Aneurisma aortico abdominal
-
Upload
angy-pao -
Category
Health & Medicine
-
view
35 -
download
0
Transcript of Aneurisma aortico abdominal
![Page 1: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/1.jpg)
Aneurisma Aórtico Abdominal
Dr. José Luis Flores Dueñas
![Page 2: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/2.jpg)
Anatomía
![Page 3: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/3.jpg)
![Page 4: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/4.jpg)
![Page 5: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/5.jpg)
Definiciones
Aneurisma: dilatación anormal de un segmento de un vaso sanguíneo
Disección arterial: se produce cuando la sangre penetra en la pared vascular
![Page 6: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/6.jpg)
Clasificación
Aneurisma verdadero: afecta a las tres capas del vaso
Aneurisma falso: defecto en la pared del vaso que da lugar a un hematoma extravascular
![Page 7: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/7.jpg)
Clasificación
Aneurisma sacciforme: afecta una porción del segmento vascular
Aneurisma fusiforme: afecta toda la circunferencia del segmento vascular
![Page 8: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/8.jpg)
Clasificación
![Page 9: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/9.jpg)
Epidemiologia
Distribución universal Europa, cercano Oriente y EU 2-3% México < 1% 3 de cada 4 personas son > 60 años 85-90 % de los aneurismas son
infrarrenales
![Page 10: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/10.jpg)
Etiología
![Page 11: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/11.jpg)
Patogenia
Calidad deficiente del tejido conectivo en la pared vascular
Desequilibrio entre síntesis y degradación del colágeno
Necrosis quística de la media
![Page 12: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/12.jpg)
Fisiopatología
Dilatación crece entre 3 y 5 mm por año
Probabilidad de ruptura 10 % en < 4 cm 20 % a los 5 cm 75 % a los 8 cm
![Page 13: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/13.jpg)
Cuadro clínico
Asintomáticos 60-75 % Hallazgo incidental Masa palpable, pulsátil, no dolorosa Pulsaciones abdominales Dolor torácico, lumbar o escrotal Dolor intenso espontaneo o a la
palpación: escape Dolor agudo e hipotensión: rotura
![Page 14: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/14.jpg)
Laboratorio
Biometría hemática Química sanguínea Examen general de orina Perfil de lípidos Pruebas de coagulación EKG
![Page 15: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/15.jpg)
Gabinete
Radiografía simple abdominal lateral Ultrasonido Doppler TAC RM
![Page 16: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/16.jpg)
![Page 17: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/17.jpg)
![Page 18: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/18.jpg)
![Page 19: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/19.jpg)
Tratamiento
Cirugía Aneurisma con diámetro ≥ 5 cm Dolor espontaneo o secundario a
exploración Crecimiento rápido Embolias distales Obstrucción de víscera contigua Hemorragia gastrointestinal
![Page 20: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/20.jpg)
Tratamiento
Riesgo quirúrgico Cardiopatía isquémica Ateroesclerosis Hipertensión arterial Alteración de función renal Enfisema o EPOC Obesidad mórbida
![Page 21: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/21.jpg)
![Page 22: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/22.jpg)
![Page 23: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/23.jpg)
![Page 24: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/24.jpg)
![Page 25: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/25.jpg)
![Page 26: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/26.jpg)
![Page 27: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/27.jpg)
![Page 28: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/28.jpg)
![Page 29: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/29.jpg)
![Page 30: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/30.jpg)
Complicaciones
Transoperatorias Hemorragia Choque
![Page 31: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/31.jpg)
Complicaciones
Postoperatorias tempranas Insuficiencia renal aguda Trombosis o embolia del lecho arterial Íleo paralitico Estasis gástrica Colitis isquémica Paraplejia Infección de la prótesis
![Page 32: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/32.jpg)
Complicaciones
Postoperatorias tardías Oclusión de la prótesis Oclusión de ramas aorticas Seudoaneurismas Fistula aortoenterica
![Page 33: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/33.jpg)
Pronostico
Cirugía programada < 3 % Aneurisma roto 20-90 % Sobrevivencia a 5 años 40-60 % Causas de muerte tardía
Cardiovasculares Neurológicas
![Page 34: Aneurisma aortico abdominal](https://reader036.fdocuments.mx/reader036/viewer/2022062302/587bf8621a28ab7c668b4fd5/html5/thumbnails/34.jpg)
GRACIAS