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MSPA- Gastroenterology > AAA > Flashcards

AAA Flashcards

1
Q

What is the definition of true dilation of the AA?

A

It is defined as >50% of expected diameter or
>3cm.

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2
Q

What is the mean diameter of normal AA?

A

2 cm.

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3
Q

What are the locations of AAA ?

A

– Infrarenal
– Suprarenal
– Juxtarenal
– Pararenal

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4
Q

90% of AAA are located ?

A

Infrarenal

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5
Q

What are the most common variants of AAA?

A

Fusiform and sacular

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6
Q

what percentage of AAA patients have associated femoral or popliteal artery
aneurysm?

A

25%

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7
Q

What is the presentation of most cases of AAA?

A

Asymptomatic and diagnosed incidentally.

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8
Q

What is the presentation of symptomatic AAA?

A

The main presentation is Vague epigastric, abdominal, and back pain. Acute limb ischaemia due to peripheral emobolisation known as bluetoe syndrome and referred testicular pain due to ureteral stretch can also be seen.

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9
Q

What is the main risk factor for AAA ?

A

Smoking has 10 times increased risk of causing and accelerating the expansion of AAA.

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10
Q

What are the general risk factors for AAA?

A
  • 4 times more common in men than woman.
  • 5% of the cases are seen in men >65.
  • Uncontrolled HTN and family Hx of AAA.
  • Connective tissue disorders such as Marfan syndrome.
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11
Q

What are the conservative management measures in AAA?

A
  • Smoking cessation.
  • Exercise & wt loss.
  • Medications
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12
Q

What are the medications in AAA?

A

– B-blockers & ACEis to control HTN
– Statins to help reduce vessel wall inflammation
– Doxycycline (protease inhibition)

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13
Q

What is the main screening modality for AAA?

A

abdomina US which has 98% accuracy and is offered to men >65.

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14
Q

What is the average growth rate of AAA?

A

0.3cm/yr

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15
Q

What is the size and screening frequency of mildly dilated AAA?

A

(3-3.5cm)
Every 5 years

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16
Q

What is the size and screening frequency of small AAA?

A

(3.5cm – 4.4cm)
Every 12 months

17
Q

What is the size and screening frequency of medium AAA?

A

(4.5cm – 5.4cm)
Every 3 months

18
Q

What is the size and management of large AAA?

A

(>5.5cm)
Repair indicated

19
Q

What is the indication for CT abdomen in AAA?

A

It can be used in haemodynamically stable pts
w/suspected rupture. It helps to Determines size & extent of aneurysm. Besides, it can help to confirm diagnosis and determine the best management.

20
Q

What is the risk and indication of CT-angiogram with contrast in AAA?

A

It is Used pre-operatively to give detailed
info about the aneurysm and surrounding anatomy and has risk of contrast induced nephrotoxicity.

21
Q

What are the indications for surgery in AAA?

A

– >5.0cm in females and >5.5cm in males
– Symptomatic
– Rapid increase in size >0.5cm/6 months and an increased risk of rupture.
– Rupture
– Development of fistulating disease.

22
Q

What is the procedure for Endovascular Stent Graft repair ?

A

It Involves the placement of a modular stent graft through the iliac or femoral arteries to
line the aorta to devoid flow in aneurism. The graft must provide an adequate seal proximally at the aortic neck & distally in each of the iliac arteries.

23
Q

What are the advantages of EVAR over open repair ?

A

– Better for pts w/multiple co-morbidities
– Suitable for older age groups

24
Q

What are the complications of EVAR ?

A
  • Device migration
  • Separation of components
  • Graft limb occlusion
  • Graft infection
  • Endoleak
  • Life long surveillance required
25
Q

What are the types of endoleak ?

A

*Type I: leak at graft attachment site.
* Type II: aneurysm sac filling via branch vessel (most common).
* Type III: leak through defect in graft.
* Type IV: leak through graft fabric as a result of graft porosity.
*Type V: continued expansion of aneurysm sac without demonstrable leak on imaging.

26
Q

What are the complications of open AAA repair ?

A
  • Higher peri-operative morbidity & mortality compared to EVAR
  • Graft infection
  • Lower limb ischaemia
  • Bowel ischaemia
  • Renal dysfunction
  • Sexual dysfunction (sympathetic plexus injury)
  • Aorto-enteric fistula
27
Q

What are the symptoms of AAA rupture ?

A

– Abdominal pain
– Pulsatile abdominal mass (not always palpable)
– Hypotension
– Testicular / groin pain

28
Q

What is the managment of AAA rupture ?

A

– Secure airway and give 15L 100% O2 via non-rebreather mask.
– 2 x wide-bore IV access for fluids with permissive hypotension.
– FBC, U&E, Coag, Group & cross-match
– Monitor urinary output w/a UC
– Analgesia

MSPA- Gastroenterology (14 decks)

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