Aneurizma
August 12, 2009
Aneurizma predstavlja alergijski i imunološki poremećaj. Aneurizme su ograničena proširenja krvne žile, posebno aorte ili arterija na periferiji. Nastaju zbog slabljenja određenog dela žilnog zida. Može postojati porodična sklonost, no specifični uzroci su aterioskleroza, gljivične infekcije, infekcije sifilisom, aortitis (upala aortnog zida) ili trauma.
Najznačajnija je aneurizma aorte, koja može nastati u bilo kojem delu, ali 3/4 se javljaju u trbušnom delu aorte (AAA). Arterioskleroza je bolest koja je najčešće povezana s aortnim aneurizmama. Ona oslabljuje zid aorte, zbog čega se zid proširuje, a povišeni krvni pritisak i pušenje tome doprinose.
Klinička slika aneurizme
Aneurizma abdominalne aorte najčešće počinje ispod bubrežnih arterija i često se širi prema gore u jednu ili obe ilijačne arterije. Može se javiti bol koji je tipično dubok i probadajući, obično je trajan i najjače se oseća u lumbosakralnom području. Pacijent može imati osećaj nenormalno jakih pulsiranja u stomaku. Kod pažljivog pregleda pacijenta palpacijom stomaka, često se može otkriti široko područje u kojem se oseti pulsiranje trbušne aorte, nad njom se može čuti i šum, ali čak se i vrlo velike aneurizme teško mogu otkriti fizikalnim pregledom.
Aneurizme koje se brzo povećavaju i koje prete rupturom često su bolno osetljive, no često mogu i rupturirati bez prethodnih simptoma.
Aneurizma torakalne (prsne) aorte očituju se često dubokom difuznom (raspršenom) boli u grudnom košu, disfagiju (otežano gutanje), promuklost, hemoptizu (iskašljavanje krvi), pa čak i suvi kašalj.
Dijagnostička obrada aneurizme
Pregled ultrazvukom (UZV) je najsigurniji pregled i često se može jasno odrediti veličina i proširenost aneurizme. Veličina i karakterisitike aneurizme mogu se definisati i CT-om (kompjuterska tomografija), posebno ako se primeni intravenski kontrast. Abdominalnom aortografijom može se odrediti veličina aneurizme i prikazati zahvaćenost drugih velikih krvnih žila.
Aortografija je potrebna i opravdana kada se sumnja na proširenje aneurizme iznad bubrežnih arterija. Većina bolesnika s aneurizmom trbušne aorte ima generalizovanu ateriosklerozu, pa je zato pre operacije potrebno proveriti kardiovaskularni status pacijenta.
Prognoza i lečenje aneurizme
Tok bolesti zavisi od veličini aneurizme. Ruptura retko nastaje ako je širina aneurizme manja od 5 cm, ali učestalost se značajno povećava ako je širina aneurizme veća od 6 cm. Kod svih takvih aneurizmi se zato preporučuje hirurški zahvat, osim ako nema kontraindikacija za operaciju. Korekcija se sastoji u zameni dela zida krvnog suda zahvaćenog aneurizmom sa sintetskim umetkom.
Na rupturu trbušne aneurizme aorte može se posumnjati kod pojave jakog bola u donjem delu stomaka i leđima. Zavisno od jačine krvarenja, mogu uslediti hipovolemijski šok (šok usled gubitka krvi), pa i smrt. Ruptura ili preteća ruptura zato se ubrajaju u hitna hirurška stanja. Rizik kod operacije rupturirane aneurizme je oko 50%, a ukoliko dođe do zatajivanja bubrega nakon operacije, prognoza je posebno loša.
Autor KardioNet · u Bolesti srca
O autoru: KardioNet je prvi domaći Internet portal - servis koji pružaocima zdravstvenih usluga u domenu kardiologije, naučno-istraživačkim organizacijama, lekarima, predstavnicima farmaceutske i industrije medicinske opreme, države i fondova osiguranja, kao i pacijentima i zdravoj populaciji, omogućava pristup traženim medicinskim informacijama u bilo kom momentu, sa bilo kog mesta.
Ja bolujem od aneurizme aorte vec skoro cetiri godine. Dijagnoza glasi aneurizma aorte ascedentis et descedentis et abdominalis. Sirina je na zadnjem snimanju 6,1 na nekim mestima manje 3,4 ili 4,5 itd. Sve znam i rizik od operacije i nemanje lekova za tu bolest i niko nezna poreklo niti ga trazi, ali me zanima zasto niko ne prati sta se desava sa ostalim organima. Npr. ja licno imam probleme sa disanjem najvise kad legnem, ponekad disem kao asmaticar, zatim pojavila mi se cista na bubregu /a to nije nista/ imam probleme sa nervozom i nekontrolisanim trzanjem nogu u toku spavanja ili malo duzeg sedenja, da ne nabrajam vise. U domu zdravlja mi propisu terapiju koju sam dobila pre cetiri godine kad su mi otkrili aneurizmu i to je to. Hvala na strpljenju
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