تمدد الأبهر البطني

Definition

Abdominal aortic aneurysm is a permanent widening of the abdominal aorta, usually below the renal arteries, defined as a diameter of 3 cm or more.

Risk factors

Smoking, men over 65, hypertension and family history.

Symptoms

• Usually silent and found incidentally
• A pulsating mass around or above the umbilicus
• Abdominal or back pain when it expands quickly

Rupture

Sudden severe back or flank pain, hypotension, tachycardia and sometimes flank bruising. Mortality is very high.

Diagnosis

Ultrasound for screening and surveillance, CT before repair.

Treatment

• Regular size surveillance
• Repair when large (often 5.5 cm in men), growing fast or symptomatic, open or endovascular (EVAR)

Nursing care

• Avoid repeated deep palpation of the mass
• BP control and smoking-cessation teaching
• After repair: limb pulses, kidney function and bleeding signs

Exam point

The rupture triad is back or abdominal pain, hypotension and a pulsating mass. Prepare for theatre at once, accepting a relatively low pressure until bleeding is controlled.