Abdominal aortic aneurysm: Difference between revisions
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===Risk Factors=== | ===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 | |||
== Diagnosis == | == Diagnosis == | ||
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#Pain control (avoid hypotension) | #Pain control (avoid hypotension) | ||
#BP control | #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 | ||
===Asymptomatic=== | ===Asymptomatic=== | ||
*Prompt vascular surgery outpatient follow-up appt | *Prompt vascular surgery outpatient follow-up appt | ||
== | == References == | ||
[[Category:Cards]] | [[Category:Cards]] | ||
Revision as of 15:23, 23 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
Diagnosis
- 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
Workup
- 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
Differential Diagnosis
Diffuse Abdominal Pain
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
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