Question

A 66 year-old male presents to the local ER at 6 AM. The patient reports that he has been having severe chest pain since last night before he went to bed. The patient says that he just simply thought that he was having a “bad case of indigestion and gas” after eating a bunch of fatty foods while watching the football with his friends last night. He says he took Pepto Bismol to help ease the pain. The patient says that he woke up around 3 AM this morning with increased upper and mid abdominal pain. He described the pain as “sharp and gnawing” right underneath his rib cage. The patient was immediately brought back to a room from triage. The ER staff was about to do a shift change and so the overnight physician medically screened the patient and ordered a standard set of lab tests. The patient was given a 325 mg aspirin tablet after getting undressed and laying down on the bed. After approximately 15 min after arrival to his room, the patient started writhing in the bed complaining of increased abdominal pain. The patient reported his pain level of 20 on a scale of 1 to 10. The patient’s history is significant for noncompliant hypertension, hypercholesterolemia, moderate obesity, and smoking 1.5pk/d, but had stopped five years ago.

Upon physical examination, the patient was diaphoretic, and had pallor. Strong pulsations were found with light palpation over the middle of the abdomen. With deeper palpation, aortic bruits were detected by auscultation. There was radiation of the pain to the lumber area of the back. The morning physician ordered a series of diagnostic imaging studies to determine if there were any issuescontributing to the patient’s pain within the abdomen. After the imaging studies were completed. The radiologist called the physician on duty and said that patient needed immediate surgery. One of the imaging studies done showed there was a 5.4 cm diameter measurement of the aorta. Arrangement were immediately made to fly the patient to a trauma center for surgery.

1. What condition does this patient have?

2. What are the diagnostic testing that the morning physician ordered?

3. What are the risk factors that contributed to the patient’s condition?

4. What is the proper protocol for treatment of the patient’s condition? How is it done?

5. What would happen if the patient did not receive the appropriate treatment in time?

Answer 1

1) ABDOMINAL AORTIC ANEURYSM:

An aneurysm is an area of a localized widening (dilatation)of a blood vessel.

2) DIAGNOSTIC TESTS:-

Complete blood count :-

canpredict the calcification grade of abdominal aortic aneurysm

Abdominal ultrasound

CT scan

MRI

Risk factors:-

Risk factors are mainly divided into two types

A)predisposing factors

B) protective factors

A) predisposing factors:

Smoking

Above 60 years of age

Male gender

Family history

Hypertension

Dislipidemia

COPD

Obesity

PROTECTIVE FACTORS:-

Diabetes mellitus

Female gender

<50 years of age

protocol:- for this patient generally surgery is recommended because aneurysm is 5.4 cm( surgery is recommended aneurysm is 4.8 to 5.6 cms)it's growing quickly

Depending on the several factors, including location and size of the aneurysm,age repair options might includes.

Open abdominal surgery:-This involves removing the damaged section of the aorta and replacing it with asynthetic tube(graft),which is sewn into place.

endovascular repair:this is less invasive procedure is more often.doctors attache a synthetic graft to the end of a thin tube(catheter)that is inserted through an artery in your leg and threaded into your aorta

5) A Ruptured aneurysm can cause massive internal bleeding which is usually fatal. The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in abdomen.with a rupture either die before they reach hospital or patient is not survive with surgery.