Abdominal aortic aneurysm physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Template:Abdominal aortic aneurysm}} | {{Template:Abdominal aortic aneurysm}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; {{HP}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; {{HP}} {{RG}} | ||
==Overview== | ==Overview== | ||
| Line 9: | Line 9: | ||
===General=== | ===General=== | ||
====Vital Signs==== | ====Vital Signs==== | ||
The following may or may not be present: | The following may or may not be present:<ref name="MollPowell2011">{{cite journal|last1=Moll|first1=F.L.|last2=Powell|first2=J.T.|last3=Fraedrich|first3=G.|last4=Verzini|first4=F.|last5=Haulon|first5=S.|last6=Waltham|first6=M.|last7=van Herwaarden|first7=J.A.|last8=Holt|first8=P.J.E.|last9=van Keulen|first9=J.W.|last10=Rantner|first10=B.|last11=Schlösser|first11=F.J.V.|last12=Setacci|first12=F.|last13=Ricco|first13=J.-B.|title=Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery|journal=European Journal of Vascular and Endovascular Surgery|volume=41|year=2011|pages=S1–S58|issn=10785884|doi=10.1016/j.ejvs.2010.09.011}}</ref> | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
*[[Hypotension]] | *[[Hypotension]] | ||
===Skin=== | |||
* Skin examination of patients with abdominal aortic aneurysm is usually normal. | |||
===HEENT=== | |||
* HEENT examination of patients with abdominal aortic aneurysm is usually normal. | |||
===Neck=== | |||
* Neck examination of patients with abdominal aortic aneurysm is usually normal. | |||
===Lungs=== | |||
* Pulmonary examination of patients with abdominal aortic aneurysm is usually normal. | |||
===Heart=== | |||
* Cardiovascular examination of patients with abdominal aortic aneurysm is usually normal.<ref name="FinkLederle2000">{{cite journal|last1=Fink|first1=Howard A.|last2=Lederle|first2=Frank A.|last3=Roth|first3=Craig S.|last4=Bowles|first4=Carolyn A.|last5=Nelson|first5=David B.|last6=Haas|first6=Michele A.|title=The Accuracy of Physical Examination to Detect Abdominal Aortic Aneurysm|journal=Archives of Internal Medicine|volume=160|issue=6|year=2000|pages=833|issn=0003-9926|doi=10.1001/archinte.160.6.833}}</ref> | |||
*[[Tachycardia]] may be present in ruptured aneurysm. | |||
* Radiated [[bruit]] may be present in [[auscultation]]. | |||
===Abdomen=== | ===Abdomen=== | ||
====Inspection==== | ====Inspection==== | ||
Flank ecchymosis ([[Grey Turner sign]]) may be present in cases of ruptured aneurysms due to retroperitoneal hemorrhage. | Flank ecchymosis ([[Grey Turner sign]]) may be present in cases of ruptured aneurysms due to retroperitoneal hemorrhage.<ref name="FinkLederle20002">{{cite journal|last1=Fink|first1=Howard A.|last2=Lederle|first2=Frank A.|last3=Roth|first3=Craig S.|last4=Bowles|first4=Carolyn A.|last5=Nelson|first5=David B.|last6=Haas|first6=Michele A.|title=The Accuracy of Physical Examination to Detect Abdominal Aortic Aneurysm|journal=Archives of Internal Medicine|volume=160|issue=6|year=2000|pages=833|issn=0003-9926|doi=10.1001/archinte.160.6.833}}</ref> | ||
====Palpation==== | ====Palpation==== | ||
A pulsating or non-pulsating [[abdominal mass]] may be palpable. | A pulsating or non-pulsating [[abdominal mass]] may be palpable. | ||
====Auscultation==== | ====Auscultation==== | ||
The presence of an [[abdominal bruit]] is nonspecific for a nonruptured aneurysm and can be present in cases of visceral or [[renal artery stenosis|renal arterial stenosis]] <ref name="Chaikof-2009">{{Cite journal | last1 = Chaikof | first1 = EL. | last2 = Brewster | first2 = DC. | last3 = Dalman | first3 = RL. | last4 = Makaroun | first4 = MS. | last5 = Illig | first5 = KA. | last6 = Sicard | first6 = GA. | last7 = Timaran | first7 = CH. | last8 = Upchurch | first8 = GR. | last9 = Veith | first9 = FJ. | title = The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. | journal = J Vasc Surg | volume = 50 | issue = 4 Suppl | pages = S2-49 | month = Oct | year = 2009 | doi = 10.1016/j.jvs.2009.07.002 | PMID = 19786250 }}</ref>. | The presence of an [[abdominal bruit]] is nonspecific for a nonruptured aneurysm and can be present in cases of visceral or [[renal artery stenosis|renal arterial stenosis]] <ref name="Chaikof-2009">{{Cite journal | last1 = Chaikof | first1 = EL. | last2 = Brewster | first2 = DC. | last3 = Dalman | first3 = RL. | last4 = Makaroun | first4 = MS. | last5 = Illig | first5 = KA. | last6 = Sicard | first6 = GA. | last7 = Timaran | first7 = CH. | last8 = Upchurch | first8 = GR. | last9 = Veith | first9 = FJ. | title = The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. | journal = J Vasc Surg | volume = 50 | issue = 4 Suppl | pages = S2-49 | month = Oct | year = 2009 | doi = 10.1016/j.jvs.2009.07.002 | PMID = 19786250 }}</ref>. | ||
===Management of Patients With Peripheral Artery Disease=== | |||
===Symptomatic Aortic or Iliac Aneurysms=== | |||
* Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.<ref name="pmid23473760">{{cite journal| author=Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L et al.| title=Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. | journal=J Am Coll Cardiol | year= 2013 | volume= 61 | issue= 14 | pages= 1555-70 | pmid=23473760 | doi=10.1016/j.jacc.2013.01.004 | pmc=4492473 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23473760 }} </ref> | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''In patients with the clinical triad of abdominal and/or back pain, a pulsatile abdominal mass, and hypotension, immediate surgical evaluation is indicated.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''In patients with symptomatic aortic aneurysms, repair is indicated regardless of diameter. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | |||
|} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[CME Category::Cardiology]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
| Line 30: | Line 61: | ||
[[Category:Up-To-Date cardiology]] | [[Category:Up-To-Date cardiology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
Latest revision as of 14:42, 7 January 2020
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Abdominal Aortic Aneurysm Microchapters |
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Differentiating Abdominal Aortic Aneurysm from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Abdominal aortic aneurysm physical examination On the Web |
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Directions to Hospitals Treating Abdominal aortic aneurysm physical examination |
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Risk calculators and risk factors for Abdominal aortic aneurysm physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Hardik Patel, M.D. Ramyar Ghandriz MD[3]
Overview
A physical examination has low sensitivity in the detection of small abdominal aortic aneurysms (29-61% for abdominal aortic aneurysms 3.0-3.9 cm in diameter), but has a sensitivity of 76-82% in the detection those abdominal aortic aneurysms that are 5.0 cm or larger that may warrant repair. It is easier to detect a pulsatile mass in thin patients and those who do not have tense abdomens. Contrary to popular belief, gentle palpation of abdominal aortic aneurysms is safe and does not precipitate a rupture.
Physical Examination
General
Vital Signs
The following may or may not be present:[1]
Skin
- Skin examination of patients with abdominal aortic aneurysm is usually normal.
HEENT
- HEENT examination of patients with abdominal aortic aneurysm is usually normal.
Neck
- Neck examination of patients with abdominal aortic aneurysm is usually normal.
Lungs
- Pulmonary examination of patients with abdominal aortic aneurysm is usually normal.
Heart
- Cardiovascular examination of patients with abdominal aortic aneurysm is usually normal.[2]
- Tachycardia may be present in ruptured aneurysm.
- Radiated bruit may be present in auscultation.
Abdomen
Inspection
Flank ecchymosis (Grey Turner sign) may be present in cases of ruptured aneurysms due to retroperitoneal hemorrhage.[3]
Palpation
A pulsating or non-pulsating abdominal mass may be palpable.
Auscultation
The presence of an abdominal bruit is nonspecific for a nonruptured aneurysm and can be present in cases of visceral or renal arterial stenosis [4].
Management of Patients With Peripheral Artery Disease
Symptomatic Aortic or Iliac Aneurysms
- Management of Patients With Peripheral Artery Disease (Compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations) : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.[5]
| Class I |
| "1.In patients with the clinical triad of abdominal and/or back pain, a pulsatile abdominal mass, and hypotension, immediate surgical evaluation is indicated.(Level of Evidence: B)" |
| "2.In patients with symptomatic aortic aneurysms, repair is indicated regardless of diameter. (Level of Evidence: C) " |
References
- ↑ Moll, F.L.; Powell, J.T.; Fraedrich, G.; Verzini, F.; Haulon, S.; Waltham, M.; van Herwaarden, J.A.; Holt, P.J.E.; van Keulen, J.W.; Rantner, B.; Schlösser, F.J.V.; Setacci, F.; Ricco, J.-B. (2011). "Management of Abdominal Aortic Aneurysms Clinical Practice Guidelines of the European Society for Vascular Surgery". European Journal of Vascular and Endovascular Surgery. 41: S1–S58. doi:10.1016/j.ejvs.2010.09.011. ISSN 1078-5884.
- ↑ Fink, Howard A.; Lederle, Frank A.; Roth, Craig S.; Bowles, Carolyn A.; Nelson, David B.; Haas, Michele A. (2000). "The Accuracy of Physical Examination to Detect Abdominal Aortic Aneurysm". Archives of Internal Medicine. 160 (6): 833. doi:10.1001/archinte.160.6.833. ISSN 0003-9926.
- ↑ Fink, Howard A.; Lederle, Frank A.; Roth, Craig S.; Bowles, Carolyn A.; Nelson, David B.; Haas, Michele A. (2000). "The Accuracy of Physical Examination to Detect Abdominal Aortic Aneurysm". Archives of Internal Medicine. 160 (6): 833. doi:10.1001/archinte.160.6.833. ISSN 0003-9926.
- ↑ Chaikof, EL.; Brewster, DC.; Dalman, RL.; Makaroun, MS.; Illig, KA.; Sicard, GA.; Timaran, CH.; Upchurch, GR.; Veith, FJ. (2009). "The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines". J Vasc Surg. 50 (4 Suppl): S2–49. doi:10.1016/j.jvs.2009.07.002. PMID 19786250. Unknown parameter
|month=ignored (help) - ↑ Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss L; et al. (2013). "Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA Guideline Recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 61 (14): 1555–70. doi:10.1016/j.jacc.2013.01.004. PMC 4492473. PMID 23473760.