that cause a weakening of the media, which is the middle layer of an artery
-occur slowly overtime and symptoms are around age 50 primarily in men, woman 60-70s - typically asymptomatic due to slow gradual change in blood vessel diameter
Chief complaint and onset of symptoms for AAA
-majority or asymptomatic due to slow and gradual nature
-25 to 30% can experience pain in the abdominal and lower thoracic and lumbar regions
-diffuse, dull ache, may have a pounding or throbbing quality, especially with exertion (tends to be more of a vascular source of symptoms)
- if the artery has broke (dissected) and bleeding occurs, patient may experience sharp/severe intense pain, intense activities may provoke cold and clammy sweats
- dissection or breakage occurs at 5 cm diameter (start to discuss surgery at this amount)
-onset: insidious but progressive overtime, depending how quickly the aneurysm progresses
Is the abdominal aorta closer in the front or the back?
-closer to the back, retro-peritoneal
-midline or just to the left side of midline pain
- pancreas as well
Aggravating verse alleviating factors for abdominal aortic aneurysm
-Aggravating: may worsen with exertion associated with the stairs, walking up; NON-MECHANICAL PAIN PATTERN
-alleviating: not associated with trunk posture or movements
Physical examination is related to AAA
-Pain provocation with palpation, vibration, percussion over the spine process
-may have neurological deficits
-Palpable pulse along the abdominal aorta
Describe what a bruit is
-an abnormal ausculatory sound, pulsatile and nature
-Turbulent blood flow
-if found, it demonstrates high specificity compared to the high sensitivity of palpating for the abdominal aorta
Common red flags that could detect an AAA
-insidious onset of back pain
-a non-mechanical pain pattern
-no provocation of back pain with the trunk flexion
-new night pain
-Feeling a pulse where he had not felt a pulse before
Which of the following statement is true related to
abdominal aortic aneurysms?
a. b. The peak age of onset is between 30-35 years
Pain from an aneurysm will only be felt in the
abdomen
c. Patients with an abdominal aortic aneurysm will
always present with a palpable abdominal mass
d. The number one cause of an abdominal aortic
aneurysm is atherosclerosis
D
Describe “ankylose” & the hallmark sign for an area that’s ankylosed
-stiffness or fixation of a joint by disease or surgery
-Bamboo spine appearance is a Hallmark sig
Common area is affected by ankylosing spondylitis
-the sacroiliac joint
-facet joint
-Costovertebral joint
-Intervertebral disc articulation
Information related to ankylosing spondylitis
-Precursor is enthesitis (information of the attachment site for ligaments, tendons, synovial linings of the joint; then leads to stiffness/fixation
-Can lead to osteopenia and bony overgrowth that can lead to fibrosis
-presence of the antigen HLA – B 27 in the blood
Patient demographics related to ankylosing spondylitis
-condition of the younger population
-age of onset is between mid teens to 40 years old
-Occurs 2 to 3 times more often than men
-more commonly in Caucasian and Native American population
Chief complaint of symptoms & onset related to ankylosing spondylitis
-initially, diffuse stiffness and soreness, and a dull ache typically noted in the lumbar, buttocks, hip area
-Can also see within the neck, shoulder, lumbosacral, wrist, finger, knee, heel
-onset: insidious in nature, duration of three months or longer, and worsening overtime
- if patient reports it takes 30 to 60 minutes or longer to loosen up their joints, this can raise a concern about the presence of an inflammatory connective tissue disorder
Aggravating versus alleviating factors for ankylosing spondylitis
-aggravating: stiffness and soreness is worse with rest; different compared to a spinal infection and other pathology; can be especially pronounced upon awakening
-Alleviating: better with mild to moderate movements and activities; may overdo the activity in flare up their pain, but they are worse with rest and better with activity
Review of systems- symptoms pt may be experiencing with ankylosing spondylitis
-low-grade fever
-Fatigue
-weight loss with loss of appetite
- the eyes are the most involved
- 20 to 30% of patients develop uvetis (eyes that feel irritated and sore)
- small subset may experience ciliary flush (redness in eye)
Physical examination findings for ankylosing spondylitis
– AROM of the involved body regions will be limited in
multiple plains with complaints of stiffness and
soreness at the ends of the movements.
– Loss of chest mobility, chest excursion, is a hallmark
finding. Using a tape measure at approximately the
T4 spinal level, measure circumference changes
from full inhalation to full exhalation. A change of less
than one inch suggests limited range of motion
Criteria for inflammatory back pain and young middle-age adults related to ankylosing spondylitis
•Morning stiffness of >30 minutes’
duration
•Improvement in back pain with exercise but not with rest
•Awakening because of back pain during the second half of the night only
•Alternating buttock pain
*The criteria are fulfilled if at least 2
of the 4 parameters are present
Potential complications related to ankylosing spondylitis
-Osteoporosis
-Fracture
-spinal stenosis (leading to neurogenic clarification and potentially cauda Equina syndrome)
-atlanto axial subluxation (through time this area starts to stiffen and a minor blow to the head or neck area or whiplash could cause a fracture)
-cardio pulmonary system affected (cardiomegaly, aortic regurgitation, decreased total lung capacity or upper lobe fibrosis)
-May be caused from loss of rib cage or chest mobility
- as movement stops overtime, less bonus laid down. This then makes the bone at an increased risk for fracture.; a simple cough, sneeze, slip without falling, may be enough to cause this fracture
- thoracic and lumbar areas are the most frequent sites
Which of the following statement is true related to
ankylosing spondylitis?
a. Involvement of the eyes is the most common extra-
articular complication associated with ankylosing
spondylitis
b. Ankylosing spondylitis is a short-term inflammatory
condition
c. First thing in the morning is the best time of day for
these patients symptomatically
d. Peak of onset for ankylosing spondylitis is between
55-75 years of age
A (20-30% of pts have eye involvement)
