Abdominal aortic aneurysm history and symptoms: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
 
(28 intermediate revisions by 10 users not shown)
Line 1: Line 1:
__NOTOC__
{{Template:Abdominal aortic aneurysm}}
{{Template:Abdominal aortic aneurysm}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; {{HP}}


{{CMG}}
==Overview==
Abdominal aortic aneurysms (AAA) are usually asymptomatic until they expand or rupture. Spontaneous [[abdominal pain]] in a patient with a [[Pulsatile flow|pulsatile]] [[epigastric]] mass or a known AAA may signal a rupture into the [[retroperitoneum]] or leakage within the [[aneurysm]] wall. If a patient does develop symptoms, the risk of rupture is quite high, which is why symptoms are considered an indication for [[surgery]]. Pain is the most common symptomatic manifestation.


'''Associate Editor-In-Chief:''' {{CZ}}
==History and Symptoms==


==History & Symptoms==
=== History ===
AAAs are commonly divided according to their size and symptomatology. An aneurysm is usually considered to be present if the measured outer aortic diameter is over 3 cm (normal diameter of  [[aorta]] is around 2 cm). The natural history is of increasing diameter over time, followed eventually by the development of symptoms (usually rupture). If the outer diameter exceeds 5 cm, the aneurysm is considered to be large. For aneurysms under 5 cm, the risk of rupture is low, so that the risks of surgery usually outweigh the risk of rupture.  Aneurysms less than 5cm are therefore usually kept under surveillance until such time as they become large enough to warrant repair, or develop symptoms.
The vast majority of aneurysms are asymptomatic. The risk of rupture is high in a symptomatic aneurysm, which is therefore considered an indication for surgery. Possible symptoms include low back pain, flank pain, abdominal pain, groin pain or pulsating abdominal mass. The complications include rupture, peripheral [[embolisation]], acute aortic occlusion, aortocaval or aortoduodenal [[fistulae]]. On physical examination, a palpable abdominal mass can be noted. Bruits can be present in case of renal or visceral arterial stenosis.


[[Image:AAA-101.jpg|right|thumb|CT image showing an abdominal aortic aneurysm.]]
* Given that [[smoking]] increases the risk of developing an abdominal aortic aneurysm (AAA), a [[smoking]] history should be obtained in elderly men. If a male over the age of 65 has a history of [[smoking]], he should undergo [[ultrasonography]] to screen for an AAA.<ref name="Isselbacher2005">{{cite journal|last1=Isselbacher|first1=Eric M.|title=Thoracic and Abdominal Aortic Aneurysms|journal=Circulation|volume=111|issue=6|year=2005|pages=816–828|issn=0009-7322|doi=10.1161/01.CIR.0000154569.08857.7A}}</ref>
As most of the AAAs are asymptomatic, their presence is usually revealed during an abdominal examination for another reason - the most common being abdominal ultrasonography. A physician may also detect the presence of an AAA by abdominal palpation. Ultrasonography provides the initial assessment of the size and extent of the aneurysm, and is the usual modality for surveillance.  Preoperative examinations include [[Computed tomography|CT]], [[MRI]] and special modes thereof, like CT/MR angiography. Angiography may be useful also, as an additional method of measurement for the planning of endoluminal repair. Note that an aneurysmal aorta may appear normal on angiogram, due to thrombus within the sac.
 
* Many AAAs are detected incidentally during cardiac catheterizations, computed tomography (CT), or magnetic resonance imaging (MRI) performed for unrelated reasons.
=== Symptoms ===
* Up to 50% of AAAs can be recognized on plain roentgenograms as a calcified aneurysmal wall.
 
* Spontaneous abdominal pain in a patient with a pulsatile epigastric mass or a known AAA may signal rupture into the retroperitoneum or leakage within the aneurysm wall
* Abdominal aortic aneurysms are usually asymptomatic until they expand or rupture. The following symptoms may be present:<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref>
*:* This could lead to rapid expansion or imminent rupture.
 
* Peripheral embolization to the lower extremities (common in popliteal artery aneurysms) is rare with AAAs.
**[[Abdominal pain]], radiating to the back, flank, and groin
*:* Rarely in larger or unstable aneurysms, disseminated intravascular coagulopathy may develop.  
**[[Clammy skin]]
**[[Early satiety]]
**[[Flank pain]]
** Groin [[pain]]
** Lower [[back pain]]
**[[Nausea and vomiting]]
**[[Syncope]]
 
===Associated Symptoms===
* [[Hematemesis]] (when associated with aortoenteric [[fistula]]s)
* Lower extremity pain and discoloration (when associated with [[thromboembolization]])
* [[Melena]] (when associated with aortoenteric [[fistula]]s)<ref>{{cite book | last = Ferri | first = Fred | title = Ferri's clinical advisor 2015 : 5 books in 1 | publisher = Elsevier/Mosby | location = Philadelphia, PA | year = 2015 | isbn = 978-0323083751 }}</ref>
* Urinary symptoms (when associated with [[ureteral obstruction]])<ref name="Chaikof-2009">{{Cite journal  | last1 = Chaikof | first1 = EL. | last2 = Brewster | first2 = DC. | last3 = Dalman | first3 = RL. | last4 = Makaroun | first4 = MS. | last5 = Illig | first5 = KA. | last6 = Sicard | first6 = GA. | last7 = Timaran | first7 = CH. | last8 = Upchurch | first8 = GR. | last9 = Veith | first9 = FJ. | title = The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. | journal = J Vasc Surg | volume = 50 | issue = 4 Suppl | pages = S2-49 | month = Oct | year = 2009 | doi = 10.1016/j.jvs.2009.07.002 | PMID = 19786250 }}</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


== Acknowledgements ==
The content on this page was first contributed by: [[C. Michael Gibson]] M.S., M.D.
{{WH}}
{{WH}}
{{WS}}
{{WS}}
[[CME Category::Cardiology]]


[[Category:Disease]]
[[Category:Disease]]
Line 30: Line 42:
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Up-To-Date cardiology]]
[[Category:Up-To-Date]]
[[Category:Best pages]]

Latest revision as of 13:37, 7 January 2020

Abdominal Aortic Aneurysm Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Abdominal Aortic Aneurysm from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Abdominal aortic aneurysm history and symptoms On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Abdominal aortic aneurysm history and symptoms

CDC on Abdominal aortic aneurysm history and symptoms

Abdominal aortic aneurysm history and symptoms in the news

Blogs on Abdominal aortic aneurysm history and symptoms

Directions to Hospitals Treating Abdominal aortic aneurysm history and symptoms

Risk calculators and risk factors for Abdominal aortic aneurysm history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Hardik Patel, M.D.

Overview

Abdominal aortic aneurysms (AAA) are usually asymptomatic until they expand or rupture. Spontaneous abdominal pain in a patient with a pulsatile epigastric mass or a known AAA may signal a rupture into the retroperitoneum or leakage within the aneurysm wall. If a patient does develop symptoms, the risk of rupture is quite high, which is why symptoms are considered an indication for surgery. Pain is the most common symptomatic manifestation.

History and Symptoms

History

  • Given that smoking increases the risk of developing an abdominal aortic aneurysm (AAA), a smoking history should be obtained in elderly men. If a male over the age of 65 has a history of smoking, he should undergo ultrasonography to screen for an AAA.[1]

Symptoms

  • Abdominal aortic aneurysms are usually asymptomatic until they expand or rupture. The following symptoms may be present:[2]

Associated Symptoms

References

  1. ↑ Isselbacher, Eric M. (2005). "Thoracic and Abdominal Aortic Aneurysms". Circulation. 111 (6): 816–828. doi:10.1161/01.CIR.0000154569.08857.7A. ISSN 0009-7322.
  2. ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
  3. ↑ Ferri, Fred (2015). Ferri's clinical advisor 2015 : 5 books in 1. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323083751.
  4. ↑ Chaikof, EL.; Brewster, DC.; Dalman, RL.; Makaroun, MS.; Illig, KA.; Sicard, GA.; Timaran, CH.; Upchurch, GR.; Veith, FJ. (2009). "The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines". J Vasc Surg. 50 (4 Suppl): S2–49. doi:10.1016/j.jvs.2009.07.002. PMID 19786250. Unknown parameter |month= ignored (help)

Template:WH Template:WS CME Category::Cardiology

Retrieved from "https://www.wikidoc.org/index.php?title=Abdominal_aortic_aneurysm_history_and_symptoms&oldid=1594330"