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Med Year 3 > Abdominal Aortic Aneurysm > Flashcards

Abdominal Aortic Aneurysm Flashcards

1
Q

what are the differentials for severe abdo pain, sudden onset, radiating to the back?

A

perforated viscus
acute pancreatitis
biliary colic
acute mesenteric occlusion

ruptured AAA

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2
Q

what are the 3 main branches of abdominal aorta

A

super mesenteric, inferior mesenteric and coeliac trunk

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3
Q

how does CO and BP change in patient who is losing blood?

A

o Body is able to maintain pressure at expense of CO and tissue BF until a large blood volume has been lost
o Only when compensatory mechanisms are unable to cope that BP begins to fall
o Hence, any person esp young and well, who have low BP in the context of acute blood loss are EXTREMELY ill and need urgent care

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4
Q

what is an AAA and what is a ruptured AAA?

A

dilated abdominal aorta

aneurysm pops and starts bleeding into the abdominal cavity

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5
Q

what is an aneurysm?

A

dilatation of ALL layers of the arterial wall and most are caused by degenerative disease

loss of intima and elastic fibres in media and associated with lymphocytic infiltration

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6
Q

what are the risk factors for a AAA?

A 
smoking
HTN
diabetes 
age >60
being male 4:1
caucasian 
FH 
connective tissue disease such as marfans
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7
Q

how does a AAA present

A

often asymptomatic

symptoms of peripheral vascular disease

non specific abdo pain

visible or palpable pulsation

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8
Q

how do you investigate for a AAA

A

USS or angiography CT or MRI

examine pulse in all limbs (aneurysm in popliteal also likely)

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9
Q

how do you treat a triple A?

A

treat reversible risk factors
monitoring size
treat peripheral arterial disease
surgery

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10
Q

what surgery is done for AAA

A

endovascular stenting (into abdominal aorta to prevent blood from collecting in the aneurysm)

complication = endo-leak

laparoscopic repair and open surgical repair

can also clamp the artery

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11
Q

what happens in a ruptured triple A

A

risk of rupture increases with diameter

high mortality

presents with pulsatile mass and severe abdo pain, haemodynamic instability, may have generalised shock state and bilateral leg ischaemia

NO delay for imaging, diagnosis of rupture can be confirmed by immediate CT abdomen

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12
Q

what other aneurysms may you see?

A

thoracic, suprarenal, popliteal

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13
Q

what is the management of major haemorrhages?

A

recognise blood loss
resuscitate and call for help
stop the bleeding (pressure, reverse anti-coagulants, transexamic acid)
blood samples: group and save then cross match = give blood components as necessary
massive haemorrhage packs (1 and 2)
monitor coagulation tests and move to goal directed

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14
Q

what massive haemorrhage packs 1 and 2

A

pack 1: 4 units of RBC and 4 units of FFP

pack 2: (given if MH continues)
- 4 units RBC, 4 units of FFP, 1 dose of platelets and 2 packs cryoprecipitates)

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15
Q

what is the patient at risk of after the MH is under control?

A

patient will be at risk of thrombosis and will require thromboprophylaxis

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16
Q

what is peripheral vascular disease?

A

atherosclerosis in arteries, can be chronic limb ischaemia or acute limb ischaemia

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17
Q

what is claudication

A

pain on exertion due to ischaemia, predictable pain that settles swiftly at rest

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18
Q

what is chronic limb ischaemia

A

ulceration, limb loss as well as rest pain

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19
Q

what is acute ischaemia

A

emboli, dissection, large vessel thrombosis and the 6 p’s

20
Q

what are the 6ps?

A

pale, perishing cold, pulseless, painful, paraesthetic and paralysed (the last 2 are threatening and then non-viable meaning amputation)

21
Q

what are the risk factors for peripheral vascular disease?

A

increasing age, male sex, FH

smoking, HTN, cholesterol and diabetes

22
Q

what are the 4 stages of chronic limb ischaemia

A

o Fontaine 1: asymptomatic
o Fontaine 2: claudication
o Fontaine 3: rest pain
o Fontaine 4: tissue loss

23
Q

what is rest pain

A

o Icy, burning, constant pain in foot
o Worse in evening or elevation due to drop in BP and perfusion pressure in foot is less so wakes them up
o Needs opiates
o Needs this for 2 weeks before diagnosed as critical limb ischaemia

24
Q

what is tissue loss

A

gangrene and ulceration

25
Q

what is the treatment for PVD

A 
o	STOP SMOKING
o	Antiplatelets – aspirin
o	BP control
o	Cholesterol reduction – statin
o	Regular exercise
o	Lose weight
o	Tight diabetic control
26
Q

what is the prognosis for PVD

A

improves over 6-12 months

MI in next 5 years risk is 30%

27
Q

what is cerebrovascular disease

A

atheroma in carotid artery, presenting with stroke, TIA or amaurosis

investigation is duplex for carotid artery stenosis or angiography, MR/CT

treatment is carotid endarterectomy for symptomatic patients
>70% stenosis in ICA is an indication for surgery

28
Q

what is an aortic dissection

A

Life-threatening condition: separation in layers of artery wall
Tear in tunica intima; causes blood to flow between layers of the wall of the aorta
Creating false lumen in the aorta

29
Q

what part of aorta does an AD commonly affect

A

surrounding ascending and aortic arch

surgical emergency

30
Q

what are the RF for AD

A

chronic hypertension, connective tissue disorders such as ehler-danlos, marfans

male, age >65, trauma

31
Q

how does an AD present

A 
o	Tearing chest pain of sudden onset 
o	Sweating, nausea, SOB and weakness
o	Radiating to the back 
o	Hypertension
o	Hypotension as dissection becomes more severe = shock
32
Q

how can you classify an AD

A

type A: involve the artery before origin of left subclavian, requires surgery

type B: descending thoracic, medically treated

33
Q

how do you manage an AD

A

resusc, confirm by imaginng: first line is CT with contrast

urgent surgery: stenting

34
Q

what is shock

A

Acute clinical syndrome initiated by ineffective perfusion and cellular hypoxia, resulting in severe dysfunction of organs vital to survival

35
Q

what is the basic cardio physiology?

A

learn notes

36
Q

what are the 4 types of shock?

A

Hypovolaemic = reduced intravascular volume due to fluid loss
Eg haemorrhage, burns, GI losses, dehydration

• Cardiogeneic – intrinsic cardiac failure of such severity that organ perfusion is compromised eg MI, arrythmias

• Distributive – vasodilation and malperfusion
eg Sepsis, pancreatitis, trauma, anaphylaxis, neurogenic

• Obstructive – failure of circulatory flow
eg Tension pneumothorax, pericardial tamponade, PE

37
Q

what are the physiological responses to shock?

A
  • Preload falls  SV falls  CO falls
  • To compensate, SNS activates SAN  tachycardia and increased contractility  SVR or vascular tone increased  offset reduction in mean arterial pressure
38
Q

what would you see in a person with shock?

A

cold and pale skin
oliguria
confusion and lethargy
possibly metabolic acidosis

39
Q

how do you manage shock

A 
ABCDE
oxygen
fluids IV; 2 large bore cannulae
bloods: crossmatch
ABG
treat cause eg MH

aim to prevent irreversible organ failure and injury

40
Q

what is a crystalloid

A

contains electrolytes dissolved in water eg normal saline, hartmanns

electrolytes and water distribute easily into ECF so much doesnt stay intravascularly

41
Q

what is a colloid

A

large molecules inelectrolyte solution

useful for patients who need a quick increase in circulating volume

42
Q

what is septic shock

A

widespread inflammation due to infection

vasodilation and capillary leak

43
Q

what are the complications of a massive blood transfusion

A

Transfusion-related acute lung injury (TRALI)
- Rare but serious syndrome (1 in 12,000) characterised by sudden acute respiratory distress following transfusion.

new acute lung injury (ALI) during or within 6 hours after blood product administered

hence req careful coagulation monitoring

44
Q

what other complications may you see after a transfusion

A

infection
hypocalcaemia (bc citrate binds to calcium)
haemolytic reactions (rhesus status; due to mismatched blood)
hypothermia
allergy / anaphylaxis

45
Q

what would you see an an acute haemolytic transfusion reaction

A

fever, abdominal and chest pain, agitation and hypotension

46
Q

what is a non-haemolytic febrile reaction

A

due to WBC HLA antibodies, use paracetamol

47
Q

what problems will someone in the ICU have when they are discharged?

A 
muscle weakness and wasting
nutritional deficiencies
sleep disorders
inability to swallow effectively 
microaspiration of food
recurrent chest infections

Med Year 3 (25 decks)

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