ANEURISMA KULIAH 1

8/13/2019 ANEURISMA KULIAH 1

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Dr.Gunawan Tohir SpB, M


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Figure 19.1a


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Aneurysm: localized dilation of thevessels or the heart

May occur at any site, most important is

aorta and ventricles.

True aneurysm is bounded by vessel wall

False aneurysm: extravascular hematoma

with communication to vascular space(Pulsating hematoma)


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Most aneurysms are caused bydegenerative disease affecting the vessel(atherosclerosis)

Structural weakness & Haemodynamicforces Damage to, and loss of intima

Reduction in the elastin and collagen contentof the media

Collagen; tensile strength, adventitia

Elastin; recoil capacity, media

Risk factors smoking, hypertension, hypercholesterolaemia


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Laplaces low

(Tension varies directly with radius when pressure

is constant)

For every increase in the radius there is a large

increase in tension, leading to further

enlargement of the aneurysm


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Congenital Marfans syndrome, Berry aneurysms

Post-stenotic Coarctation of the aorta, Cervical rib, Popliteal

artery entrapment syndrome

Traumatic Gunshot, stab wounds, arterial punctures

Inflammatory Takayasos disease, Behcets disease


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Mycotic

Bacterial endocarditis, syphilis

Pregnancy associated

Splenic, cerebral, aortic, renal, iliac & coronary


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False Due to traumatic

breach in the wall The sac made up

from thecompressedsurrounding tissue

True Dilatation involving

all layers of thewall

Fusiform Spindle-shaped

involving wholecircumference

Saccular Small segment of

wall ballooning dueto localized

weakness


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>90% affecting abdominal aorta

Infra-renal segment in ~95%

Male : Female ratio 4:1

More common in western countries

5% over 50s, 15% over 80s

Associated with iliac aneurysms in 30%

Associated with popliteal aneurysms in

10%


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Asymptomatic in 75%

Incidentally discovered during clinical exam.or

radiographic investigation

Pain Central abdominal radiating to the back

Chronic due to stretching the vessel wall or

compression/erosion of surrounding structures

Acute pain due to rupture


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Rupture

Risk of rupture correlate with aneurysm size

Retroperitoneal, back pain, stable

Intraperitoneal, abdo/back/falnk pain, shock 5-year rupture rate 0% in AAA 5cm

Risk of rupture can be predicted by

High diastolic BP, COAD


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Fistulation, rare Gut, IVC, left renal vein

Thrombosis, rare Acute lower limb ischaemia

Distal embolism Acute ischaemia to small distal areas (trash foot)

Distal obliteration Claudication, rest pain, gangrene


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MEKANISME YANG DIDUGA

1.DEGRADASI PROTEOLITIK DARI JAR IKAT

2.INFLAMASI DAN RESPONS IMUN

3.STRESS BIOKIMIA DARI DINDING 4.MOLEKULER GENETIK


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ANEURISMA KULIAH 1

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