Abdominal Vessels

Question 1

When does the thoracic aorta become the abdominal aorta?

Answer 1

As it passes posterior to the diaphragm and enters the abdominal cavity

Question 2

What is the maximum normal diameter of the abdominal AO?

Answer 2

< 3 cm

Question 3

What is the first branch of the abdominal AO?

Answer 3

The celiac axis

Question 4

What are the three vessels that branch off the celiac axis?

Answer 4

The splenic, common hepatic, and left gastric veins

Question 5

What is the second branch of the abdominal AO?

Answer 5

The superior mesenteric artery

Question 6

Where are the renal arteries located in relation to the SMA?

Answer 6

Distal to SMA

Question 7

Where are the renal arteries located in relation to the iliac arteries?

Answer 7

Proximal to iliacs

Question 8

What actions can a patient take to increase IVC diameter?

Answer 8

Valsalva maneuver and holding their breath

Question 9

What actions can a patient take to decrease IVC diameter?

Answer 9

Take in a sniff of air

Valsalva

Question 10

What are the three layers of a vessel wall?

Answer 10

Tunica intima, media, and adventitia

Question 11

How do the walls of the AO and IVC differ?

Answer 11

AO has thick tunica media w/ more muscle layers, IVC has thin tunica media and less elasticity

Question 12

What is the purpose of the valves of the venous system?

Answer 12

They provide unidirectional flow to the vena cava

Question 13

How do the walls of the AO appear on ultrasound?

Answer 13

Bright and echogenic

Question 14

Is the AO pulsatile?

Answer 14

Yes, AO is pulsatile

Question 15

Where is the AO in relation to the spine?

Answer 15

Anterior and to the anatomic left

Question 16

What AO branches can be seen on ultrasound?

Answer 16

Celiac axis, SMA, renal arteries, and iliac arteries

Question 17

What landmarks divide the abdominal AO into proximal, mid, and distal segments?

Answer 17

Proximal: diaphragm to celiac
Mid: celiac to SMA
Distal: SMA to ILI BIF

Question 18

What transducer is most commonly used in abdominal AO scanning?

Answer 18

Low frequency (3-5 MHz) with a curvilinear probe

Question 19

What other transducer can be used for AO scanning?

Answer 19

Phased array (1-5 MHz)

Question 20

How is the patient usually positioned during an AO scan?

Answer 20

Supine position

Question 21

What are the 4 techniques to optimize AO images?

Answer 21

1. Decrease depth caudally
2. Decrease depth at iliacs
3. Increase gain in larger patients
4. Lower transducer frequency for better pen

Question 22

What is responsible for the image artifact delineated by the indicator on the anatomic left of the patient?

Answer 22

Stomach

Question 23

Is the diameter of the AO or IVC highly dynamic and variable with compression?

Answer 23

IVC

Question 24

What are tributaries of the IVC characteristically seen on ultrasound?

Answer 24

Hepatic veins

Question 25

What can be seen when scanning proximal IVC in transverse?

Answer 25

Liver and hepatic veins

Question 26

What do the walls of the IVC appear like on ultrasound?

Answer 26

Thin with highly echogenic walls surrounding anechoic lumen

Question 27

What vessel does the left renal artery come from?

Answer 27

AO

Question 28

What organ does the left renal artery drain into?

Answer 28

Left kidney

Question 29

How can you clear acoustic enhancement from bowel gas?

Answer 29

Drinking water or shifting positions

Question 30

What does the SMA supply with blood?

Answer 30

Intestines

Question 31

What are IVC tributaries typically seen with ultrasound?

Answer 31

Hepatic veins, common iliac veins, and renal veins

Question 32

What are indications for diagnostic evaluation of abdominal AO?

Answer 32

Palpable or pulsatile mass Pain in lower back, flank, abdomen. Follow up for AAA or ab AO or iliac stent graft

Question 33

What are indications a patient should undergo screening for AAA?

Answer 33

Male > 65 Female > 65 w/ cardiovascular risk Pt > 50 w/ hx of peripheral vascular aneurysmal disease HTN, smoking

Question 34

What measurements should be included when scanning AO?

Answer 34

Prox, mid and distal AO in long Transverse for width Dimension of aneurysm if any

Question 35

What are criteria for if a patient has AAA?

Answer 35

AO is > or = diameter of 3 cm | AO is 1.5x proximal infrerenal AO

Question 36

Where do you get a lot of pt information before exam?

Answer 36

Ultrasound request form and pt chart

Question 37

What information is in the assessment notes?

Answer 37

Physical exam, lab results