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Medicine

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Cardiology

Question
11 out of 67
 

MC cause of abdominal aortic aneurysm (AIIMS May 2009)



A Atherosclerosis
B FMD

C Trauma
D Syphilis

Ans. A

Atherosclerosis

Abdominal aortic aneurysm (AAA) (AIIMS May 2011)

1. Abdomen (infrarenal) is the most common site of aortic aneurysm.

2. Reasons

a. Elastin, the principal load-bearing protein present in the wall of the aorta, is reduced in the abdominal aorta as compared to the thoracic aorta.

b. The abdominal aorta does not possess vasa vasorum, hindering repair.

3. Most are true aneurysms that involve all three layers (tunica intima, tunica media and tunica adventitia), and are generally asymptomatic before rupture.

4. The prevalence of AAAs increases with age, with an average age of 65–70 at the time of diagnosis.

5. AAAs have been attributed to atherosclerosis.

6. There is a large risk of rupture once the size has reached 5 cm, though some AAAs may swell to over 15 cm in diameter before rupturing.

7. Before rupture, an AAA may present as a large, pulsatile mass above the umbilicus. A bruit may be heard from the turbulent flow in a severe atherosclerotic aneurysm or if thrombosis occurs.

8. Most of the time rupture is usually the first hint of AAA. Once an aneurysm has ruptured, it presents with a classic pain-hypotension-mass triad.

9. The pain is classically in the abdomen, back or flank. It is usually acute, severe and constant, and may radiate through the abdomen to the back.

10. The diagnosis of an abdominal aortic aneurysm by the use of ultrasound.

11. Rupture could be indicated by the presence of free fluid in potential abdominal spaces, such as Morison's pouch, the splenorenal space, subdiaphragmatic spaces and peri-vesical spaces.

12. A contrast-enhanced abdominal CT scan is needed for confirmation.

Treatment

1. Medical treatment

Strict blood pressure control.

2. Surgical treatment

The definitive treatment for an aortic aneurysm is surgical repair of the aorta.

Coronary Artery Disease (Ref. Hari-18th ed., Pg-1998)

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