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ANEURYSM

A Research Paper Submitted In Partial Fulfillment of the Requirements in English IV

Submitted to: Mrs. Elizabeth L. Arcilla (Teacher)

by: Leahbelle M. Reginio (Student) IV-A

October 5,2009

Aneurysm Thesis Statement: An aneurysm is the bulging of blood vessel wall because of weak spot or loss of elasticity that develops. This may result in pain and may occasionally rupture, causing sudden death. It can be classified in several different ways: true or false, morphology, location, arterial or venous and underlying condition. In this research paper, the symptoms, effects and risks. Complications and when to contact a Medical Professional will be discussed. Also, the causes, treatment and diagnosis, and prevention are discussed.

I.

Aneurysm a. Definition b. Classification c. Common Locations Symptoms Effects and Risks Complications When to contact a Medical Professional

II. a. b. c. d. III. a. Causes b. Treatment and Diagnosis c. Prevention IV. Conclusion V. Bibliography

I. Aneurysm: a. Definition
Aneurysm is the dilatation of an artery or vein caused when weak spot occurs in the wall. The layers of the elastic tissue that form the wall enable the vessel to dilate and contract. When they are stretch at any point, because of initiate weakness, the enfeebled section pouches out and causes distention, just as in the weakened wall of rubber tire. This result in pain and may occasionally rupture, causing sudden death. It can form anywhere in the vessels, but they are found most commonly in the blood vessel of the brain and in the aorta, the main vessel of the arterial blood. The most important aneurysms are those which affect the important aortic artery, the main trunk of the entire arterial system. And the most painful of all aneurysms is the dissecting aneurysm. This type occurs when a patch of atherosclerotic (hardened) material on the blood vessel wall gives you away, leaving openings between layers of the vessels wall. Blood flows between these layers and separate them. Aneurysms vary in degree from slightly widening of the blood vessel to an enlargement great enough to involve the ribs, esophagus and lungs. They may be single or multiple, and of varying shapes. Frequently they are filled with large thrombi, or blood clots. Those under 4 to 5 mn. In diameter rarely ruptured, whereas most aneurysms that reach 5 to 7 mn are likely to bleed, usually from dome. Some reach the size of 2 to 3 cm more (giant aneurysm) before rupturing, or never rupture at all and act as a mass lesion compressing adjacent structures. Aneurysms that are known to rupture under these conditions associated with sudden rise in blood pressure.
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Richard Wagman, The New Complete Medical and Health Encyclopedia, Vol. 2, p. 90
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b.. Classification
Aneurysms can be classified in several different ways: true or false, morphology, location, arterial or venous and underlying condition. True or False Aneurysm. True aneurysm is the inner layers of a vessel have bulged outside the outer layer that normally confines them. The aneurysm is surrounded by these inner layers. This is when layers of the artery are all ruptured, leaving the surrounding tissues to retain the blood. On the other hand, false or pseudoaneurysm is a collection of blood leaking completely out of an artery or vein, but confined next to the vessel by the surrounding tissue. It can cause by trauma that punctures the artery and are a known complication of percutaneous arterial procedures. It is a collection of blood in the tissues that pulsates because there is a passage to it from a ruptured artery. Morphology. Aneurysm described by their shape: fusiform aneurysm (look like spindles) resembles a narrow cylinder; saccular aneurysm (sack-shaped or pouch-shaped) resembles a smell sac; and cylindroid(like cylinders). Location. Most frequent site of occurrence is in the arterial cerebral artery from the Circle of Willis. Most (94%) of non-intracranial aneurysms arise distal to the origin of the renal arteries at the infrarenal abdominal aorta. Aortic aneurysm may involve any part of the aorta: the ascending aorta, aortic arch, descending aorta, thoracoabdominal aorta or abdominal aorta. The most common cause of aortic aneurysm are atherosclerosis and degeneration of the vessel media. They are common after 50 years of age and affect men more often than women. Abdominal aortic aneurysms involve the bifurcation of the aorta and proximal end of the common iliar arteries. Most of it are asymptomatic because of arterial origin, a pulsating mass may provide the first evidence of the disorder. With thoracic and abdominal aneurysms, the most dreaded complication is rupture. The likehood of rupture correlates with increasing aneurysm size. While dissecting is an acute, life-threatening condition. It involves hemorrhage into the vessel wall with longitudinal tearing of the vessel wall to form blood-filled channel. Unlike atherosclerosis aneurysm. Dissecting aneurysm occur without evidence of previous vessel dilation. It can originate anywhere along the length of the aorta. The second most common site is the thoracic aorta just distal to the origin of the subclavian artery. They are caused by conditions that weakened or caused degenerative changes in the elastic and smooth muscle of the layers of the aorta. It is most common in the 40 to 60 year-old age group and more prevalent in men than in women. 2
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Dorlands Illustrated Medical Dictionary, 31st Edition, p. 355

Aneurysm occurs in the legs also, particularly in the deep vessels (e.g., the popliteal vessel in the knee). Popliteal artery aneurysm is easily detected by the affected person because it causes a noticeable, pulsating bulge behind the knee. The bulge brings discomfort and interferes with crossing the legs. Pressure on nearby nerves may be painful, and there maybe intermittent lameness of calf muscles (intermittent claudication). An aneurysm in this location may also cause formation of a blood clot and anything cut off of circulation to the lower leg with danger of gangrene unless an emergency operation restores the circulation. Arterial vs. Venous. Arterial aneurysms are much more common, but venous aneurysms do happen. Arterial (berry) aneurysms are round or saccular dilatations characteristically found at arterial bifurcations. The cause of berry aneurysms is unsettled. Muscle and elastic tissue defects in the media, possibly of congenital origin, are subjected to physical effects of pulsatile arterial pressure aggravated by turbulence in the circulation through the aneurysm. The result is the gradual distention and thinning of the weakened segment until the wall is no longer able to contain the blood under arterial pressure. Occurring most often in the elderly, diabetic or hypertensive persons. They may be caused by congenital thinning of the muscular portions of the artery; during atherosclerotic degeneration of the aorta or of the carotid or basiliar arteries; by trauma to a vessel wall; by infectious injury; or by high blood pressure. Defects on arteries of the eye may result in military (small, multiple) aneurysms of retina. Underlying Condition. Myotic aneurysm is for fungal infections only, while others describe them bacterial infections as well. Myocardial infarction (death of heart cells) provokes a reaction by white blood cells that secrete digestive enzymes in an effort to clean up dead tissue. This begins about three days after the damage and continues for several weeks. Scar tissue forms a patch of weak tissue but does not begin to be significantly protective until the 10th and 5th days of a persons recovery.3

Ibid, p. 356

c.. Common Locations


Common locations for aneurysms are the major artery from the heart (the aorta), the brain (cerebral aneurysm), in the leg behind the knee (popliteal artery aneurysm), intestine (mesenteric artery aneurysm) and an artery in the spleen (splenic artery aneurysm). The most common site is at the origin of the posterior communicating artery from the internal carotid artery, followed in frequency by the middle cerebral and anterior communicating arteries. 4

Goldman, Autello, Arend et al, Cecil Medicine: Expert Consult, p.1257

II. Aneurysm: a. Symptoms


Symptoms depend on the location of the aneurysm. It also depends on the size of the aneurysm. If the aneurysm occurs near the bodys surface, pain and swelling in the throbbing mass is often seen. Aneurysms within the body or brain often cause no symptoms. If an aneurysm ruptures, low blood pressure, high heart rate and lightheadedness may occur. The risk of death after a rupture is high. Chronic cough, frequent pneumonias, blood splitting and a picture that resembles lung cancer may reveal the presence of an aneurysm in the arch of the aorta that is compressing the bronchial tubes. Other symptoms are hoarseness, difficulty in swallowing, swelling of the neck and perhaps swelling of an upper extremity. The symptoms of aortic aneurysm vary with size of the defect and its location. If it presses against the windpipe and the bronchi, for example, it may interfere with breathing and lead to coughing. 5

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Dorlands Illustrated Medical Dictionary, 31st Edition, p. 356

b. Effects and Risks


Aneurysm destroys a section of the elastic tissue, maybe the result of infection such as pneumonia, of a streptococcal or staphylococcal infection. It may be painful, or produce difficulty in breathing, dyspnea, by pressing against the air passages/cause swelling. And after it developed, it tends to grow, with danger that the vessel wall will rupture. Rupture may cause sudden death. Rupture and blood clotting are the risks involved with aneurysms. While there are two risks factor that predispose to a dissecting aneurysm: hypertension and degeneration of the medial layer of the vessel wall. And there is a risk of aortic rupture with blood moving into the pericardium and compressing the heart. Although the length of dissection varies, it is possible for the abdominal aorta to be involved with progression into the renal iliac or femoral arteries.6

Carol Mattson Porth, Pathophysiology, 6th edition, p. 444

c. Complications
The main complications of aneurysm include the compression of nearby structures such as nerves, which may lead to weakness and numbness (most common with aneurysms that occur in the artery behind the knee); infection, can lead to body-wide illness and rupture; rupture which can cause massive bleeding that may lead to death. Massive bleeding is commonly seen with abdominal aortic aneurysms, mesentic aneurysms and splenic artery aneurysms. And rupture of brain aneurysms can cause stroke, disability and death. The most serious complication occurs when the sac bursts. The result is hemorrhage and death. Depending upon the size and site of the aneurysm, other complications can develop. These include pulmonary infection, congestive heart failure and circulatory problems of the extremities. A lethal complication is the rupture of the vessel with resultant massive hemorrhage. It usually occur in the arteries but may also be seen in the heart after local damage, or in veins. With thoracic and abdominal aneurysms, the most dreaded complication is rupture. The likehood of rupture correlates with increasing aneurysm size.7

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Academic American Encyclopedia, Vol. 1, p. 411

d. When to Contact a Medical Professional?


Call your health care provider for of you develop a lump in your body, whether or not it is painful and throbbing.8

Ibid, p.441

III. Aneurysm: a. Causes


Aneurysm is caused by weak spot or loss of elasticity that develops. It is also caused by the destruction of elastic tissue in the artery or vein involved during the coarse of diseases such as arteriosclerosis, hypertension and syphilis. Aneurysm formation is probably the result of multiple factors affecting the arterial segment and its local environment. Often arteriosclerosis (hardening of the arteries), embolism, infection or physical injury. Also syphilis, which may erode the breastbone and cause severe chest pain. And also caused by the pressure of the blood on a weakened part. It causes chronic disabilities when there is compression or displacement or interference with circulation to adjacent body structures. On the front part of the aorta may cause erosion of the ribs and even more bulging of the front chest wall. But it is not clear exactly what causes aneurysm. Some aneurysms are present at birth (congenital). Defects in some of the parts of the artery wall may be responsible. 9

b. Treatment and Diagnosis


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Cecil, banett and plum, CecilBook of Medicine, p. 2066

In the past, treatment for aneurysm was not very satisfactory and death often results. Today, gratifying results are being achieved with new and improve techniques for removing aneurysms and repairing vessels. New techniques of surgery have been develop to repair the damaged artery walls. Smaller blood vessels are tied off and other arteries take over their functions. It is possible to coagulate the blood in the sac and form a clot and thus strengthen the walls. Plastic materials are used around the aneurysm to prevent its growth, giving the weakened arterial wall opportunity to strengthen. Historically, the treatment of arterial aneurysms has been surgical intervention, or watchful waiting in combination with control of blood pressure. Recently, endovascular or minimally invasive techniques have been developing for many types of aneurysms. There are two treatment options for brain aneurysms: surgical clipping or endovascular coiling. Surgical clipping was introduced by Walter Dandy of the John Hopkins Hospital in 1937. it consists of performing a craniotomy, exposing the aneurysm, and closing the base of the aneurysm with a clip. Surgical clipping remains the best method to permanently eliminate aneurysms. On the other hand, endovascular coiling was introduced by Guido Guglielmi at UCLA in1991. it consists of passing a catheter into the femoral artery in the groin, through the aorta, into the brain arteries and finally into the aneurysm itself. Once the catheter is in the aneurysm, platinum coils are pushed into the aneurysm and released. These coils initiate a clotting or thrombotic reaction within the aneurysm. In the case of broadbased aneurysms, a stent is passed first into the parent artery to serve as a scaffold for the coils (stent-assisting coiling). The major problem associated with endovascular coiling, is the high reoccurrence rate and subsequent bleeding of the aneurysms. It has shorter recovery period as compared to surgical clipping. Aneurysms are treated by either endovascular techniques (angioplasty with stent) or open surgery techniques. Open techniques include exclusion and excision. Exclusion means tightly tying suture thread around the artery both proximally and distally to the aneurysm, to cut off blood flow through the aneurysm. Excision means cut off or out and removed from the body.10

For aneurysms in the aorta, arms, legs or head, the weakened section of the vessel may be replaced by a bypass graft that is sutured at the vascular Richard Wagman, The New Complete Medical and Health Encyclopedia, Vol. 2, p. 91
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stumps. Instead of sewing, the graft tubes ends, made rigid and expandable by nitinol wireframe, can be inserted into the vascular stumps and permanently fixed there by external ligature. Less invasive endovascular techniques allow covered metallic stent grafts to be inserted through the arteries of the leg and deployed across the aneurysm. With ruptured aneurysm, reduction of blood pressure, bed rest for two weeks, replacement of the weakened vessel by a graft or encasement in plastic or mechanically stopping blood flow to or through the aneurysm. Drugs may relief some of the symptoms and slow down further enlargement, but they will not cure the deformitory already there. Diagnostic methods include the use of ultrasound imaging, computed tomographic (CT) scan, and magnetic resonance imaging (MRI). Diagnosis of a ruptured cerebral aneurysm as commonly made by finding signs of subarachnoid hemorrhage on a CT scan (Computed Tomography, sometimes called CAT scan, a computerized test that rapidly x-rays that the body in cross-sections, or slices, as the body is moved through a large, circular machine). If the CT scan is negative but a ruptured aneurysm is still suspected, a lumbar puncture is performed to detect blood in the cerebrospinal fluif(CSF). Computed Tomography Angiography (CTA) is an alternative to the traditional method and can be performed without the need of arterial catheterization, this test combines a regular CT scan with a contrast dye injected into a vein.11

c. Treatment and Diagnosis


Aneurysms resulting from syphilis can be prevented by therapy with antisyphilitic drugs during the early stages of his illness. Once a syphilitic aneurysm has formed, the doctor still prescribes treatment with these anti-syphilitic drugs
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Philip Goetz, The New Encyclopedia Britannica, Vol. 1,p. 398 Zeleny, Kwiatkowski, Fenner et al, Worl Book Encyclopedia, Vol. 1, p. 437

but how effective they will be, depends upon how long the diseased has progressed. While there is no way of preventing aneurysms that result from arteriosclerosis, except surgery in which the diseased part will be replaced. Control of high blood pressure may help prevent some aneurysms. Following a health diet, getting regular exercise and keeping your cholesterol at a healthy level may also help prevent aneurysms or their complications.12

IV. Conclusion Aneurysm is a weakening of the walls of an artery or vein so that it balloons out. It may result in pain and may occasionally rupture, causing sudden death. It can be classified in several
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Health Principles and Practice, 3rd edition, p. 47

different ways: true or false, morphology, location, arterial vs. venous and underlying condition. Symptoms of aneurysms= depend on the location and its size. The most serious complication of it occurs when the sac bursts. Because this results to hemorrhage and death. The cause of aneurysm is not clear exactly. Some aneurysms are present at birth and defects of some parts of the artery wall may be responsible. Surgery is generally recommended treatment. The type of surgery and when you need it depends on your symptoms and the size and type of the aneurysm. Control of high blood pressure, following healthy diet, getting regular exercise and keeping your cholesterol at healthy level may prevent aneurysms.

V. Bibliography: Carol Mattson Porth, Alterations in Blood Flow in the Systematic Circulation, 6th Edition Pathophysiology (Metro Manila: C & E Publishing, Inc., 2002) p. 444

Lee Goldman, Dennis Arthur Austello, William Arend et al, Cardiovascular Functions, Cecil Medicine: Expert Consult (New York: WB. Saunders Co., Aug. 27, 2007) p. 1257 Philip W. Goetz, Aneurysm, The New Encyclopedia Britannica, Vol. 1 (1989, 398) Richard J. Wagman, Aneurysm, The New Complete Medical and Health Encyclopedia, Vol. 2 (2005, 90-93) Robert Zeleny, Gordo Kwiatkowski, Frank Fenner et al, Aneurysm, 50th Anniversary Edition World Book Encyclopedia, Vol. 1 (1966, 437) Russel Cecil, J. Claude Bannet, Fred Plum, Neurological and Behavioral Diseases, Cecil Textbook of Medicine (New York: WB. Saunders Co., Dec. 1995) p. 2066-2068 Aneurysm, Academic American Encyclopedia, Vol. 1 (June 1997, 411) Aneurysm, Dorlands Illustrated Medical Dictionary, 31st Edition (May 17, 2007, 355-356) Aneurysm, Health Principles and Practice, 3rd Edition (1961, 47)