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DEFINE
aortic aneurysm
outpouchings or dilations of the arterial wall and are common
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PATHOPHYSIOLOGY OF:
- aneurysms of the descending and abdominal aorta is atherosclerosis.
- Atherosclerotic plaques deposit beneath the intima. Plaque formation causes degenerative changes in the middle layer of the arterial wall. leading to loss of elasticity, weakening, and eventual aortic dilation.
- congenital
- blunt trauma
- inflammatory aortitis
- infectious aortitis
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CLASSIFICATIONS OF
(hint 2)
- TRUE - the artery wall forms the aneurysm, vessell layer still intact
- -fusiform uniform outpouching
- -saccular - pouch like w/ a narrow neck on one side of the wall
- FALSE - not aneurysm but diruption of all layers of the arterial wall
- -bleeding
- -ruptures
- -catheter tares
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CLINICAL MANIFESTATIONS
asymptomatic
- deep,diffuse chest pain radiates to interscapular area
- angina - from disruption of blood flow
- hoarsness - pressure upon laryngeal nerve
- dysphagia - pressure on esphagus
- distended neck veins, swelling edema head and arms - pressure on the superior vena cava r/t decreased venous return.
- pulsatile mass - periumbilical area
- bruits - by auscultation
- AAA - mimic abd. or back pain
- - blue toe syndrome - patchy mottling of feet and toes w/ palpable pedal pulses
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SURGICAL MANAGEMENT
perioperative - pt is hydrated, electrolytes balanced, coagulation monitored, hematocrits WNL.
- OR - if rupture - emergent surgical repair 33-94% mortality
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SURGICAL TECHNIQUES
- 1. incising the diseased segment
- 2. removing intraluminal thrombus or plaque
- 3. inserting a synthetic graft
- 4. suturing the native aortic wall around the graft as a protective cover
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DIAGNOSTIC STUDIES FOR AA
- X-RAY
- ECG R/O MI
- ECHOCARIOGRAPHY - diagnsis of aortic valve insufficiency
U/S - aneurysm size- CT - most accurate for size and thrombus presence
- MRI - if indicated
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