Real-life challenge: Abdominal aortic aneurysms
A 75-year-old female patient with diabetes was diagnosed with two small abdominal aortic aneurysms. She also had a history of elevated blood pressure, 150/90 mm Hg. Lisinopril had been prescribed to maintain an acceptable level. The physician had suggested that the course of treatment could be watchful waiting. A surgeon had been consulted, and after reviewing laboratory values and CT scans of the abdomen and abdominal aorta, the surgeon recommended not pursuing a surgical course at the time of the tests.
Follow-up appointments every 3 months were scheduled. The first 3-month examination revealed no significant change. The second 3-month examination showed that the aneurysm had started to increase in size. The course of watchful waiting was to continue. The patient was instructed to monitor her blood pressure closely and not to lift anything heavier than 10 pounds. Additionally she was advised not to stretch or reach out.
The surgeon preferred to schedule a procedure to install a stent into the abdominal aorta. The patient began to experience severe muscle spasms in the muscles of the lower legs. She also was unsure about the proposed procedure and asked what would happen if she did not have the procedure.
1. What might be the cause of the aneurysms?
2. Why is controlling blood pressure important?
3. Why would the surgeon want to adopt a wait-and-see approach at first?
4. What is the significance of cramping in the legs?
5. Why would the patient be instructed not to lift or stretch?
6. What would be the outcome if the aneurysm began to leak?
7. What would be the chances of survival if the aneurysm ruptured?
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