ABDOMINAL AORTIC ANEURYSM Presentation: The AAA can present in a number of ways yet the most common is as an incidental finding on either clinical examination or during investigation for another complaint. Those whom are symptomatic may have any of the following: Abdominal pain Back pain Distal embolisation Acute rectal bleed ‘herald bleed’ due to an aorto-enteric fistula Do have any pain? In acute cases the pain may be so severe the patient may not be able to localise the pain. A patient with a ruptured AAA will be in a shocked state and only a collateral history will be possible. Generally in the chronic setting, the pain is more a discomfort (pressure effects on the adjacent lumbar vertebral bodies), it may have started a couple of days previously and settled only to return more severely. This may be a sign of a contained leaking AAA, or pancreatitis, gastritis or gallstone disease. Does the pain move anywhere? As the Aorta is a retroperitoneal structure the pain is often noted in the back, and may even be described as shooting from the front right through to the back. A tearing sensation may be described if the aneurysm dissects. A rapidly expanding abdominal aneurysm can cause sudden onset of severe, steady, and worsening lower back and lower abdominal pain. A rapidly expanding aneurysm is also at imminent risk of rupture. Actual rupture of an abdominal aneurysm can cause sudden onset of back and abdominal pain, sometimes associated with abdominal distension, a pulsating abdominal mass, and even shock Does the pain come and go? The pain is usually steady but may be relieved by changing position. The person may also become aware of an abnormally prominent abdominal pulsation. Investigations PFA: In about 90% of the cases, X-rays of the abdomen show calcium deposits in the aneurysm wall. But plain x-rays of the abdomen cannot determine the size and the extent of the aneurysm. Ultrsound: Ultrasonography usually gives a clear picture of the size of an aneurysm. Ultrasound has about 98% accuracy in measuring the size of the aneurysm, and is safe and noninvasive. But ultrasound cannot accurately define the extent of the aneurysm and is inadequate for surgical repair planning. CT: CT scanning of the abdomen, particularly with intravenous contrast dye, can be highly accurate in determining the size and extent of the aneurysm, and its relation to the renal arteries. Also it can be

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Those whom are symptomatic may have any of the following:

Abdominal pain

Back pain

Distal embolisation

Acute rectal bleed herald bleed due to an aorto-enteric fistulaDo have any pain?

In acute cases the pain may be so severe the patient may not be able to localise the pain. A patient with a ruptured AAA will be in a shocked state and only a collateral history will be possible. Generally in the chronic setting, the pain is more a discomfort (pressure effects on the adjacent lumbar vertebral bodies), it may have started a couple of days previously and settled only to return more severely. This may be a sign of a contained leaking AAA, or pancreatitis, gastritis or gallstone disease.Does the pain move anywhere?

As the Aorta is a retroperitoneal structure the pain is often noted in the back, and may even be described as shooting from the front right through to the back. A tearing sensation may be described if the aneurysm dissects. A rapidly expanding abdominal aneurysm can cause sudden onset of severe, steady, and worsening lower back and lower abdominal pain. A rapidly expanding aneurysm is also at imminent risk of rupture. Actual rupture of an abdominal aneurysm can cause sudden onset of back and abdominal pain, sometimes associated with abdominal distension, a pulsating abdominal mass, and even shockDoes the pain come and go?The pain is usually steady but may be relieved by changing position. The person may also become aware of an abnormally prominent abdominal pulsation.InvestigationsPFA:

In about 90% of the cases, X-rays of the abdomen show calcium deposits in the aneurysm wall. But plain x-rays of the abdomen cannot determine the size and the extent of the aneurysm.Ultrsound:

Ultrasonography usually gives a clear picture of the size of an aneurysm. Ultrasound has about 98% accuracy in measuring the size of the aneurysm, and is safe and noninvasive. But ultrasound cannot accurately define the extent of the aneurysm and is inadequate for surgical repair planning.CT:

CT scanning of the abdomen, particularly with intravenous contrast dye, can be highly accurate in determining the size and extent of the aneurysm, and its relation to the renal arteries. Also it can be determined if there is leaking f the aneurysm which may lead to imminent rupture!Pre operative assessment:

Cardiac unstable angina, Recent MI, CCF

ECG, Stress Test, Echo, Coronary Angiogram

70% of patients with an AAA will have significant Coronary Artery Disease

Pulmonary Respiratory reserve

PFTs, CXR, ABG

Renal Cr >260

Prophylactic procedure

Not all patients will die due to their AAA.