tailieunhanh - Emergency Vascular Surgery A Practical Guide - part 5

Bệnh nhân với một AAA vỡ những người không phải là cú sốc hiện nay có dấu hiệu tương tự như một loạt các bệnh cấp tính ở bụng hoặc quay trở lại. Để tránh chẩn đoán sai với các điều kiện mà không cần phải mở bụng khẩn cấp, cẩn thận kiểm tra các động mạch chủ bụng là quan trọng. | Diagnostics 77 Differential Diagnosis Patients with a ruptured AAA who are not in shock present with signs that are similar to a variety of other acute diseases in the abdomen or back. To avoid misdiagnosis with conditions that do not require emergency laparotomy careful examination of the abdominal aorta is important. Ruptured AAA or symptomatic aneurysms with incipient rupture should be included in the discussion about differential diagnosis in all abdominal emergencies particular in elderly men. Kidney stones located in the ureter diverticulitis constipation intestinal obstruction pancreatitis gastric or intestinal perforation intestinal ischemia vertebral body compression and even acute myocardial infarction are all primary diagnoses that can be mixed up with a ruptured AAA. Of course there is a potential risk of sending a patient home believing that for example a ureteral stone has caused the trouble when AAA rupture is the true diagnosis. A significant risk is also related to performing a major operation because of a suspected ruptured AAA in a patient who actually is suffering from an acute myocardial infarction. The only way to avoid this is to keep the AAA diagnosis in mind and to carefully examine the patient. Another important differential diagnosis is aortic dissection. It is common that a patient will initially have been treated at a smaller healthcare unit or in the emergency department where an ultrasound was performed and misinterpreted as dissection in an aortic aneurysm. This misunderstanding is caused by the thrombus within the AAA which can be interpreted as a doubled aortic lumen. There is however a clear distinction between rupture and dissection. Rupture is a true burst of the aortic wall with bleeding out from the vessel. Dissection starts with a tear in the inner layer of the vascular wall through which the blood passes and cause a longitudinal separation of the layers causing a double lumen. Rupture is common in AAA but .