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31 Cards in this Set
- Front
- Back
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who gets screened for a AAA?
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men 65-75 who have ever smoked--> do abdominal U/S
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sxs of AAA
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pulsatile abdominal mass
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tx AAA conservatively if...
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- <5cm
- asympt --> monitor growth every 3-12mo |
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surgery for AAA indicated if:
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- >5cm
- growing <4mm/yr |
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severe sudden abd/flank/back pain, shock, tender pulsatile mass
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ruptured AAA (50% die before reaching hospital)
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#1 COD post-op AAA repair
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MI
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post-op AAA complications
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- MI (#1 COD)
- ischemic colitis (bldy diarrhea) - ASA syndrome (wkness, dec'd pain w/preserved vibr, proprio) - aortoenteric fistula (1-2yrs later if brisk GI bleeding) |
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acute abdom pain in pt w/Afib subtherapeutic on warfarin or pt s/p vasoconstrictors (shock, bypass)
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acute mesenteric ischemia
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work up for acute abdom pain concerning for acute mesenteric ischemia
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angiography (aorta & SMA/IMA)
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tx for acute mesenteric ischemia
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embolectomy
(if thrombus, or aortomesenteric bybass) |
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describe chronic mesenteric ischemia
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-slow progressing stenosis
-reqs stenosis of 2.5 vessels (celiac, SMA, IMA) -severe MEG pain aft eating, food fear, wt loss ("pain out of proportion to exam") |
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dx chronic mesenteric ischemia w/..
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duplex or angiography
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tx chronic mesenteric ischemia w/...
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aortomesenteric bypass or trans aortic mesenteric endarterectomy
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tx acute arterial occlusion w/...
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-immed heparin + prep for surgery
-surgery (embolectomy, bypass) -thrombolytics if no surg in <2wks, hemorrhagic stroke |
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surgery for acute arterial occlusion
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-embolectomy or bypass
-done w/in 6 hrs to avoid loss |
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complications of acute arterial occlusion fixation
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compartment synd during reperfusion period--> do fasciotomy, watch for myoglobinuria
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pain in butt, calf, or thigh upon exertion
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claudication
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best test for claudication
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ankle-brachial index
(nml = >1) |
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ABI for claudication & ulcers
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0.4-0.8
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tx of claudication & ulcers w/ABI 0.4-0.8
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med mgmt
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ABI for limb ischemia
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0.2-0.4
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tx of limb ischemia w/ABI 0.2-0.4
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surgery
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ABI for gangrene
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<0.2
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tx of gangrene w/ABI <0.2
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may req amputation
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dx DVT w/...
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duplex U/S
(& also check for PE) |
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tx DVT w/...
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heparin, then overlap w/warfarin for 5 days, then cont warfarin for 3-6 mos
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complications of DVT
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post phlebotic synd = chronic valvular incompetence, cyanosis & edema
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signs of PE
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- R heart strain on EKG
- sinus tachycardia - decr vascular markings on CXR - wedge infarct - ABG w/low CO2 & O2 |
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if PE suspected, next step?
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give HEPARIN first! before w/u!
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w/u of PE:
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V/Q scan, then spiral CT
(pulm angiography is gold std) |
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tx of PE
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- heparin warfarin overlap
- use thrombolytics if severe but NOT if s/p surgery or hemorrhagic stroke - surgical thrombectomy if life thrxning - IVC filter if contraindications to chronic coag |
