Chest Examination inspection and palpation

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This is a video which presents a thin lean patient with visible epigastric pulsations. Normally, epigastric pulsations are observed in thin and lean people, otherwise it may represent a heart, liver or aortic disease. One of the causes of visible epigastric pulsations is abdominal aortic aneurysm (AAA), the patient experiences pain and pulsations in epigastrium or upper abdomen. • Abdominal aortic aneurysm (AAA) is a serious and potentially life-threatening condition characterized by the abnormal enlargement of the abdominal aorta, the major blood vessel that supplies blood to the lower part of the body. One of the less common but significant presentations of AAA is visible epigastric pulsations. Recognizing this symptom can be crucial for early diagnosis and management, which can significantly reduce the risk of rupture and improve patient outcomes. • AAA occurs when the walls of the abdominal aorta weaken, causing it to bulge or balloon out. This weakening can result from several factors, including atherosclerosis, high blood pressure, genetic predisposition, and smoking. Over time, the aneurysm can enlarge and become more susceptible to rupture, leading to catastrophic internal bleeding. Early detection and monitoring are vital to prevent such severe complications. • Epigastric pulsations are a visible or palpable throbbing sensation in the upper abdominal area, just below the sternum. This symptom can be indicative of an underlying AAA, especially in individuals with risk factors such as advanced age, male gender, smoking history, and hypertension. The pulsations occur because the enlarged aorta transmits its pulsatile flow to the overlying abdominal wall, making the pulsation visible or palpable to the observer. • When epigastric pulsations are observed, a thorough clinical evaluation is necessary. Physicians should consider a detailed patient history and physical examination, focusing on risk factors and other symptoms like back pain, abdominal discomfort, or a pulsatile mass. • Imaging studies are critical in confirming the diagnosis. Ultrasound is the first-line imaging modality due to its non-invasive nature, accessibility, and high sensitivity for detecting AAA. If the ultrasound findings are inconclusive or further anatomical detail is required, computed tomography (CT) or magnetic resonance imaging (MRI) can provide detailed images of the aorta and surrounding structures. These imaging techniques are essential in assessing the size and extent of the aneurysm and planning appropriate intervention. • The management of AAA depends on the size and growth rate of the aneurysm and the patient's overall health status. Small aneurysms (less than 5.5 cm in diameter) are typically monitored with regular imaging studies to track their growth. Lifestyle modifications, such as smoking cessation, blood pressure control, and lipid management, are recommended to slow aneurysm progression. • For larger aneurysms or those showing rapid growth, surgical intervention may be necessary. The two main surgical options are open repair and endovascular aneurysm repair (EVAR). Open repair involves replacing the affected section of the aorta with a synthetic graft, while EVAR is a minimally invasive procedure where a stent-graft is placed within the aneurysm through the blood vessels. The choice of procedure depends on various factors, including the patient's anatomical suitability and overall health. • Early detection of AAA presenting as epigastric pulsations is crucial for preventing rupture, which carries a high mortality rate. Public awareness and education about the risk factors and symptoms of AAA can aid in early diagnosis. Health care providers should maintain a high index of suspicion, especially in high-risk individuals presenting with epigastric pulsations. #epigastric #pulsations #clinical #examination • Keywords: • [Epigastric pulsation causes, abdominal aortic aneurysm symptoms, visible abdominal pulse, epigastric pulsation differential diagnosis, epigastric pulsation treatment, pulsation in upper abdomen, abdominal aortic aneurysm diagnosis, abdominal pulsation medical emergency, visible pulse in stomach, epigastric pulsation physical exam, abdominal aortic aneurysm emergency, pulsating sensation in abdomen].

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