A 69 years old hypertensive female was brought to A&E department for having an acute abdominal pain after lifting her furniture. She describes her pain as sharp and radiate to the back. On quick assessment, her abdomen is found to be distended and tender; her pulse is 120 beats per minute and weak and her BP is 70/68. However, the patient suddenly collapse and she dies after the resuscitation fail. Post Mortem revealed a ruptured abdominal aorta.
1) Based on history, state 2 predisposing factors and 1 precipitating factor in this patient (3m)
2) Explain the Pathophysiology of ruptured abdominal aorta in this patient (4m)
3) Explain the mechanism causing the low BP and high but weak pulse. (3m)
Answer at the bottom of the post. Do it on your own first please!!
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Answer:
1)
a) Predisposing factor
- Age > 65 years old
- Hypertension
b) Precipitating factor
-Increase abdominal pain after lifting up the furniture.
2) Pathophysiology
Atherosclerosis à Narrowing of the abdominal aorta lumina à Weakening of intima layer and separation of its layer à blood filled the cavity and for hematoma. à Hypertension worsening the hematoma à Aorta dilatation and aneurysm formationàIncrease in abdominal pressure trigger the rupture of abdominal aorta
3) Mechanism of compensation
Bleedingà low blood pressure à reduce the aortic and carotid baroreceptor firingà reduce the inhibition to the medulla à activation of the sympathetic system and releasing of adrenaline à Increase heart rate à Increase in pulse rate. However, continuous loss of blood cause the pulse to be weak due to lack of volume.
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