|
 | Presentation
 | Patient has a "blue toe." |
| Back pain or asymptomatic |
| Early satiety |
| Boring, tearing pain, may radiate to perineum |
| History of claudication |
| History of erectile dysfunction |
|
| History
| HTN, DM, tobacco use, connective tissue disorders |
|
| PE
| HEENT: Roth spots on fundoscopic exam |
| CV: BP, pulses in all
extremities, auscultate, bruits |
| Lungs: auscultate |
| Abdomen: bruits, nontender pulsatile mass |
| Extremities: blue fingers/toes due to cholesterol
emboli |
|
| DDx
| CV: AAA, AMI |
| Lungs: PE, pneumonia |
| GI: pancreatitis, PUD, GERD, cholecystitis,
ischemic bowel |
| MS: lumbosacral muscle strain |
|
| Laboratory
| Abdominal ultrasound (or possible CT?), CXR, EKG |
| CBC w/ diff, BMP, coags, amylase, lipase, UA |
| Type and crossmatch some blood |
|
| Treatment
| Admit to ICU |
| Surgery consult |
| If > 5 cm or hemodynamically unstable, then surgery.
 | Mortality 3-10%. |
|
| If < 5 cm and stable, medically manage.
| Frequent ultrasounds. If incr. > 1/2 cm in 6
months, then surgery. |
| Nitroprusside, propranolol, morphine (reduces shearing
forces, BP). |
|
|
|
