Which sign is considered a late indicator of a rupturing abdominal aortic aneurysm?

• A. Pulsating abdominal mass
• B. Back pain with normal blood pressure
• C. Tachycardia due to anxiety
• D. Hypotension

Answer: (D)

When an abdominal aortic aneurysm ruptures, the situation evolves from pain and local signs to systemic shock as bleeding continues. Early clues include sudden severe abdominal or back pain and, if felt, a pulsatile abdominal mass. However, a pulsatile mass isn’t always present and can be unreliable, and pain with a normal or elevated blood pressure can occur early. As blood loss worsens, the body's compensatory mechanisms raise heart rate and can cause anxious appearance, but those signs can be nonspecific. The late indicator is hypotension, reflecting significant intraperitoneal or retroperitoneal bleeding and advancing shock. Recognizing hypotension in this context signals a now-critical, decompensated state that requires immediate emergency action.