aortic aneurysm

Question 1

pathology of aortic anuerysm

Answer 1

An aneurysm is a permanent localised dilation of an artery to twice normal diameter

They may be asymptomatic or cause symptoms

Question 2

2 types of aortic aneurysm

Answer 2

true

false

Question 3

what are true aneurysms

Answer 3

Affects all 3 layers (intimal, media and adventitia)

Have different shapes – saccular or fusiform

Question 4

what arteries are most commonly involved in true aneurysms

Answer 4

Abdominal aorta – most common

Iliac, popliteal and femoral

Thoracic

Question 5

what is a false aneurysm

Answer 5

Collection of blood under adventitia only (outer layer)
Can happen after trauma

Question 6

causes of aneurysms

Answer 6

Atheroma
Trauma
Connective disorders

Question 7

what 2 connective disorders can cause aneurysms

Answer 7

1. Marfan’s – gene coding for fibrillin-1 affected (fibrillin-1 used in ECM structure)
2. Ehlers-Danlos syndrome – affects gene that usually alter the structure, production or processing of collagen or proteins that interact with collagen

Question 8

risk factors for abdominal aortic aneurysm

Answer 8

Smoking
Family History
Age
Male
HTN
Trauma
COPD
Hypercholesterolaemia

Question 9

symptoms of anbominal aortic aneurysm

Answer 9

Asymptomatic - unruptured
Sometimes there is abdomen, back, loin or groin pain due to pressure effects

Question 10

signs of abdominal aortic aneurysm

Answer 10

1. Pulsatile abdominal swelling – normal but if diameter is >5.5cm it suggests it is unruptured
2. Expansile aorta – suggests aortic rupture
   
   • Presents with
   • Epigastric pain radiating to back
     -Hypovolaemic shock
3. Hypotension
4. Collapse

Question 11

differential diagnosis for abdominal aortic anueyrsm

Answer 11

GI bleed
Perforated GI ulcer
Appendicitis
Pyelonephritis

Question 12

investigations for abdominal aortic aneurysm

Answer 12

Abdominal ultrasound
CT and/or MRI angiography

Question 13

management for abdominal aortic aneurysm

Answer 13

Monitoring of small aneurysm
Treat underlying cause
Surgery

Question 14

3 causes of throacic aortic anuerysm

Answer 14

1. Cystic medial necrosis
2. Atherosclerosis
3. Connective tissue disorders
   
   • Marfan’s syndrome
     -Ehlers-Danlos syndrome

Question 15

symptoms of thoracic aortic anueyrsm

Answer 15

Asymptomatic – most commonly
Pressure effects on local structures causing back/neck/chest pain, dysphagia and cough

Question 16

signs of thoracic aortic anuerysm

Answer 16

Aortic regurgitation if aortic root is involved
Collapse
Cardiac tamponade
Haemoptysis

Question 17

differential diagnosis for thoracic aortic aneurysm

Answer 17

MI
Thoracic back pain

Question 18

investigations for thoracic aortic aneurysm

Answer 18

Screening of men between 65-74 – aortic ultrasound

CT angiography – suspected rupture or assessing for surgery

MRI

Question 19

treatment for thoracic aortic anuerysm

Answer 19

Surgical replacement

BP control – betablockers e.g. bisoprolol