Ebook 100 cases in surgery (2nd edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook 100 cases in surgery (2nd edition): Part 2
Ebook 100 cases in surgery (2nd edition): Part 2
https://khothuvien.cori!VASCULARCASE 42: A PULSATILE MASS IN THE ABDOMENHistoryA 68-year-old man presents to the emergency department with a 1-h histo Ebook 100 cases in surgery (2nd edition): Part 2ory of pain in the left side of his abdomen. The pain started suddenly while he was getting up from a chair. It became constant and radiated through to his back. His past medical history includes hypertension and stable angina. He lives with his wife and is normally independent.ExaminationThe patien Ebook 100 cases in surgery (2nd edition): Part 2t is pale, sweaty and clammy. His pulse is 100/min and the blood pressure is 90/50 mmHg. Heart sounds are normal and the chest is dear. Examination ofEbook 100 cases in surgery (2nd edition): Part 2
the abdomen reveals a large tender mass in the epigastrium. The mass is both pulsatile and expansile. The peripheral pulses are present and equal on https://khothuvien.cori!VASCULARCASE 42: A PULSATILE MASS IN THE ABDOMENHistoryA 68-year-old man presents to the emergency department with a 1-h histo Ebook 100 cases in surgery (2nd edition): Part 29/L4.0-11.0 X 109/LPlatelets250 X 109/L150-400 X 109/LSodium143mmol/L135-145mmo!/LPotassium4.4mmol/L3.5-5.0mmol/LUrea4.2mmol/L2.S-6.7 mmol/LCreatinine72pmol/L44-BOpmol/LC-reactive protein (CRP)20mg/L<5mg/LAmylase22IU/dL0-100 lU/dLQuestions•What is the most likely diagnosis?•What is required in the i Ebook 100 cases in surgery (2nd edition): Part 2mmediate management of this patient?•What is the prognosis?97100 Cases in SurgeryANSWER 42The most likely diagnosis is a ruptured abdominal aortic aneEbook 100 cases in surgery (2nd edition): Part 2
urysm. An aortic aneurysm is defined as an increase in aortic diameter by greater than 50 per cent of normal (>3cm). The aneurysm diameter can increashttps://khothuvien.cori!VASCULARCASE 42: A PULSATILE MASS IN THE ABDOMENHistoryA 68-year-old man presents to the emergency department with a 1-h histo Ebook 100 cases in surgery (2nd edition): Part 2 per cent 5-year risk of rupture•6.0-6.9cm, approximately 35 per cent 5-year risk of rupture•More than 7 cm, approximately 75 per cent 5-year risk of ruptureAneurysm rupture (Figure 42.1) can present with abdominal pain radiating to the back, groin or iliac fossae. An expansile mass is not always de Ebook 100 cases in surgery (2nd edition): Part 2tectable and other conditions, such as acute pancreatitis or mesenteric infarction, should always be considered. Intravenous access should be establisEbook 100 cases in surgery (2nd edition): Part 2
hed quickly with two large-bore cannulae. Ten units of crossmatched blood, fresh-frozen plasma and platelets should be requested. Tile bladder should https://khothuvien.cori!VASCULARCASE 42: A PULSATILE MASS IN THE ABDOMENHistoryA 68-year-old man presents to the emergency department with a 1-h histo Ebook 100 cases in surgery (2nd edition): Part 2e a second fatal bleed. The patient should be taken immediately to theatre and prepared for surgery. A vascular clamp is placed onto the aorta above the leak and a graft used to replace the aneurysmal segment. Endovascular repair of ruptured aneurysms, using a stent graft introduced via the femoral Ebook 100 cases in surgery (2nd edition): Part 2arteries, is now a well-established alternative to the open operation. The patient must undergo computerized tomography (CT) scanning prior to endovasEbook 100 cases in surgery (2nd edition): Part 2
cular repair to ensure that the morphology of the aneurysm is suitable for this approach.The mortality from a ruptured aneurysm is high, with haemorrhhttps://khothuvien.cori!VASCULARCASE 42: A PULSATILE MASS IN THE ABDOMENHistoryA 68-year-old man presents to the emergency department with a 1-h histo Ebook 100 cases in surgery (2nd edition): Part 2 scan demonstrating a ruptured abdominal aortic aneurysm (top arrow) and retroperitoneal haematoma (lower arrow).KEY POINTS•Aneurysms less than 5.5cm in diameter should be monitored.•Aneurysms greater than 5.5cm in diameter should be considered for surgical intervention.•Aneurysms can be repaired by Ebook 100 cases in surgery (2nd edition): Part 2 both open and endovascular procedures.https://khothuvien.cori!VASCULARCASE 42: A PULSATILE MASS IN THE ABDOMENHistoryA 68-year-old man presents to the emergency department with a 1-h histohttps://khothuvien.cori!VASCULARCASE 42: A PULSATILE MASS IN THE ABDOMENHistoryA 68-year-old man presents to the emergency department with a 1-h histoGọi ngay
Chat zalo
Facebook