Abdomen Vasculature

Question 1

The function of the _______ system, along with the heart and lymphatics, is to transport gases, nutrient materials, and other essential substances to the tissues and subsequently transport waste products from the cells to the appropriate sites for excretion.”

Answer 1

Circulatory

Question 2

Vascular Function Construction

Function:

• _______ & smaller _______
• _______ and smaller _______
• _______

Vessel Wall Layers:

• Tunica _______
• Tunica _______
• Tunica _______

Answer 2

Arteries
Arterioles
Veins
Venules
Intima
Media
Adventitia

Question 3

Function
Arteries & Smaller Arterioles

• Carry blood _______ from the heart
• Typically _______
• _______

Answer 3

Away
Oxygenated
Pulsatile

Question 4

Function
Arteries & Smaller Arterioles

Elastic tubes
-Smaller Arterioles contain less _______ tissue & more _______ muscles than larger arteries

-Elasticity of the larger arteries is important in maintaining a steady _______ flow

Answer 4

Elastic
Smooth
Blood

Question 5

Function
Veins & Smaller Venules

• Carry blood _______ the heart
• Typically ___-_______
• _______

Answer 5

Toward
De-oxygenated
Phasic

Question 6

Function
Veins & Smaller Venules

Collapsible tubes
-Appear collapses due to little _______ tissue or _______ within their walls

-Larger total diameter than _______ & move _______ more slowly than arteries

Venous return to the heart is aided by:
-_______ valves, _______ contraction, overflow from capillary beds, gravity, and suction from negative thoracic pressure

Answer 6

Elastic
Muscle
Arteries
Blood
Venous 
Muscle

Question 7

Function
Capillaries

• _______-walled, hair-sized vessels connect the _______ and _______ system
• Fluids passing through _______ walls provide nutrients to cells & tissues and carry _______ waste products

Answer 7

Single
Arterial
Venous
Capillary
Away

Question 8

Vessel Wall Layers
Tunica (coat) Intima

• The _______ layer
• Comprised of a _______ layer of endothelial cells and _______ tissue; cells longitudinally organized
• Smooth, thrombo-resistant surface _______ friction
• Serves as selective interface for diffusion, convection & _______ transport of circulating substances into underlying arterial wall

Answer 8

Inner
Single
Connective 
Reduces
Active

Question 9

Vessel Wall Layers
Tunica Media

• The _______ layer
• Usually the thickest layer in _______
• Composed of:
• _______ for recoil
• _______ for distensibility
• _______ muscle for caliper change
• Helps control _______ of blood vessel lumen by vasodilation & vasoconstriction
• Regulated by vasomotor fibers of _______ nervous system

Answer 9

Middle
Arteries
Elastin
Collagen 
Smooth 
Diameter
Autonomic

Question 10

Vessel Wall Layers
Tunica Adventitia

• The _____ layer
• Comprised of elastic tissue surrounded by a thin _____ layer
• Usually thickest in _____

Vasa vasorum ("vessels of vessels")
-Vessels that supply the adventitia & \_\_\_\_\_ media;

-______ media & intima supplied via direct diffusion from lumen

Sympathetic nerve fibers
-Control _____ activity within the media

Answer 10

outer
fibrous
veins
outer
inner
muscular

Question 11

Vessel Wall Layers

• Vessel wall construction is similar for arteries & veins except venous walls are _____ & less _____
• Extremity veins contain valves that extend inward from the tunica _____ to prevent backflow of blood

Answer 11

thinner
elastic
intima

Question 12

Abdominal Vasculature

• _____
• _____ Branches
• _____ Axis
• _____ Mesenteric Artery
• _____ Arteries
• _____ Arteries
• _____ Mesenteric Artery
• Common _____ Arteries

Answer 12

Aorta
Aortic
Celiac
Superior
Renal
Gonadal
Inferior
Iliac

Question 13

Aorta

• Main artery of _____ & _____
• Carries _____ blood to the systemic circulation

Largest artery in the human body; divided into sections:
-Root, _____/arch, _____/thoracic and _____

Answer 13

chest
abdomen
oxygenated
ascending
descending
abdominal

Question 14

Aorta - Root

• Arises _____ ventricular outflow tract (LVOT)
• Comprises _____ semi-lunar cusps
• Prevent blood from flowing back into the _____
• Cusps open in ventricular _____ & are closed during ventricular _____
• Ao root ascends posterior to main pulmonary artery to form _____ aorta
• Right & left coronary arteries arise superiorly from right and left coronary _____
• Carry O2 rich blood to the _____

Answer 14

left
3
LV
systole
diastole
ascending 
cusps
heart

Question 15

Aorta - Ascending

-Arises a short distance from _____ & arches superior to form Ao arch

3 branches, supplying head, neck & upper extremities, arise from superior border of Ao arch:

• Innominate or _____
• Left common _____(LCCA)
• Lt. _____

Answer 15

LV
brachiocephalic
carotid
subclavian

Question 16

Aorta - Descending / Thoracic

• Descends ________ along back wall of heart from Ao arch & passes through aortic hiatus of the diaphragm
• At this point called the ________ aorta

Answer 16

Posteriorly

Abdominal

Question 17

Aorta - Abdominal

• Lies to the _____ of midline, adjacent to the inferior vena cava (IVC) and _____ to the spine
• Extends to the umbilicus where it bifurcates into the right and left common _____ arteries (RCIA and LCIA)

Answer 17

left
anterior
iliac

Question 18

Aorta - Abdominal

• US-anechoic tubular structure slightly to the _____ of midline; pulsatile; caliber does not vary with respirations or valsalva
• Tapers as it courses inferiorly; ___-cm at diaphragmatic hiatus to ___-cm at bifurcation; considered abnormally enlarged when diameter exceeds _____-cm

Answer 18

left
2
1.5
3.0

Question 19

Aorta - Abdominal

Doppler
-Aortic blood flow is considered _____ flow (same velocity throughout the lumen)

Answer 19

plug

Question 20

Aorta - Abdominal

Doppler

• Proximal to the _____ artery origins, Ao waveform typically monophasic demonstrating _____ resistance flow
• Distal to renal artery origins, Ao has triphasic, _____ resistance flow

Answer 20

renal
lower
high

Question 21

Aortic Branches

Anterior

• _____ Artery (Splenic, Common Hepatic and Lt Gastric)
• _____ Mesenteric Artery
• _____ Mesenteric Artery

Lateral

• _____ Arteries
• _____ Arteries
• _____ Arteries

Dorsal
-_____ Arteries

Answer 21

celiac
superior
inferior
phrenic
renal
gonadal
lumbar

Question 22

Inferior Phrenic Arteries

• _____ branch
• Arises _____ from Ao
• Not visualized by US
• Lies just _____ to diaphragm

Answer 22

1st
laterally
inferior

Question 23

Celiac Axis

• _____ branch (sonographically) of abdominal aorta visualized by US (2nd branch anatomically)
• Celiac axis/trunk/artery arises anteriorly, ___-__ cm from diaphragm (1st anterior Ao branch) and immediately divides into common _____, _____, and left _____ arteries
• Doppler demonstrates _____ resistance blood flow with continuous flow throughout diastole

Answer 23

1st
1
2
hepatic
splenic
gastric
low

Question 24

Celiac Axis
Splenic Artery (SA)

• Courses to the left entering the _____ at the splenic hilum
• Travels along the posterio-superior margin of the pancreatic _____ and _____
• Supplies blood to the body of the _____
• SA is tortuous and has turbulent flow in the _____ portion
• _____ resistance flow with continuous flow throughout diastole

Answer 24

spleen
body
tail
pancreas
distal
low

Question 25

Celiac Axis Common Hepatic Artery (CHA) - Courses horizontally to the _____ - Runs adjacent to the _____ vein and common _____ duct toward the porta hepatis - After the gastroduodenal artery branches off it becomes the proper _____ artery

Answer 25

right portal bile hepatic

Question 26

``` Celiac Axis Gastroduodenal Artery (GDA) ``` -Courses caudally (inferiorly) in a path posteriomedial to the _____ toward the anterior-lateral surface of the pancreatic head

Answer 26

duodenum

Question 27

Celiac Axis Proper Hepatic Artery (PHA) - Continues to porta hepatis and divides into _____, _____, and _____ hepatic arteries within the liver - Hepatic arteries are _____ resistance flow with continuous flow throughout diastole

Answer 27

right middle left low

Question 28

Celiac Axis Right Hepatic Artery (PHA) - Typically seen as the middle structure in a long-axis of the portal triad, with _____ duct anterior and portal _____ posterior - A "replaced" RHA may come directly off the _____ 11% of the time

Answer 28

bile vein SMA

Question 29

Superior Mesenteric Artery - _____ sonographically visualized branch of the abdominal aorta - Arises anteriorly, about _____ cm inferior to the celiac artery, and courses inferiorly - Its anterior surface borders the _____ surface of the body of the pancreas - SMA provides the major arterial supply to _____ intestine; also supplies blood to the pancreatic head, cecum, ascending colon, and part of transverse colon - As SMA courses anteriorly, it _____ the Ao; distance between the anterior wall of the Ao and the posterior wall of the SMA there should be < 11-mm

Answer 29

``` 2nd 2 posterior small parallels ```

Question 30

Superior Mesenteric Artery Doppler -_____ patient - high resistance flow with sharp systolic peak and absent late diastolic flow, possible bi or triphasic SMA becomes a low resistance vessel with broad systolic peak and continuous flow throughout diastole

Answer 30

fasting

Question 31

Renal Arteries - Branch from posterior-lateral border of the Ao, at a level just _____ to the origin of the SMA; the right somewhat inferior than the left - _____ courses horizontally and passes posterior to IVC to enter right renal hilum; longer than LRA; passes posterior to RRV as it enters renal hilum - _____ travels horizontally directly to the left renal hilum - Duplicate renal arteries occur in ___-___% of the population - Renal arteries has _____ resistance flow with continuous flow in diastole; same flow pattern seen in intrarenal arteries

Answer 31

``` inferior RRA LRA 10 20 low ```

Question 32

Renal Arteries - As right and left renal arteries reach the hilum they divide into multiple _____ arteries; each segmental artery supplies _____ segment of the kidney - As segmental arteries enter renal parenchyma, they form _____ arteries that course toward the renal cortex along the lateral borders of the renal pyramids - The _____ arteries give off minute interlobular arteries; branch off at right angles to course through the cortex toward the periphery of the kidney

Answer 32

segmental one interlobar arcuate

Question 33

Gonadal Arteries - Gonadal (testicular or ovarian) arteries are small in caliber and difficult to visualize on US; arise off the _____ aspect of the Ao, _____ to the renal arteries - Follow the _____ muscles into the pelvis to the gonadal area

Answer 33

anterior inferior psoas

Question 34

Inferior Mesenteric Arteries - IMA is the last branch to originate from the Ao before the Ao _____ - Much _____ in diameter than the SMA and is generally not identified on routine sonograms - IMA arises from the anterior border of the Ao and courses _____ and slightly to the _____ of midline - Supplies blood to the _____ transverse colon, descending and sigmoid colon, and upper rectum

Answer 34

``` bifurcation smaller inferiorly left left ```

Question 35

Common Iliac Arteries - Arises at Ao bifuraction (L4); divides into _____ and _____ iliac arteries - _____ iliac arteries enter pelvis to supply pelvic viscera, peritoneum, buttocks, and sacral canal - _____ iliac arteries after ligament become common femoral down the lower extremity

Answer 35

internal external internal external