Abdominal aortic aneurysm

123 Abdominal aortic aneurysm



Instruction


This patient presented with low-back pain; examine the abdomen.



Salient features



History




• Vague abdominal pain


• History of embolization


• Family history of rupture of abdominal aortic aneurysm


• History of smoking.


Remember: Three-quarters of the patients are asymptomatic.



Examination




• Large expansile pulsation along the course of the abdominal aorta (examination for a pulsatile mass should be done by bimanual palpation of the supraumbilical area)


• Auscultate for bruit over the aneurysm and over the femoral pulses


• ‘Trash’ foot: digital infarcts in patient with easily palpable pulses (suggests either a popiliteal or abdominal aneursysmal source of emboli) (BMJ 2000;320:1193–6)


• Examine all peripheral pulses.


Proceed as follows:



• Tell the examiner that you would like to check the following:


• Urine for sugar

• BP

• Serum lipid panel.

Remember:



• Popliteal artery aneurysms often coexist and, in fact, their presence should prompt the physician to look for an abdominal aortic aneurysm.


• Ninety per cent of atherosclerotic abdominal aortic aneurysms present below the origin of the renal arteries and can involve the aortic bifurcation.


• The infrarenal aorta is normally 2 cm in diameter; when it exceeds 4 cm an aneurysm is said to exist.


• True arterial aneurysms are defined as 50% increase in the normal diameter of the vessel.


• Aneursymal process may affect any medium or large artery.


• The most commonly affected vessels are the aorta and iliac arteries, followed by popiliteal, femoral and carotid vessels.



Diagnosis


This patient has a large pulsatile mass in the epigastrium (lesion) caused by an aneurysm of the abdominal aorta (aetiology). The patient complains of pain over the location of the mass, suggesting inflammation and impending rupture (functional status).



Questions




Is clinical examination sensitive in the detection of abdominal aortic aneurysm?


Sensitivity of abdominal palpation for detection of abdominal aortic aneurysms increases with the diameter of the lesion: 61% for aneurysms 3·0–3·9 cm, 69% for those 4·0–4·9 cm and 82% for those ≥5·0 cm. The palpation sensitivity also depends inversely on the size of the abdominal waistline (Arch Intern Med 2000; 160:833–6).



Which investigations would you do to confirm your diagnosis?




• B mode ultrasonography of the abdomen: a simple, cheap and accurate screening test.


• Large aneurysms require angiography, but angiography may underestimate the size of lumen because of large clots.


• MRI is useful, particularly as it does not require administration of contrast.


• CT (Fig. 123.1).

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Abdominal aortic aneurysm

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