AAA

Question 1

AAA

Answer 1

Abdominal Aortic Aneurism

Question 2

What physiologically causes AAA

Answer 2

Loss of elastin and collagen in arteries. degernerative process. affected by amount of pressure applied to walls

Question 3

Predisposing Factors for AAA

Answer 3

• 5x more common in males
• Familial Link
• Genetic - common in Marfans
• Age >50
• Smoking
• CAD
• HTN
• COPD

Question 4

Symptoms of Un-ruptured AAA

Answer 4

• Vague abd - belt-like tightening on abd
• back pain - from pressing on spinal nerves
• Related symptoms of AAA pressing on other structures
  
  • Nausea/vomiting - pressing on GI viscera
• Ischemia from embolization resulting from aneurism

Question 5

Symptoms of AAA Rupture

Answer 5

-Hypovolemic Shock
-PEA arrest
-if RPB - may have radiating groin pain and swelling
Symptoms Triad:
-Severe Abd pain
-Hypotension
-Pulsatile Mass

Question 6

When to operate?

Answer 6

> 5.5cm, measured on CT/US

-or of course if its ruptured

Question 7

Declamping shock

Answer 7

• area proximal to area has increased preload to heart, inc HTN, inc afterload, activating PNS to compensate
• area distal to aorta has been ischmic during procedur,e, leading to significant vasodilation from CO2 buildup
• When blood flow through aorta is suddenly returned. preload tanks, afterload drops in to boggy vasodilated systemic circulation, CO dec. acidosis from lactate and CO2. takes a bit to normalize. dec effect by slow unclamping

Question 8

Post op complications

Answer 8

• Dysrhythmias
• embolism
• fluid imbalance
• CNS effects from ischemia during clamp
• organ ischemia distal to clamp