John Bielinski, MS PA-C 
Evaluating an Abdominal Aortic Aneurysm (AAA)
In this PANCE Board Review Course Blog, we are going to teach you how to evaluate an AAA. The vast majority of aneurysms are asymptomatic. However, as abdominal aortic aneurysms expand, they may become painful and lead to pulsating sensations in the abdomen or pain in the chest, lower back, or scrotum.
[one_second]The risk of rupture is high in a symptomatic aneurysm, which is therefore considered an indication for surgery. The complications include rupture, peripheral embolization, and acute aortic occlusion. On physical examination, a palpable abdominal mass can be noted. Bruits can be present in the case of renal or visceral arterial stenosis. The clinical manifestation of ruptured AAA usually includes excruciating pain of the lower back, flank, abdomen and groin.
The bleeding usually leads to a hypovolemic shock with hypotension, tachycardia, cyanosis, and altered mental status. The mortality of AAA rupture is up around 90%. 65–75% of patients die before they arrive at hospital and up to 90% die before they reach the operating room. The bleeding can be retroperitoneal or intraperitoneal, or the rupture can create a fistula. Flank ecchymosis is a sign of retroperitoneal hemorrhage, and is also called Grey Turner’s sign.
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Whether you’re studying for your boards at home or attending any PANCE Board Review Course, be sure you know how to evaluate an AAA, and how a patient with an AAA would look.
