Abdominal aortic aneurysm: Difference between revisions
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== Background == | ==Background== | ||
*Infrarenal diameter >3cm or >50% increase in size of diameter | *Infrarenal diameter >3cm or >50% increase in size of diameter | ||
*Rupture Risk | *Rupture Risk | ||
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*HTN | *HTN | ||
==Clinical Features == | ==Clinical Features== | ||
*Triad: pain + hypotension + pulsatile mass | *Triad: pain + hypotension + pulsatile mass | ||
**Pain often described as sudden, severe, radiating to back | **Pain often described as sudden, severe, radiating to back | ||
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{{Lower back pain DDX}} | {{Lower back pain DDX}} | ||
== Diagnosis== | ==Diagnosis== | ||
[[File:AAA.png|thumb|AAA]] | |||
*[[Ultrasound: AAA|Ultrasound]] | *[[Ultrasound: AAA|Ultrasound]] | ||
**~100% sensitive for increased diameter | **~100% sensitive for increased diameter | ||
**Cannot reliably visualize rupture | **Cannot reliably visualize rupture | ||
*CT | *CT | ||
**~100% sensitive for incr diameter and rupture | **~100% sensitive for incr diameter and rupture | ||
**IV contrast is preferred but not essential | **IV contrast is preferred but not essential | ||
== Treatment == | ==Treatment== | ||
===Rupture=== | ===Rupture=== | ||
#Do not waste time in ED trying to "stabilize" pt | #Do not waste time in ED trying to "stabilize" pt | ||
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*Prompt vascular surgery outpatient follow-up appt | *Prompt vascular surgery outpatient follow-up appt | ||
== References == | ==References== | ||
<references/> | |||
[[Category:Cards]] | [[Category:Cards]] | ||
Revision as of 09:28, 25 June 2015
Background
- Infrarenal diameter >3cm or >50% increase in size of diameter
- Rupture Risk
- <4cm: low risk for rupture
- 4-5cm: 5 year risk 3-12%
- >5cm: 25-41%
- Rupture poss at any size, most commonly >5cm
Risk Factors
- Age
- Prevalence is negligible in age < 50 yrs
- Smoking
- Risk factor most strongly assoc with AAA
- Also promotes the rate of aneurysm growth
- Family history
- HTN
Clinical Features
- Triad: pain + hypotension + pulsatile mass
- Pain often described as sudden, severe, radiating to back
- Syncope (10%)
- Pain + AAA = rupture until proven otherwise
- Acute abdomen + hypotension = possible rupture
Differential Diagnosis
Diffuse Abdominal pain
- Abdominal aortic aneurysm
- Acute gastroenteritis
- Aortoenteric fisulta
- Appendicitis (early)
- Bowel obstruction
- Bowel perforation
- Diabetic ketoacidosis
- Gastroparesis
- Hernia
- Hypercalcemia
- Inflammatory bowel disease
- Mesenteric ischemia
- Pancreatitis
- Peritonitis
- Sickle cell crisis
- Spontaneous bacterial peritonitis
- Volvulus
Lower Back Pain
- Spine related
- Acute ligamentous injury
- Acute muscle strain
- Disk herniation (Sciatica)
- Degenerative joint disease
- Spondylolithesis
- Epidural compression syndromes
- Thoracic and lumbar fractures and dislocations
- Cancer metastasis
- Spinal stenosis
- Transverse myelitis
- Vertebral osteomyelitis
- Ankylosing spondylitis
- Spondylolisthesis
- Discitis
- Spinal Infarct
- Renal disease
- Intra-abdominal
- Abdominal aortic aneurysm
- Ulcer perforation
- Retrocecal appendicitis
- Large bowel obstruction
- Pancreatitis
- Pelvic disease
- Other
Diagnosis
- Ultrasound
- ~100% sensitive for increased diameter
- Cannot reliably visualize rupture
- CT
- ~100% sensitive for incr diameter and rupture
- IV contrast is preferred but not essential
Treatment
Rupture
- Do not waste time in ED trying to "stabilize" pt
- Immediate surgery consultation/ go to OR
- Crossmatch 6 units of pRBC
- Pain control (avoid hypotension)
- BP control
- Controversial
- Too little (ischemia), too much (increased bleeding)
- Consider allowing for permissive hypotension (SBP 80-100) in conscious pt
- Pressors
- Norepi 0.05mcg/kg/min IV; titrate by 0.02mcg/kg/min q5min
- Phenylephrine 100-180mcg/min; titrate by 25mcg/min q10min
- Dopamine 5mcg/kg/min; titrate by 5mcg/kg/min q10min
- Too little (ischemia), too much (increased bleeding)
- Controversial
Asymptomatic
- Prompt vascular surgery outpatient follow-up appt