Here are some amazing summaries for more advanced biology courses at Temple. They definitely helped me succeed and get into medical school. Great outlines, mnemonics, detailed study guides.
ABDOMINAL AORTIC ANEURYSM Fast Facts - Aneurysm: permanent dilation of an artery with an increase in diameter >50% (1.5 normal size) - Ectasia: diameter increased <50% - Infrarenal aorta most common - Male aortas are 20% larger than female - If there is a ƉŽƉůŝƚĞĂůĂŶĞƵƌLJƐŵ͕LJŽƵŵƵƐƚůŽŽŬĨŽƌ͕ŽƚŚĞƌǁŝƐĞŝƚ͛Ɛmalpractice - Familial component: screen for any first degree relative Cause/Pathogenesis - Atherosclerosis in most cases - Increased collagen:elastin - Inflammation - Chlamydia/syphilis - Higher rupture risk in emphysema patients - Ehlers-Danlos Clinical Manifestations - Most are asymptomatic o incidental finding on imaging/abdominal surgery - Back/flank/abdominal pain - Abrupt onset 10/10 pain - Hypotension - Shock - Pulsatile abdominal mass - 25% are ruptured Diagnostic Methods 1. Physical: AAA ~5cm to palpate 2. XR: ĐĂŶĞƐƚĂďůŝƐŚĚŝĂŐŶŽƐŝƐ͕ĐĂŶ͛ƚƚĞůůLJŽƵŵƵĐŚŽĨĂŶLJƚŚŝŶŐĞůƐĞ 3. US: Accurate, not good for thoracic/suprarenal, not accurate for rupture 4. CT: radiation, good visualization, nephrotoxic 5. MRI: better at visualizing 6. Aortography: GOLD STANDARD, rarely used, CTA less invasive Operate/Follow Up - If AAA <4.5 cm and asymptomatic repeat US in 6 mo o if unchanged, return in 1 year - If AAA >4.5 cm repeat US 1 year - If 5cm, >1cm growth in 1 year, or if there are any symptoms (regardless of size)
operate - Once ruptured, mortality is 100% (said 90% at beginning so idk) Treatment No cure, we want to decrease rupture ƌŝƐŬďLJ͙ - Control BP - No heavy lifting (>15 lbs) - Stop smoking - Ambulation - Antiplatelet - 3 surgical approaches o Oblique: retroperitoneal, avoids juggling organs Prior to surgery - Cardiac eval, pulmonary function test, type & screen Post-Op Must monitor indefinitely Repeat CT @ - 1 month - 6 month - 1 year - yearly PERIPHERAL VASCULAR DISEASE OF THE LOWER EXTREMITIES General Considerations - 70% stenosis operate Causes of ASPVD - Genetics - Tobacco use - HTN - DM - HLD - Increased homocysteine - Female (estrogen, smaller arteries) Pathophysiology of LEOD - Diabetic patient
more susceptible to ischemia
higher risk of amputation o neuropathy, decreased arterial flow/resistance to infection o Charcot joint Symptoms - Intermittent claudication o cold calves/feet, presents similar to compartment syndrome o Paralysis, pulseless, pain, pallor, paresthesia, poikilothermy (cold) - Leriche Syndrome: pain in buttocks due to aorta/aortoiliac disease - Rest pain - Ischemia/gangrene Physical Exam - Bruit - Thrills (bruit you can feel) - cold skin - capillary refill - ulcers - Pulse exam (0: no feel, 1: barely there, 2: good/normal) - Monofilament testing: always do on DM pts, checks neuropathy Diagnosing - ABI
Doppler LE Arterial
Angiogram
surgical intervention - Segmental limb pressure/ABI o Pressure legs > arms o 1.0 Normal o >1.3: calcification, ignore this o <0.9: PAD <0.5 ʹ severe <0.4 ʹ pain at rest <0.3 ʹ ischemia/gangrene - Duplex scanning o Triphasic: good arterial flow o Biphasic/Monophasic: bad flow - Contrast study o Gold Standard: Aortogram with runoffs o CT/MRA ʹ pay attn to renal function - Angiograms (See below)
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