Condition- Abdominal Aortic Aneurysm

Question 1

What is an aneurysm and what are the two types?

Answer 1

A permanent pathological dilation of the aorta with a diameter over 50% its normal diameter (>3cm).

The two types:

• Fusiform (most common)
• Saccular

Question 2

What are false aneurysms (pseudoaneurysms)?

Answer 2

Collections of blood in the outer layer of blood vessels in the adventitia (eg after trauma) that communicate with a vessel lumen

Question 3

Where is the most common location for an AAA to occur?

Answer 3

90% occur below the renal arteries

Question 4

Describe the epidemiology of AAAs

Answer 4

• Ruptured AAAs: 125 deaths/millions in 55-59 and 2728/million in over 85s (AGE)
• Unruptured Males: Females= 3:1 ratio (MALES)
• Fell rapidly between 90s->00’s because of fall in SMOKING rates and better elective surgery

Question 5

What portion of the population are screened for AAAs?

Answer 5

>65 males- USS

Question 6

List some of the risk factors that increase the risk of devloping AAAs.

Answer 6

• Modifiable:
  
  • Smoking
  • Severe atherosclerotic damage to aortic wall (CV Hx-angina, intermittent claudication, TIA, stroke)
  • Hypertension
  • Hyperlipidaemia
• Non-modifiable:
  
  • Family history
  • Male (but risk of rupture greater in females)
  • Age
  • Connective tissue disorders: Marfan’s syndrome, Ehlers-Danlos syndrome
  • Inflammatory disorders

Question 7

List some of the presenting symptoms of someone with an unruptured AAA

Answer 7

UNRUPTURED:

• Usually ASYMTPOMATIC and is an incidental finding
• May have pain in back, abodmen (hypogastric/ umbilical) and groin (down genito-femoral nerve)

Question 8

List some of the presenting symptoms of someone with a ruptured AAA

Answer 8

RUPTURED:

• Sudden severe TEARING pain in abdomen (intermitten/ continuous), radiated to back + groin
• Syncope- because of low pressure
• Shock

Question 9

What are the signs of AAA that you might observe upon examination?

Answer 9

• Palpable pulsatile laterally expansive mass on bimanual palpation
• Abdominal bruit
• Hypotension + tachycardia

Question 10

Which investigations could you order to identify an AAA. What is GS for a ruptured AAA?

Answer 10

1. Abdominal Ultrasound- can only indicate presence of AAA
2. Bloods:
   
   • ESR and CRP to see if inflammatory/ infective cause
   • FBC: clotting scree, RFTs and LFTs
3. CT/MRI angiography- used to ID if ruptured