Aortaaneurismer
Sist oppdatert: Sist revidert:
Sist revidert av:Ingard Løge
Definisjon:
Lokalisert utvidelse av aorta, hyppigst i abdominal aorta, som antas å skyldes aterosklerose og der røyking og hypertensjon er viktige disponerende faktorer
Forekomst:
I obduksjonsmaterialer foreligger bukaortaaneurisme hos 2-4% ved alder over 50-60 år
Symptomer:
Vanligvis asymptomatisk, men kan med tiden gi symptomer som følge av trykk fra aneurismet. Ved ruptur oppstår raskt magesmerter og sjokk
Funn:
Ev. pulserende oppfylning i abdomen
Diagnostikk:
Verifiseres og følges med ultralyd eller CT
Behandling:
Forebyggende kirurgi ved diameter over 55 mm eller ekspansjon over 1 cm i året
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- Ingard Løge, spesialist allmennmedisin, redaktør NEL
Tidligere fagmedarbeidere
- Torbjørn Dahl, overlege, kirurgisk avdeling, St. Olavs Hospital, Trondheim
- Terje Johannessen, professor i allmennmedisin, Trondheim (tilpasning til NEL)
- Peter D. Jost, spesialist i allmennmedisin, Trondheim (oppdatering)