Abdominal aortic aneurysms (AAAs) are relatively common and are potentially life-threatening. Patients at greatest risk for AAA are men who are older than 65 years and have peripheral atherosclerotic vascular disease.

[Signs and symptoms]
AAAs are usually asymptomatic until they expand or rupture. An expanding AAA causes sudden, severe, and constant low back, flank, abdominal, or groin pain. Syncope may be the chief complaint, however, with pain less prominent.

Most clinically significant AAAs are palpable upon routine physical examination. The presence of a pulsatile abdominal mass is virtually diagnostic but is found in fewer than half of all cases.

Patients with a ruptured AAA may present in frank shock, as evidenced by cyanosis, mottling, altered mental status, tachycardia, and hypotension. Whereas abrupt onset of pain due to rupture of an AAA may be quite dramatic, associated physical findings may be very subtle. Patients may have normal vital signs in the presence of a ruptured AAA as a consequence of retroperitoneal containment of hematoma.

At least 65% of patients with a ruptured AAA die of sudden cardiovascular collapse before arriving at a hospital.

[Diagnosis]
No specific laboratory studies can be used to diagnose AAA. The following imaging studies, however, can be employed diagnostically:

**Ultrasonography - Standard imaging technique for AAA

**Plain radiography - Using this method to evaluate patients with AAA is difficult because the only marginally specific finding, aortic wall calcification, is seen less than half of the time

**Computed tomography (CT) - This offers certain advantages over ultrasonography in defining aortic size, rostral-caudal extent, involvement of visceral arteries, and extension into the suprarenal aorta

[Management]
AAAs are treated with surgical repair. When indicated, unruptured aneurysms can be addressed with elective surgery, whereas ruptured AAAs necessitate emergency repair. The primary methods of AAA repair are as follows:

1) Open - This requires direct access to the aorta via a transperitoneal or retroperitoneal approach

2) Endovascular - This involves gaining access to the lumen of the abdominal aorta, usually via small incisions over the femoral vessels; an endograft, typically a polyester or Gore-Tex graft with a stent exoskeleton, is placed within the lumen of the AAA, extending distally into the iliac arteries

Photo © My Senior Resident
Info: [Medscape]

anonymous asked:

thanks for the allergy response, that's super helpful for people (like me two years ago) who are worried but not sure! it might also be helpful to note that even specialists sometimes don't test as extensively or effectively as you'd hope. if you go to one and they don't test for or elaborate on all the issues you think are important, you should keep pushing. and above all, trust your body -- if you've reacted badly to something in the past, don't assume it's safe just because they say it's fine

If you have reacted badly to something in the past, TELL YOUR DOCTOR. Even if it doesn’t show up on the allergy test, your doctor needs to know and should put it in your chart. As someone with ASD, I have a lot of food sensitivities that aren’t precisely allergies, which means they don’t show up on the test, but they’re still things I need to avoid. My medical chart reflects that.

It’s your body and you know it better than anyone, so if you feel like something is wrong, you need to say something, even if the tests say otherwise.

Southern Women In The Civil War- This was the trial that tested the grain and purity of our womanhood, and left it without alloy of fear or selfishness

And there was no section of the South where this desire to do all they might, and more was oftener in evidence than another. In every camp of the early days of the great struggle, the incoming troops bore trophies of home love, and as the war progressed to need, then to dire want–the sacrifices of those women at home became almost a poem, and one most pathetic. Dress–misconceived as the feminine fetish–was forgotten in the effort to clothe the boys at the front; the family larder–ill-stocked at the best–was depleted to nothingness, to send to distant camps those delicacies–so equally freighted with tenderness and dyspepsia–which too often never reached their destination. And later, the carpets were taken from the floors, the curtains from the windows–alike in humble homes and in dwellings of the rich–to be cut in blankets for the uncomplaining fellows, sleeping on freezing mud.

So wide, so universal was the rule of self-sacrifice, that no one reference to it can do justice to the zeal and devotion of “Our Girls.” And the best proof of both was in the hospitals, where soon began to congregate the maimed and torn forms of those just sent forth to glory and victory. This was the trial that tested the grain and purity of our womanhood, and left it without alloy of fear or selfishness. And some of the women who wrought in home and hospital–yen in trench and on the firing line–for the “boys,” had never before handled aught rougher than embroidery; or seen aught more fearsome than its needle-prick. Yes, these untried women, young and old, stood fire like veteran regulars! indeed, even more bravely in moral view, for they missed the stimulus of the charge–the tonic in the thought of striking back! 

T. C. DeLeon’s Eloquent Tribute to Their Courage WHAT THEY DID FOR WOUNDED AND SUFFERING SOLDIERS. The Hospital Offered Opportunities for Heroism. [From the New Orleans, La., Picayune, June 12, 1904.] http://civilwarhome.com/southernwomen.htm

“Aftermath” Painting- shows Civil War nurse, Fannie Beers (model-Laura Bradley) at Brown’s Mill battlefield the afternoon of the battle. By Martin Pate http://www.martinpate.com/

Medical Student Resources 101

I’ve been thinking about this post for quite a while now, and I have finally decided how I want to approach it. If you have any suggestions, please comment or message me! So, when I started medical school 18 months ago all I had available to me was a crazy long list of textbooks recommended by the university. It has been an uphill battle figuring out what textbooks are helpful and which are less than helpful. So this is my masterpost of resources I’ve used for medical school thus far, organised by systems! 


Basics

You’ll need a good anatomy atlas, physiology text and pathophysiology book as a bare minimum. Most universities also guide you towards a clinical skills book of some sort.

Anatomy: 

Rohen and Yokochi “Color Atlas of Anatomy: A Photographic Study of the Human Body”

I used an old version of this book, and it was amazing for our human dissection block, I would strongly recommend it. 

Physiology:

Boron “Medical Physiology”

Guyton and Hall  “Textbook of Medical Physiology”

I used a combination of these two, Boron can be very heavy, so I only used it for topics I had a really good grasp of and wanted to know more about. I would recommend Guyton over Boron if you can only get one. 

Pathophysiology:

Robbins and Cotran “Pathologic Basis of Disease”

This is one of the best books ever written. I cannot recommend it highly enough. 

Clinical and Practical Skills:

Talley and O’Connor “Clinical Examination” 

This was recommended by my university. It is a good textbook, however I’ve recently discovered: 

Thomas and Monaghan “Oxford Handbook of Clinical Examination and Practical Skills”

and I personally prefer this, but it is much more concise, so Talley is great for all the background information. 


Cardiovascular

Lilly “Pathophysiology of Heart Disease” 

This textbook is fantastic, very easy to read and covered all of our cardiovascular block thoroughly.


Respiratory

West “Respiratory Physiology: The Essentials”

This book can be a bit hit and miss. I really didn’t like respiratory physiology, so I struggled a bit with this one, I used a combination of Guyton and Hall, and West. For pathophysiology you can’t go wrong with Robbins and Cotran.


Genitourinary

I didn’t use a specialised book for this block. For physiology I used Boron, which was insanely hard as a first year student. I also used Guyton and Hall at the end of the block, which was much better. So I’d definitely recommend Guyton and Hall for physiology and Robbins and Cotran for pathophysiology. 


Gastrointestinal

Chew “Crash Course Gastrointestinal System 3e” 

I really liked this book for this book, I thought it covered the hepatic system very well, overall it was very easy to read and understand. This book and Guyton and Hall if you wanted to supplement it would be great. As always, Robbins and Cotran for indepth pathophysiology. 


Endocrine and Reproductive

The little orange book (TBA)

This was one of my favourite blocks! The university recommended Greenspan’s “Basic and Clinical Endocrinology”, which for what we needed was probably too much. I found a fantastic little orange book at the library, which I will need to go get the name of, so keep an eye on this if you need a good endocrinology book. 


Psychiatry

Kaplan and Saddock’s “Synopsis of Psychiatry”

This is actually a really great book for any psychiatry you might do. We only used it for four weeks, but I’d definitely recommend hiring a copy if you can! 


Neurology and Neuroanatomy

Yogarajah “Crash Course Neurology, 4e” 

Fix “BRS Neuroanatomy”

This has been an incredibly hard block to find a good text for, at a reasonable price. These two have been very helpful, and I find them easy to read. Only time will tell if it has been enough to pass!


Musculoskeletal

Jenkins “Hollinshead’s Functional Anatomy of the Limbs and Back”

This is the most amazing textbook for any block of all time ever. Literally. It is so good! I’ve used a combination of this book, and:

Moore and Dalley’s “Clinically Oriented Anatomy” 

for our musculoskeletal block. It’s been absolutely fantastic. I’ve enjoyed it so much! I would also recommend investing in some quality flashcards. I have:

Hansen “Netter’s Anatomy Flash Cards”

Which have been great, another really great resource has been WinkingSkull.com, which you do have to pay for, but it is helpful! 


Other

So, there are a few other resources I’ve used that have been very helpful. Mostly online databases and websites but I thought it would be handy to have them. Many (most?) universities have subscriptions to them so try your university library website! 

UpToDate: www.UpToDate.com 

Everything you ever needed about anything in medicine

Best Practice: www.bestpractice.bmj.com 

This is my favourite resource. Ever. It goes through signs, symptoms, risk factors, diagnostics, differentials, everything. It is a small slice of heaven in medical school.

Lancet Review Articles 

There were a really great series on Immunology in The Lancet, I would strongly recommend trying to find them for a concise overview of immunology

Life In The Fast Lane: www.lifeinthefastlane.com

Great series on ECGs!

Radiopedia: www.radiopaedia.org

These guys are great for understanding what you’re actually supposed to be seeing on any radiological film. I’ve been using it a lot for musculoskeletal, looking at Le Fort fractures, etc. 

Toronto Notes

So I just borrowed a friend’s copy of Toronto, but I believe there may be online access. Maybe an online version. It’s great for an overview and is a little more clinically focused. I really liked it for gastrointestinal, psychiatry and neurology.

I know I’ve probably missed a few things, I’ll add them as I think of them but I hope this helps a few pre-clinical medical students out there! If it’s helpful I’ll keep you posted as I move into my clinical years on new texts and resources I find helpful! 

Hello all of my followers and mutuals I talk to daily, I have some news. yesterday, I had a heart attack I had to go to the hospital, and have a blood clot removed.  I have had two surgery’s in the past 24 hours. I am okay, and they think I will be fine.. I have had heart issues in the past, I am being looked at closely, and it will take some time for me to heal, possibly even 8 weeks. In this time.. I may not post a lot or do a lot of things.. It is important for me to focus on healing so I may only be liking or re-blogging things for awhile. I may be able to do somethings but it will not be much perhaps. I am okay I am doing well, and they expect me to recover fine they think I am over the worst of it and i will be getting additional help and check ups. please have patients with me and I hope to keep a lot of my followers!

Hey guys also:
If you’re like me and your period is super painful and you take medicine to help the pain like every six hours, but your stomach is sensitive, please avoid medicine such as ibuprofen and aleve. Amongst other problems with the medicine, it’s caused serious irritation to my stomach due to how much I take during my period. My doctor recommended medication specifically targeted for menstrual cramps. But read it first and see if it can be irritating.
My symptoms have been constant nausea and pain. Keep yourselves healthy.
Also bananas help with the pain!

cbc.ca
Ebola vaccine from Canada seems to work in trial in Guinea: WHO
Experimental vaccine from National Microbiology Laboratory '1st ray of hope': Doctors Without Borders

The experimental Ebola vaccine designed by Canadian scientists seems to work, the interim results of a trial in Guinea suggest.

If proven effective, the vaccine could be “a game changer,” said Dr. Margaret Chan, director general of the World Health Organization, which sponsored the trial.

The interim findings were published online Friday in the medical journal The Lancet.

The findings so far are persuasive, Dr. Marie-Paule Kieny, a senior author of the trial, told reporters from Geneva.

“The data so far shows that none of the 2,014 persons vaccinated developed Ebola virus disease after 10 days after vaccination,” said Kieny, who oversees research and development related to Ebola at WHO.

Continue Reading.

I’ve been waiting to calm down from yesterday to make this post. So here goes I’m as calm as I’m going to get. I had my colonoscopy done yesterday, and when I woke up the doctor who did my surgery came over to tell me how it went. Now note tmi (I went in because I was having bleeding and lower abdominal pain constantly) so the doctor says “Your colon looks absolutely fine, we didn’t find anything, it’s text book perfect.” Alright so I’m wondering why the previous time they found colitis and why I’m still bleeding off and on. The doctor doesn’t even get to that she jumps straight to my diet, (even though she just looked at my colon saw that nothing was wrong apparently even though I’m bleeding) “What does your diet consist of? Do you eat healthy or eat a lot of junk food?” Now mind you I was just waking up from anesthesia. I said “Well I don’t really have the money to buy super “healthy” things. She proceeds to say “Well that doesn’t really matter… But do you eat a lot of junk then?” And I said no not a lot. “Chips, crackers, cookies?” and I said no not really. “Well what about soda?” she asks and I said “Well yeah I probably drink more soda then I should.” and then not even a heartbeat this doctor says to me.. “You probably wouldn’t weigh as much if you didn’t drink so much soda.” hold the phone, I came in here did all this prepping for this procedure to find out why I’m bleeding and have constant lower abdominal pain and she basically just says I’m fat and I should stop because I like to drink soda??? I’m as healthy as you can get when it comes to heart health, I freaking have low blood pressure but because I weigh more than she would like she thinks it’s necessary to tell me I wouldn’t weigh as much. And she kept saying it to. “You really wouldn’t weigh as much, soda is expensive (i buy the store brand for $4.24 for 24 cans of soda…) You wouldn’t weigh so much if you just stop drinking it. Stop drinking soda.” If I didn’t say anything about soda what would she have then to throw at me just to get to tell me that I’m fat. I’m seriously so sick of people denying me health care because of their personal opinions. I don’t have severe depression because I don’t take medication for it or see a psychiatrist because 1. they don’t respect me (texting while I’m in the room with them) 2. I DON’T HAVE THE MONEY. I just have to cope. My rheumatologist won’t give me anything for my EDS/hypermobility even though I’m in constant pain from that because it’s probably just my mood that makes me feel “icky”. And now because they can’t find some easy solution to the problems I’m having their answer is my fucking weight. I’ve really had it with doctors. It’s all just bullshit.