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Abdominal Aorta Aneurysm 

Abdominal Aorta Aneurysm 

Discussion

A 72-year-old male presents to the emergency department with sudden onset of severe, tearing abdominal pain radiating to his lower back. He describes the pain as excruciating and constant, and it started while he was lifting a heavy object. The pain is associated with nausea but no vomiting. He also mentions feeling lightheaded and faint but has not lost consciousness. His medical history includes hypertension, hyperlipidaemia, and a 40-pack-year smoking history. He is not on any anticoagulants.

On examination, the patient is in acute distress, with a blood pressure of 90/60 mmHg and a heart rate of 110 beats per minute. He is pale and slightly diaphoretic. Abdominal examination reveals a palpable, pulsatile mass in the lower abdomen. His abdomen is tender to palpation, but there is no guarding or rebound tenderness. The rest of the physical examination is unremarkable.

A CT scan of the abdomen reveals a large, ruptured abdominal aortic aneurysm (AAA) with active retroperitoneal bleeding. The patient is immediately prepared for surgery. He is started on intravenous fluids and blood transfusion while being monitored in the intensive care unit. Emergency repair of the AAA is performed, and he is closely monitored postoperatively for complications such as haemorrhagic shock or graft failure.

The patient is counselled on lifestyle modifications and is scheduled for follow-up to manage his hypertension and reduce cardiovascular risk.

Questions
1. What is the most likely diagnosis for this patient based on his symptoms and CT scan findings?

A) Acute pancreatitis

B) Abdominal aortic aneurysm (AAA) rupture

C) Renal colic

D) Acute mesenteric ischemia

 

2. Which of the following is the most significant risk factor for the development of an abdominal aortic aneurysm in this patient?

A) Family history of aneurysms

B) Smoking history and hypertension

C) Diabetes mellitus

D) History of gastrointestinal infections

 

3. What is the most appropriate initial management for this patient with a ruptured abdominal aortic aneurysm?

A) Immediate surgical repair, intravenous fluids, and blood transfusion

B) Administration of anticoagulants and monitoring

C) Antibiotics and intravenous fluids

D) Pain management and observation

4. Which of the following physical exam findings is most suggestive of a ruptured abdominal aortic aneurysm?

A) Decreased bowel sounds and abdominal distention

B) Palpable, pulsatile mass in the lower abdomen with hypotension

C) Murmur heard over the upper abdomen

D) Tenderness to palpation over the right flank

 

Reveal answers

Answers

  1. B) Abdominal aortic aneurysm (AAA) rupture
  2. B) Smoking history and hypertension
  3. A) Immediate surgical repair, intravenous fluids, and blood transfusion
  4. B) Palpable, pulsatile mass in the lower abdomen with hypotension