Chapter 8 Hagen

Question 1

Arteries and Veins contain 3 layers which are what?

Answer 1

Tunica intima- inner layer
Tunica media- middle layer
Tunica adventitia- external layer

Question 2

What 4 branches of the aorta supply visceral organs and mesentery?

Answer 2

Celiac trunk
Superior mesenteric artery (SMA)
Inferior mesenteric artery (IMA)
Renal arteries

Question 3

What is the normal Aorta measurement in men?

Answer 3

2.5-2.7 cm

Question 4

What is the normal Aorta measurement in women?

Answer 4

2.1-2.3 cm

Question 5

Where do the Phrenic arteries arise from?

Answer 5

Arise from lateral walls of the aorta and supply the undersurface of the diaphragm. (not seen on ultrasound)

Question 6

Where is the Celiac trunk located?

Answer 6

1st anterior branch, arising 1 to 2 cm inferior to the diaphragm.

Question 7

What is the proximal Aorta landmark?

Answer 7

The gastroesophageal junction.

Question 8

What is the mid-Aorta landmark?

Answer 8

Just below SMA

Question 9

What is the distal Aorta landmark?

Answer 9

Just above the bifurcation.

Question 10

The celiac trunk splits into what 3 branches?

Answer 10

The common hepatic left gastric and splenic arteries.

Question 11

What are the five main branches supply the small bowel?

Answer 11

1. Inferior pancreatic artery
2. Duodenal artery
3. Colic artery
4. Ileocolic artery
5. Intestinal artery

Question 12

What are the 3 main branches of the Inferior Mesenteric Artery?

Answer 12

Left colic
Sigmoid
Superior rectal arteries

Question 13

What are the lateral branches of the abdominal Aorta?

Answer 13

Phrenic arteries
Renal arteries
Gonadal artery

Question 14

Aorta clinical indications: (Reasons a patient may come to you for their ultrasound)

Answer 14

Pulsatile abdominal mass
Abdominal pain radiating to the back
Abdominal bruit
Hemodynamic compromise to the lower legs

Question 15

Ectasia

Answer 15

diffuse dilation it increases in transverse diameter and vertical length, which causes the distal aorta to “kink” and become tortuous.

Question 16

Aneurysm

Answer 16

Focal enlargement

Question 17

Arteriosclerosis

Answer 17

Occurs when the vascular system becomes thick and stiff- leading to restriction of blood flow.

Question 18

Atherosclerosis

Answer 18

A specific form of arteriosclerosis.

Question 19

Arteriosclerosis is most commonly associated with the development of a ______.

Answer 19

Aneurysm.

Question 20

Permanent localized dilation of an artery- usually greater than 3 cm or more than greater than 1.5 times the diameter of the proximal aorta.

Answer 20

Abdominal Aortic Aneurysm

Question 21

Most Abdominal Aortic Aneurysm are _______.

Answer 21

Infrarenal

Question 22

Abdominal Aortic Aneurysm risk factors include:

Answer 22

Tobacco use
Hypertension (HTN)
Vascular disease
Chronic Obstructive Pulmonary Disease (COPD)
Family history (Genetic Links- Marfan syndrome and Ehlers-Danlos syndrome)

Question 23

Abdominal Aortic Aneurysm clinical symptoms include:

Answer 23

Most are asymptomatic
Often found on routine physical exam
May be found during unrelated radiologic or surgical procedure (incidental finding)
Symptoms can come from rupture or expansion of the vessel
An aneurysm may impinge on other adjacent structures or cause an occlusion because of direct pressure causing symptoms
Intense back pain and drop in hematocrit point to ruptured aneurysm

Question 24

Aneurysm size and treatment

Answer 24

< 4 cm- follow every 6 months

4-5 cm- consider surgery or endovascular aneurysm repair

Question 25

What is the most important and accurate measurement of the aorta/AAA?

Answer 25

Transverse AP

Question 26

What information do you feel is important to document when you find a AAA?

Answer 26

Size, location, relationship to renal arteries/iliacs, color flow, symptoms, priors for comparison.

Question 27

The majority are infrarenal, why would it be important to document the location in relation to the renal arteries?

Answer 27

Involvement in the renal arteries, pressure on the renal arteries could compromise blood flow to the kidneys causing ischemia, compression of the renal artery can cause hypertension, & surgical approach

Question 28

False aneurysms (pseudoaneurysm)

Answer 28

Not lined by all 3 layers Pulsatile hematoma that results from leakage of blood through a hole in the intima, but contained by the deeper layers of the aorta

Question 29

Fusiform aneurysm

Answer 29

most common presentation of an atherosclerotic aneurysm (football-like shape)

Question 30

Saccular aneurysm

Answer 30

sudden transition between normal and abnormal, typically larger (5-10 cm) than fusiform

Question 31

Most common site of aneurysm rupture

Answer 31

lateral wall inferior to renal vessels

Question 32

What are some other masses that can simulate a pulsatile abdominal mass?

Answer 32

Retroperitoneal tumor Huge fibroid uterus Paraaortic nodes Because the mass is adjacent to the aorta, pulsations are transmitted from the aorta to the mass.

Question 33

Three lateral tributaries of the IVC

Answer 33

Right suprarenal vein (the left suprarenal vein drains into the left renal vein) Renal veins Right testicular or ovarian vein

Question 34

Resistive Index (RI)

Answer 34

determined by comparing peak systole with minimum diastole to determine the vessels impedance

Question 35

Plug flow

Answer 35

Seen more in large vessels where most cells are moving the same velocity across the vessel. A clear window under systole is present

Question 36

Flow towards the transducer is a

Answer 36

positive shift and seen above the baseline

Question 37

Flow away from the transducer is a

Answer 37

negative shift and seen below the baseline

Question 38

Sample volume

Answer 38

or sample gate should be adjusted to encompass the width of the vessel but not exceed the vessel walls. If it is too large then a noise artifact will appear in your waveform

Question 39

In a Renal Artery Stenosis, the blood is very ____.

Answer 39

Turbulent