Abdominal aortic aneurysm Flashcards Preview

General surgery > Abdominal aortic aneurysm > Flashcards

Flashcards in Abdominal aortic aneurysm Deck (15):
1

Definition

Permanent pathologic dilitation of the aortic aneurysm 1.5 X size expected for age and gender

2

Epidemiology

+With age
+in men

3

Etiology

Most commonly associated with atherosclerosis
Aortic elastic medial degeneration and mild cystic necrosis= aortic dilation and aneurysm formation

4

Pathopysiology

Reduction of collagen and elastin in media, adventitia and smooth muscle cell loss, tapering of medial wall, infiltration with lymphocytes, macrophages and neovascularisation
1. Proteolytic degradation
2. Transmural inflammation
3. Biochemical wall stress
4. Molecular genetics

5

Risk factors

Smoking
Family
Age
Male
CT disorder
+Lipids, HTN, obesity, DM

6

Investigations

Abdominal USS
Elevated ESR and CRP support a diagnosis of possible inflammatory AAA. Leukocytosis and a relative anaemia on FBC with positive blood cultures are indicative of infectious AAA.

7

Important history

Abdominal, back and groin pain
1. Development (lipids, DM, HTN, COPD, CTD)
2. Expansion (cardiac/renal transplant, previous stroke, +age, severe cardiac disease)
3. Rupture (female, cardiac/renal transplant, HTN)

8

Management of symptomatic but not ruptured

Semi-urgent surgical repair
B-Blocker started one day prior to surgery
Perioperative antibiotic therapy

9

Management when incidental finding

Small:
1. Surveillance-> older male, with significant comorbidities. USS for AAA BP, lipids, DM, smoking, obesity

10

When is surgical repair indicated

with a diameter exceeding 5.5 cm in men or 5.0 cm in women in the US

11

Mortality associated with rupture and surgery, rate of rupture / year

75% death rupture AA
50% if surgery
>5cm 25% rupture/year
>7cm 75% rupture

12

What to look for on physical examination

Evidence of popliteal/other aneurysms

13

What is involved in open surgical repair

Open surgical repair-->
can involve clamp and
sewing prosthetic arterial
graft, or ligating circulatoin
and creating a bypass

14

Complications of open surgical repair

Renal dysfunction
Paraplegia
Ischemic colitis
Infection

15

Management of AAA rupture

ABC
Oxygen, ETT
CV catheter, urinary catheter
Monitor and maintain BP 50-70 and withold fluids
Urgent surgical consultation, consenting
Peri-operative antibiotics
Monitor-BP, vitals, urine output, 02 sats