Aneurysms Flashcards

1
Q

What is the definition of an abnormal bulge in a vessel and what is the specific size threshold for an abdominal aortic aneurysm (AAA)?

A

An abnormal bulge in a vessel, also known as an aneurysm, is characterized by an enlargement of more than 50% of the normal diameter of the vessel. For an abdominal aortic aneurysm (AAA), it is considered when the diameter exceeds 3 cm

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2
Q

What are the characteristics of true and false aneurysms?

A

True aneurysms have an intact vessel wall, whereas false aneurysms occur due to a hole in the vessel wall, leading to a pool of blood formation that mimics an aneurysm

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3
Q

What are the risk factors and etiological factors associated with aneurysm formation?

A

Older age, male gender, family history, atherosclerosis, hypertension, and smoking.

Atherosclerosis, infections (e.g., syphilis, Escherichia coli, Salmonella), trauma, and genetic conditions (e.g., Marfan’s or Ehlers–Danlos syndrome)

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4
Q

Describe the pathophysiology of aneurysm formation, particularly focusing on the role of elastin and collagen proteins.

A

The weakening of the vessel wall is due to the loss of elastin and collagen proteins in the tunica media.

During atherosclerosis, macrophages release enzymes that break down collagen and elastin, leading to the expansion of the tunica media.

This weakening of the vessel wall causes it to bulge, with the most common location being below the renal arteries

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5
Q

Clinical presentation of Asymptomatic aneurysms

A

75% asymptomatic (incidental finding) until rupture

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6
Q

How to know if its a symptomatic aneurysm?

A

Sudden onset pain

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7
Q

Describe Proximal AAA symptomatic aneurysm.

A

upper abdomen radiating to back pain

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8
Q

Describe distal AAA symptomatic aneurysm.

A

lower abdomen radiating to back pain

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9
Q

Describe Unruptured aneurysm symptomatic aneurysm

A

vague, nonspecific pain

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10
Q

Describe ruptured aneurysm symptomatic aneurysm

A

sudden onset severe pain, pulsating mass with heartbeat, hypotension

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11
Q

What are the other signs of an abdominal aortic aneursym other that sympomatic and symptomatic causes?

A

5.5cm AP diameter
Rapid expansion of >1cm per year
Trashy foot - embolisms moving from the aorta to the peripheral

Collapse (due to hypotension)
Tachycardia

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12
Q

Investigations for monitoring abdominal aortic aneurysm

A

Monitoring - Ultrasound

= - Shows AAA presence, AP diameter, iliac involvement
- Monitoring program for all men >65 in the UK

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13
Q

Ruptured AAA investigation is what?

A

CT Angiography

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14
Q

Surgical management for an unruptured abdominal aortic aneurysm

A

Elective Aneurysm repair
= is a prophylactic operation to reduce the risk of rupture balanced against the risk of the procedure.

> 5.5 cm in diameter or rapid expansion

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15
Q

Surgical management for an ruptured abdominal aortic aneurysm

A

Emergency Aneurysm repair
= is a therapeutic procedure balancing the expectation of death against the risk of the procedure

> EVAR - Stent to open lumen
Open Lap - Opening of the chest cavity, clamping either side of the aneurysm, stitching graft to the aorta

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16
Q

Scanning regime for an aneurysm <3cm in size

A

Discharge

17
Q

Scanning regime for an aneurysm 3-4.4 in size

A

Annual surveillance

18
Q

Scanning regime for an aneurysm 4.5-5.4cm in size

A

3 monthly surveillance

19
Q

Scanning regime for an aneurysm >5.5cm in size

A

urgent referral for surgery

20
Q

What is a thoracoabdominal Aortic Aneurysm?

A

aneurysms that coexist in both segments of the aorta (thoracic and abdominal)

21
Q

How does aneurysm formation occur in the aorta according to the provided information?

A

Aneurysm formation begins when blood enters through the intima and splits the media of the aorta

22
Q

What are the two types of aortic aneurysms mentioned in the context of their location and prevalence?

A

Type A aneurysms
= comprising about 2/3 of cases, involve the ascending aorta and may extend to the descending aorta. They are commonly associated with Marfan syndrome.

Type B aneurysms
= representing the remaining 1/3 of cases, affect only the descending aorta. They are typically secondary to atherosclerosis and, less commonly now, syphilis.

23
Q

What clinical feature distinguishes aneurysms involving both segments of the aorta? (abdominal and Thoracoabdominal)

A

Presents as sudden tearing chest pain radiating to the back

24
Q

Investigations for thoracoabdominal aortic aneurysm

A

Imaging - CT or MRI

25
Q

Management for thoracoabdominal aortic aneurysm

A

Surgical management - operative repair, stenting, EVAR

26
Q

An aneurysm is found in the superior mediastinum of a 64-year-old male during radiographic imaging. The surgeon opts to remove the aneurysm. In which of vessel is the aneurysm most likely located?

A

Arch of the aorta