Search for tag: "abdominal"

Interviewer: What is abdominal aortic aneurysm, how did you end up with it, and what can be done about it? We'll talk about that next on The Scope.

Dr. Claire Griffin is a vascular surgeon with the University of Utah Health and one of the things that you deal with on occasion or often—I guess we'll find out—is an abdominal aortic aneurysm, also called "AAA." So what is that?

Dr. Griffin: Well, an aneurysm is when a blood vessel becomes larger than it should be. So we define in medicine an aneurysm as any time the blood vessel is one and a half times the normal size.

Now, normal is different depending on the patient, how big they are, if they're a man or a woman. But in general, we have an idea of how big blood vessels should be, and when they're larger than that, we call them aneurysmal.

Interviewer: All right. You get a little bit concerned about it. Let's go back for one more step. What exactly is the aorta? Where is this happening in my body?

Dr. Griffin: Okay. So you can get an aneurysm in any blood vessel in the body but the most common location is in the abdominal aorta. So the aorta is the main blood vessel in our body. It actually starts in the chest where it comes directly off of the heart and it gives branches to the arms and the head before traveling through the chest and going into the abdomen.

There are actually two main branches that come off of the aorta right after it gets into the abdomen that give blood to the liver and the intestines and then another branch goes to each kidney. Once those branches have come off there's a relatively straight section of the aorta before it divides into two around the level of our belly buttons to give blood flow to our pelvis and our legs. So that's the aorta in a nutshell, the main blood vessel or the superhighway for blood to get from the heart to everywhere else in our body.

Interviewer: So then piecing together what you've just told us, an abdominal aortic aneurysm is when the aorta in the abdominal area is larger than it should be?

Dr. Griffin: Exactly.

Interviewer: All right. So can you explain that a little bit further?

Dr. Griffin: Sure. So the normal size of the aorta depending, again, on if you're male or female or how big you are is normally about 1.7 centimeters to 2.5 centimeters. Which given that we don't use centimeters very often, really means about the size of a nickel.

When we see somebody who has an aorta that is bigger than three centimeters, so around the size of a half dollar, we consider that to be an aneurysm. Now, having an aneurysm doesn't mean that you need anything done about it. It really depends on where it's located and how big it is.

Interviewer: All right. And what caused this aneurysm to happen? Was it something that I did or does it just happen?

Dr. Griffin: So we know that there's definitely some sort of genetic component aneurysm disease but there's not one gene that causes them to happen. It's really multi-factorial.

We know for example that smoking is like fertilizer for aneurysms and causes them to grow really fast. So the number one thing we can do is avoid smoking to prevent them from happening. But even if you've never smoked, you can still have aneurysm. And if your parents or grandparents had one or uncles or aunts had one, that is a risk factor for you.

Interviewer: So how is it diagnosed?

Dr. Griffin: Because we know that smoking is the most common risk factor, there actually are screening programs that if you are a male over the age of 65 and you've been a smoker in your life, you can get an ultrasound to look at the size of your aorta. Although the most common way this is diagnosed is because people get a CT scan for something completely unrelated and it's found by accident on a CT scan.

Interviewer: So it doesn't really present any noticeable symptoms that . . . like shortness of breath or something like that. It just . . .

Dr. Griffin: No. If they're quite large, they can present symptoms because of their size or if they grow rapidly, sometimes patients will have pain associated with that, but they are most commonly asymptomatic.

Interviewer: All right. And kind of found by mistake.

Dr. Griffin: Exactly.

Interviewer: Because you're looking for something else. So when does it become a problem?

Dr. Griffin: So as the blood vessel, in this case the aorta, stretches it doesn't get any thicker. So the wall just becomes thinner and thinner. Sometimes that growing can cause abdominal pain but usually it's asymptomatic. Once it gets to a certain size, we worry that that thin wall can actually become so weak that the blood leaks out of it and that can be an emergency, considered a rupture. So we like to fix them before it gets to the size where it would rupture.

Interviewer: Yeah. And if it ruptures, then like you said, that's an emergency. That's your blood gushing out now at this point.

Dr. Griffin: Correct.

Interviewer: Pretty quickly, I'd imagine.

Dr. Griffin: It can be what we would call a contained rupture where you have some sort of symptom and pain, but even if it's a contained rupture it's still a surgical emergency to fix it.

Interviewer: So if a patient is diagnosed with one, what then? You mentioned not in all cases do you have to do something but . . .

Dr. Griffin: Depending on the size of it dictates what the next step is. So if we diagnose it and it looks like it has already met the threshold for repair, in other words, if we think that continuing to live with it is more risky than fixing it, we go ahead and do surgery to fix it. But if your aneurysm is small, it might be that you never need it fixed and so we continue to watch that or place it in surveillance and do serial imaging with either ultrasound or CT scan to keep an eye on it.

Interviewer: And then how and when do they get fixed? You'd mentioned you kind of keep an eye on it, right? If it gets stretched so far, that's when it gets fixed. So then what do you do, is it surgery?

Dr. Griffin: There are no medicines that fix aneurysms. The only thing that we can do is reroute the blood somehow so that the high blood pressure isn't touching this thinned out wall. There are two different ways that we can fix it:

1. We can either open up the patient in the operating room and replace that thinned out blood vessel or the enlarged area of the aorta or
2. If the anatomy is right, which is something that we can tell on a CT scan, we can actually travel inside the blood vessels through specialized IVs and re-line the blood vessel so that the thinned out wall is no longer getting the pressurized blood.

And depending on how we fix it, it has a lot to do with how fast the recovery is and when you can get back to your normal life.

Interviewer: After you've been diagnosed, is it . . . are you pretty good for the most part in your specialty at being able to know, "We need to do some about this right now or we have a couple of weeks?"

Dr. Griffin: Yeah. So the Society of Vascular Surgery actually has some really great guidelines that help us make decisions about patients and every patient is different. So I mentioned before how there are branches that come off the aorta. If the aneurysm includes those branches, that can make it a very complicated surgery to fix it. Or if the aneurysm is away from those branches, it can be a very straightforward repair.

So the CT scan that we usually get to diagnose it and to surveille it is critical in helping us decide how to treat it.

Interviewer: Okay. I guess what I was trying to figure out is if I was told I have an aneurysm, to me, that's an emergency, like right now. But you have a pretty good body of evidence that kind of helps dictate how dangerous you are at any given time.

Dr. Griffin: Exactly. And since this is something that I treat all the time, as a vascular surgeon, when I hear that somebody has an aneurysm, that is part of what I take care of every day. So I don't think that patients should be scared or think that it's an emergency to fix it right away. On the other hand, it is important to get plugged into a vascular surgeon so that they can tell you when and how and what the next step was going to be.

updated: August 13, 2021
originally published: August 22, 2017

Interviewer: Your young child has abdominal pain? It could be kidney stones. We'll find out more about that next on The Scope.

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Dr. Gary Faerber is a urologist at University of Utah Health Care. And if your child has abdominal pain, it could be a lot of different things, but one of the things it could be that is sometimes not diagnosed properly is kidney stones because the incidents of kidney stones in kids in increasing and increasing. That's incredible. First of all, why is that? Why are kids getting kidney stones? That doesn't seem like something that I would expect.

Gary: You're right. Most people wouldn't expect that kids should be getting kidney stones. Most people think of kidney stones as happening in somebody who is in their 40s and 50s, and not . . .

Interviewer: Yeah, guys like us.

Gary: . . . absolutely, guys like us and not young kids. But there's no question that the incidence and prevalence of kidney stones in the pediatric population has gone up, and it's gone up quite dramatically. Probably over the last 15 years, it's gone up almost two-fold. So it's not that really rare thing that happens anymore, it's what I would call commonly uncommon.

Interviewer: So if a child has abdominal pain, it could possibly be kidney stones?

Gary: Yes, absolutely. There's no question about it. It, obviously, probably wouldn't be the first thing on my differential diagnosis list.

Interviewer: Yeah, it would be a little ways down.

Gary: Right, absolutely. But it's something that I think caregivers would and should think of. For example, in the pre-pubescent age group, the most common presenting signs or symptom of a kidney stone in a young child is abdominal pain. And that's seen in up to 75% of those children who present with a kidney stone.

Interviewer: And that's different than how adults present?

Gary: Yes. Adults typically present with a terrible flank pain. Why kids don't get the flank pain is not quite clear and it's clear that they get sort of abdominal pain, which is odd. The one thing that may tip a provider off, in that it might be a kidney stone, is the abdominal pain is often associated with blood in the urine. So if a child has blood in the urine and is having abdominal pain, that certainly would make me concerned that they might be having a symptomatic kidney stone.

Interviewer: Is the increase in children pretty much the same reason for the increase in adults? They're not getting enough water, which, drinking enough water is so important in preventing kidney stones. Their diet, that sort of thing?

Gary: Absolutely. Kids are just like their adult parents, where they don't drink enough fluids. Specifically, they don't drink enough water, and it's important that they do. I would love to have my listeners think that having sugary drinks is probably not a really good thing for kids. Water's a great thing and milk and all the healthy stuff is probably better for them than the sugary drinks, that's for sure.

Interviewer: Yeah. For a whole variety of reasons, not just getting kidney stones. So it's fascinating some parents might be dealing with a child that has a kidney stone. Is the treatment the same as it would be an adult, then?

Gary: Surprisingly, yes. And the good news about most kidney stones that both children and adults present with is that the vast majority of these will pass on their own, and there are medications that we can provide both adults and children that facilitate them passing the stone. In those patients, adults and children who don't pass their stone, there are very effective surgical management strategies that are available that we can treat these stones.

Interviewer: So if you take your child to the doctor and it's abdominal pain and you have to go back a couple of times, then you might want to start considering kidney stones. If you have that conversation, how would they find out for sure whether or not that was what was causing it?

Gary: There are a number of x-ray studies that are available now. I think if a child presents to the emergency room, for example, or to their pediatrician or primary care provider, either an abdominal ultrasound exam or, in some cases, a CT scan can be done. And both of those studies are very good in identifying a kidney stone.

Interviewer: Just something else a parent and a kid has to deal with in today's age, I guess, huh?

Gary: That's exactly right.

Interviewer: Or hopefully not, if you do the right lifestyle things.

Gary: Right.

Interviewer: Yeah. Any final thoughts?

Gary: Make sure that your kids drink plenty of water, especially during these hot summertimes in Utah.

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Interviewer: You just had a surgery. You might be wondering when can you get back to your life, the things you enjoy doing, your activities? We're going to find out next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: How long after surgery until you can kind of get back to your life the way it was before surgery? That's a question a lot of people have. We're with Dr. Jeff Campsen. He's a surgeon at the University of Utah Hospital. So, when can you get back to your life after surgery?

Dr. Jeff Campsen: Well, it depends on the type of surgery you have. Anytime you have some sort of incision that goes intra-abdominal, you have to heal that incision. Depending on your state of health, it can be shorter or longer. An average time length that a lot of people say with an abdominal incision is about one to two months or even just six weeks to where you really want to let it heal and you try not to put too much pressure on your abdomen during that time.

Interviewer: Is it the skin that's the issue, that that's going to break apart, or is there muscular things underneath that need to heal as well?

Dr. Jeff Campsen: That's exactly right. It's the deeper tissues, what's called the fascia. The fascia needs to heal, and that's what you would get a hernia through. The skin heals fairly quickly, but the deeper tissues take a little bit longer to heal. That's what takes one or two months. Those tissues are basically what make up your abdominal wall. They're sewn back together, but then the stitches that we use, the deep sutures, will only hold up so long. Most of the time over time they get absorbed, so it's really your body reforming that abdominal wall.

Interviewer: Oh, so after surgery there's multiple stitches. There's the stitches inside of me, and then the stitches I see on my skin.

Dr. Jeff Campsen: That's right. You can have internal sutures or external sutures on the skin, but it's the deep sutures that are really what's prohibitive to getting back to your normal daily activities. Basically, lifting anything greater than 10 pounds, putting any kind of stress on you abdomen.

Interviewer: Wow. That's not a lot of weight. I mean, you can't go grocery shopping without lifting something that's 10 pounds.

Dr. Jeff Campsen: You can't. Most children are greater than 10 pounds, which really puts a damper on a lot of people and just daily activities puts you in that position. But it's worthwhile waiting for it and letting yourself heal because then the end result is that you tear through those sutures or don't heal, and eventually you get an abdominal wall hernia, which then can be life-threatening and will need to be fixed at some point, adding another surgery onto what you've already had.

Interviewer: Wow. So it's very serious stuff.

Dr. Jeffrey Campsen: It can be.

Interviewer: Yeah.

Dr. Jeffrey Campsen: It can be extremely serious, and this is the one thing where it's a good idea to pay attention to your doctor.

Interviewer: All right. So what types of activities are OK and not OK?

Dr. Jeffrey Campsen: I think as you get further and further out, the activities open up more. In the first two weeks you have to be very conservative. You want to walk, because getting out of bed opens up your lungs and pumps blood back from your legs to your heart, so it keeps you from getting a pneumonia or blood clots. So you definitely want to get up, walk, and do activities around the house. You can still do desk work and different things like that. You need to be active to allow healing.

After about two weeks, at two to four weeks you can start doing a little bit more physical activities. What I tell my patients is there's a little voice in your head that's probably saying, "Eh, that's not a good idea," and if that pops up, you should back away from it. Then after a month, you should start to push it a little bit. If it feels bad, don't do it. Wait a couple days. Try it again. If it feels good, move forward, because I'm not there with you, and you're going to be, basically, living this every second and you need to sort of use a lot of common sense on what to do and not to do, and basically really listen to yourself. The mantra is, "If it doesn't feel right, maybe give it a few more days."

Interviewer: Got you. When you say feel bad, you're talking about pain? Is that what you mean by feel bad?

Dr. Jeffrey Campsen: Pain, pressure. You know, you don't want to hear somebody call in and say, "I lifted something and I didn't listen to you, and I heard a pop."

Interviewer: Oh.

Dr. Jeffrey Campsen: What you want to do is not get to that point, and so you're basically. . . If you're pushing yourself a little bit, you're starting to lift something heavy, you're starting to do some exercise, all the good things that we actually do want you to do, and you start to feel pressure on your belly, maybe back away and give it a little bit of a rest.

Interviewer: So, it sounds like if you just kind of pay attention to your body, you're going to have a fairly good idea of what is appropriate or not. Or should you do far less than what you feel is appropriate?

Dr. Jeffrey Campsen: No, I think if you pay attention to your body, you can pretty much do what's appropriate. It's just you really have to use some good common sense and listen to yourself and not push it too far.

Interviewer: Anything else that we should talk about? Anything that might surprise somebody about this topic? Anything that you feel like we forgot, or feel compelled to say?

Dr. Jeffrey Campsen: I think one whole different aspect is this also comes into the realm of when can I drive after surgery? I think driving comes back into your abdominal wall healing. It's not so much your ability to turn the steering wheel and press the gas pedal. It really comes down to: Is your abdominal wall healed enough to where you can stomp on the brake? You obviously need to be off your pain medications, because you can't drive on pain medications, but if you can stand straight up after surgery, whatever many days later, and take your brake foot and stomp on the ground really hard and it doesn't hurt your belly so bad that you are writhing in pain, then you can proceed to drive.

The reason that is, is that most people can drive around. They can push on the gas pedal. They can work the clutch, all that kind of stuff, but if they get into a situation where they've got to stomp on the brake to stop their car rapidly, and they can't because it's painful to them, then they're going to get into a wreck.

This kind of goes into when is your abdominal wall healed enough that you can handle that? Everybody heals a little bit differently, and so it kind of comes into common sense. So, if you can do that test before you ever get into the car, and you're successful, chances are you're going to be fine.

Interviewer: Should you avoid twisting, turning motions?

Dr. Jeffrey Campsen: This gets into. . . You know, it's springtime in Utah, and a lot of people are golfers. What we basically say to that is very similar to lifting and all the other things. You can turn and twist, but if it starts to put too much pressure on your belly, you need to wait. As you get two, four, six week out, you can do more and more.

The analogy with a golf club is maybe in the first two weeks just sort of use your putter, and in the two to four weeks, you can sort of use an iron and just do a half of a backswing. Then, maybe after six weeks to eight weeks, you can really do that full golf swing that you want to do. I think that sort of relates to, basically, what do you do with your abdominal wall, and any of that twisting and turning you can do more and more as you get further out from the sugary, but also the rule, again, is if I feel like it's painful, if it's putting too much stress on my abdominal wall, back off. Give it a couple days to rest, and then try it again in three or four days.

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updated: June 29, 2018
originally published: June 25, 2014