- Has a thicker tunica media (to withstand the pressure of the blood pumping) - not compressible like veins are - higher pressure - takes oxygenated blood away from heart to organs

Exam 2 Flashcards by Danielle Shoebottom

What takes blood out of liver and to the IVC?

Hepatic veins

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T/F?

Transducer pressure can rupture an aneurysm.

True

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Normal IVC measurement is

2.5 cm or 25mm

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Aorta wall layers, inner to outer:

Tunica intima
Tunica media
Tunica adventitia

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Define hepatopedal

Define hepatofugal

Normal; blood flow to to the liver
—pulse wave will be above the line
— this is what u want for PV
— color Doppler will appear red

Abnormal; blood flow away/out of liver
— pulse wave will be below the line
—color Doppler will appear blue

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The celiac trunk branches into___

Hepatic artery (travels laterally to ao to enter the liver)

Splenic artery (tortuous and travels lateral to AO to the spleen)

Left gastric artery (not visible on US)

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Normal IVC variants

Double ivc
Swapped locations
Absence of portions (rare)

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Where is posterior cul de sac located?

Btw wall of uterus and rectum

Recto-uterine pouch
“Pouch of Douglas”

most common area for fluid to build up

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Name some examples of aortic pathology

Stenosis
Grafts
Aortic dissection
Aneurysm

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Which renal vein is longer than the other and why?

Left renal vein is longer than the right bc it has to cross over the aorta and the right renal vein does not

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Normal IVC size

2.5 cm (25mm)

Increases and decreases with breathing and pressure but should not exceed 3.7 cm (37 mm)

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What are the main functions of the aorta?

1) oxygenation
2) metabolism
3) maintaining blood pressure

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Ivc branches/ tributaries:

Hepatic veins (left, middle, right)
Renal veins
Gonadal veins
Lumbar veins

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responsible for melatonin (sleep cycle)

Pineal

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Describe an artery

Has a thicker tunica media (to withstand the pressure of the blood pumping)
not compressible like veins are
higher pressure
takes oxygenated blood away from heart to organs

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Gland responsible for calcium levels

Parathyroid

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Which branch of the Peripheral Nervous System (PNS) is responsible for maintaining body’s energy?

Parasympathetic

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Procedure used to drain fluid from peritoneal cavity

Paracentesis

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3 membranes that line the skull and enclose the brain and spinal cord

Meninges

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Which organs have a horizontal oblique orientation?

Liver, pancreas

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What is a pulmonary embolism?

A blood clot that breaks off and travels through heart and to lungs

*** this is deadly

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Normal Aortic measurements are:
Prox:
Distal:
Iliacs:
But should never exceed:

Prox 2cm
Distal 1.5cm
CIA 1cm
Shouldn’t exceed: 3cm

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Where is the most common location to find an aneurysm?

Intrarenal

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The urinary system is responsible for what 3 things?

Regulates blood volume
Regulates blood pressure
Production of RBCs

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What is also known as omental bursa?

Lesser sac

Right portal being branches are: Left portal vein branches are:

Right PV= anterior and posterior Left PV= medial and lateral

Where does the aorta originate?

Left ventricle of heart

The ductus venous by passes what organ of the fetus?

Liver

Intraperitoneal organs

GLOSS ``` Gallbladder Liver Ovaries Spleen Stomach ```

Normal portal vein measurement is

13mm or 1.3 cm

Portal veins bring ____ blood ___ the liver, and hepatic arteries bring ____ blood ____ the liver.

Nutrient rich To Oxygen rich To

Name the 4 sections of the ivc

Hepatic Prerenal Renal Postrenal

Where is anterior cul de sac located?

Btw wall of bladder and uterus Also called vesico-uterine pouch

The pulmonary artery takes ____ blood (to/away) the lungs and the pulmonary vein takes ___ blood ____ from the lungs.

Deoxygenated To Oxygenated Away

Another name for hilum of liver is:

Porta hepitis

Where does the aorta originate?

Left ventricle

IVC associated tests:

``` Duplex Doppler Color Doppler Venography MRI CT ```

Which system is first to function during fetal development?

Cardiovascular

The anterior pituitary ____ | While the posterior pituitary _____

Ant- releases hormones | Post- stores the hormones

The internal common iliac is also known as ___.

Hypogastric artery

Parts of the uterus from superior to inferior:

Fundus Body Cervix

Other names of posterior cul de sac:

Recto-uterine pouch | Pouch of Douglas

Name some IVC pathology

Blood clot, tumor invasion

Function of endocrine system

Maintains homeostasis by regulating body function including reproduction, growth and development, metabolism, blood glucose levels, stress response, ovulation

Normal aortic diameter Prox: Distal: Iliacs:

Prox: 2cm (20mm) Distal: 1.5cm (15mm) Iliacs: 1cm (10mm)

____ produces bile, which is sent to ___ to be stored through the ___.

Liver GB Biliary system

During systole, valves are ___. During diastole, valves are ___.

Open | Closed

What is homeostasis?

The maintenance of stability through the body’s self-regulating systems

IVC originates at

The junction of left and right iliac veins Courses superiorly to right atrium

What percent of blood going into the liver is brought by the portal venous system?

65-75% (nutrient rich) And about 25% (oxygenated blood) from hepatic artery

The greater sac is also known as ___

General cavity

First functioning system in embryonic development

Cardiovascular system -heart and aorta form at the same time

What are the 3 layers of the aorta in order from deep to superficial

Deep to superficial 1) tunica intima 2) tunica media 3) tunica adventitia

What 2 muscles are located in the false pelvis?

Quadratus lumborum | Psoas major

Celiac artery branches:

Common hepatic artery Splenic artery Lt gastric artery

Endocrine system is also called

Neuroendocrine system

The Fallopian tubes lie in the superior part of the ____.

Broad ligament

Kidneys, common bile duct, portal vein, smv, and common iliac arteries all have a ____ orientation.

Vertical oblique

The body’s computer

Nervous System -uses electrical signals to protect body from harm

“Master gland”

Pituitary gland

Gland responsible for protection against autoimmune (t cells)

Thymus

A transverse kidney, anterior to posterior, the vessels seen at hilum:

Vein Artery Ureter

The IVC returns deoxygenated blood to the ____ of the heart.

Right atrium

The anterior muscle layer includes ____ tissue and ___ muscle.

Subcutaneous | Rectus abdomina

Nervous system is divided into:

Central: brain and spinal cord Peripheral nervous system: connects the CNS with the limbs and organs of body

List the intraperitoneal organs

GB, liver, ovaries, spleen, stomach GLOSS

Describe veins

- have valves in center to prevent back flow of blood - are compressible - lower pressure - brings blood away from organs back to the heart to become oxygenated

reads which hormones are needed in body

Hypothalamus

What is Morison’s pouch and what is it known for?

Located btw right kidney and liver A common area for fluid to build up - ascites

Retroperitoneal organs

PUCKER ``` Pancreas Ureters Colon (ascending and descending only) Kidneys Esophagus Rectum ```

4 types of aortic aneurysms

Sacular Fusiform Ruptured Pseudo

What is the double fold of peritoneum that attaches intestines to posterior abdominal wall?

Mesentary

Peripheral nervous system is divided into:

Somatic- all conscious awareness of our externally environment (voluntary) and all movement (thru skeletal muscle) Ex) touching hot stove Autonomic nervous system- involuntary functions Ex) digestion

responsible for estrogen, testosterone, and progesterone

Ovaries/testes

The spleen, bone marrow, and thymus are part of the _____ system.

Lymphatic

Lumen is

Where blood flow occurs within the aorta

True or false The right real artery is longer than the left renal artery.

True Bc the right renal artery travels posterior to ivc and then meets with the rt kidney whereas the left renal artery has a direct route to the lt kidney.

Procedure for pleural effusion

Thoracentesis

Which renal artery is longer and runs posterior to ivc?

Right

The stomach is ___ to the pancreas.

Which veins increase in diameter as they approach the IVC?

Hepatic

A collection of glands that secrete hormones (chemical messengers)

Endocrine system

T/F? Visceral peritoneum is the outer layer attached to abdominal wall.

False Parietal is the outermost layer

What is responsible for directing the secretion of hormones?

Hypothalamus

The prostate gland is perforated by the ___ & ___.

Urethra | Ejaculatory duct

3 protective layers of CNS (meninges)

Pia mater- innermost Arachnoid- middle layer Dura mater- outer layer

Gland responsible for adrenaline

Adrenal gland

responsible for insulin, digestive enzymes

Pancreas

Name all of the branches on the aorta and their location

Prox aorta -Celiac trunk (anterior) Mid Ao- Sma (anterior) Renal arteries (lateral) Gonadal arteries (oblique lateral) Inferior mesentaric artery Inferior phrenic Suprarenal arteries

Autonomic nervous system is divided into:

Sympathetic division: responds to stress or danger —(increased heart rate, breathing, blood pressure) Parasympathetic division: maintains and restores body’s energy —(reduces output of adrenaline, decreases heart rate and breathing rates, lower blood pressure)

Portal venous system brings blood from the ___, ___, and ____ to the ____.

Spleen GB GI tract Liver

Ureters Renal veins Renal arteries Name them in order from anterior to posterior

Renal veins Renal arteries Ureters

The pancreas extends from the ____ of the spleen.

Hilum

A normal CBD measurement is ___

6 mm or 0.6cm

Portal veins have more ____ in the walls, which is why they appear more hyperechoic.

Collagen

Gland responsible for metabolism

Thyroid

The second branch of the anterior abdominal aorta is

SMA

What are gonadal arteries

Ovarian arteries | Testicular arteries

Left common iliac arteries bifurcate into

``` Left internal (hypogastric) Left external iliac arteries ```

Stretching of the aorta

Aortic aneurism

Plaque forming within lumen of aorta (can cause blood clots) -can be catastrophic

Atherosclerosis

Separation of layers of tunica media and tunica intima, very likely to lead to aortic rupture

Aortic dissection

Diseases of the aorta tend to be

Asymptomatic until they are catastrophic

LVOT stand for

Left ventricular output tract

Thoracic and abdominal cavities are separated by

Diaphragm

Place in the diaphragm where aorta passes

Aortic hiatus - interior to that is the abdominal aorta - aorta passes posteriorly to diaphragm

Hypogastric artery sends blood to

Pelvic area

Gonadal arteries branch ____to the aorta and ____ to renal arteries

Laterally | Inferior

The sma travels .....

Anterior to aorta and parallel inferiorly along the aorta while staying anterior

Suprarenal artery is

Adrenal artery

Left renal vein is ____ to sma and ____to aorta

Posterior | Anterior

Left renal artery is ___ to ivc

Posterior

T/F The splenic artery is very tortuous.

True (very curvy, not straight)

The common hepatic artery bifurcated into

Proper hepatic- liver Gastroduodenal artery- passes through the head of the pancreas

What makes up the “seagull”?

Body is celiac trunk Right wing is common hepatic artery Left wing is splenic artery

Structure that anchors the diaphragm -can be seen anterior in prox aorta

Crus of diaphragm

What lobe of liver is seen in sag abdominal aortic scan?

Left lobe

Aorta starts out ___ to body, but it moves ____ as it travels down the body.

Posterior | Anteriorly

Sma supplies blood to

Small intestine Ascending colon Part of transverse colon

Sma is surrounded by

Echogenic fatty halo

Splenic vein is ___ to left kidney

Superior

Portal splenic confluence becomes ____ which can be found at ___ of liver on the ___ lobe of liver.

Portal vein Hilum Right

Veins have ___ to keep blood from going backward, while ____ do not.

Valves | Arteries

Largest artery in body

Aorta

Largest vein in body

Ivc

Oxygen exchange in arteries and veins take place at _____

Capillary level

Vasoconstriction is

Constriction of veins, this is how BP is maintained

____ drains blood from left lobe of the liver into the IVC

Left hepatic vein

2 main body cavities

Dorsal and ventral

Dorsal cavity contains

Cranial cavity and spinal cavity

Ventral cavity is divided by

The diaphragm Divided into thoracic and peritoneal

Portion of peritoneum that covers the organs

Visceral peritoneum

Portion of peritoneum lining the cavity that forms a closed sac

Parietal peritoneum

Double layer of peritoneum that extends from the stomach to the adjacent abdominal organs

Omentum

Attaches to the anterior surface of the transverse colon

Greater omentum

Attaches the lesser curvature of the stomach and first part of duodenum to the porta hepatis

Lesser omentum

Where hepatic artery and main PV enter the liver and where the biliary ducts exit

Porta hepitis (hilum of liver)

____ is posterior to stomach and lesser omentum, area where fluid can build up

Greater sac

Located posterior to the stomach

Lesser sac also called omental bursa)

Division of ventral and peritoneal cavities that extends superiority from the iliac crests to pelvic diaphragm inferiorly

Pelvic cavity

Name the orientation of the structure: Aorta

Vertical

Name the orientation of the structure: Common hepatic duct

Vertical oblique

Name the orientation of the structure: Common carotid artery

Vertical

Name the orientation of the structure: Kidneys

Vertical oblique

Name the orientation of the structure: Uterus

Vertical

Name the orientation of the structure: Portal vein

Vertical oblique

Name the orientation of the structure: Common bile duct

Vertical oblique

Name the orientation of the structure: Renal arteries and veins

Horizontal

Name the orientation of the structure: Thyroid isthmus

Horizontal

Name the orientation of the structure: Splenic vein

Horizontal

Name the orientation of the structure: Pancreas

Horizontal oblique

Name the orientation of the structure: Liver

Horizon oblique

When in a longitudinal view to the pancreas, why does the tail appear to curve?

Tail is going deeper (posteriorly) towards spleen -that’s why we oblique the transducer angling to pt’s left shoulder in order to get long view of pancreas

What orientation would u need to be in to view the isthmus of the thyroid?

Trans

How would u know if you were looking at the inferior level of the right lobe of liver?

You would see right kidneys and gallbladder

__ and ___ run thru head of pancreas

Gastroduodenal artery (anterior) Common bile duct (posterior)

Formed by a double fold of peritoneal -blood vessels and lymphatics run along this

Mesentary

The fundus of the gallbladder is the ___ section and the neck of the ___ section

Wider transverse cross section | Smaller transverse cross section

Joining btw 2 things

Anastomosis

Fluid found in abdominopelvic area

Ascites

Subphrenic means

Below diaphragm

Area btw right kidney and liver

Morrison’s pouch -anechoic if fluid build up has occurred

Infracolic

Below colon -fluid can collect here

Paracolic

Around colon -fluid can collect here

Axial means

Transverse cross section

Area not encased in peritoneal cavity -most liver is encased but small portion is not

Bare area

Para means

To the side of

If the fluid has collected, when the patient is laying supine, what orientation would the fluid be sitting?

Fluid would lie dorsal the patient’s body

Most common area for fluid to collect

Posterior cul de sac Recto-uterine pouch “Pouch of Douglas”

Area where fluid can collect that is btw the uterus and rectum

Pouch of Douglas

Area where fluid can collect located btw wall of uterus and bladder

Anterior cul de sac | Vesico-uterine pouch

2 main area where fluid can collect when patient is supine **most dependent potion

1) Hepatorenal pouch (Morrison’s) 2)Recto-vesical pouch (man) Recto-uterine pouch (woman)

Once you scan past the ivc in prox long, what are u seeing?

Right lobe of liver

____ acts as a great acoustic window

Water

Formed by the confluence of splenic vein and smv

Main PV

Vessels that supply blood to liver

Splenic vein Smv Imv

The liver functions to: 1) 2) 3)

Metabolize blood Gain nutrients Detoxify and filter toxins

___ and ___ run alongside corresponding Heptic artery branches

RT PV | LT PV

Courses inferior to superior as it drains blood from large intestine

Smv Imv from intestine

Which portal triad would we see at the porta hepitis?

CBD, HA, and PV - this so the one we want to see when finding PV - extra hepatic

If we see the Common Hepatic Duct, Right Hepatic artery and portal vein, are in intrahepatic or extrahepatic?

Intrahepatic

Caudate lobe is ___ to IVC

Anterior Ligamentum vinosum separates caudate and left lobe ——— landmark for lt hep vein

Normal blood flow Flows into the liver/towards transducer Wave is above the baseline

Hepatopedal

Wave below baseline -blood flow away from transducer Abnormal blood flow

Hepatofugal

T/F? A hepatic vein pulse wave would be mostly below the baseline but also extend above the line.

True, bc it is close the heart

Left lobe is ____ to ivc

Main draining source of liver

Left hepatic vein

Fluid on top of liver can be described as

Subphrenic fluid

Rhythmic pulse Peak= systole (heart contracts) Drop= diastole (heart relaxes)

Normal arterial blood blow

Continuous wave of blood flow above the baseline

Normal PV blood flow

Drain blood from adrenal glands

Suprarenal veins - superior portion of kidneys - rt suprarenal drains directly into ivc - lt suprarenal drains into left renal vein then ivc

Left gonadal and left Suprarenal veins empty into

Left renal vein

Right gonadal and right suprarenal drain directly into

Ivc

T/F? There are valves in the IVC, which help move blood back to the heart

False No valves, respiration’s move blood

Anterior to portal vein are what 2 things?

CBD and HA - run side by side - must use color to distinguish and prove

What makes up the “bunny sign”?

Left ear- Middle hep vein Right ear- left hep vein Face- ivc

What makes up the “reindeer sign”?

Antlers-Right hep vein, Middle hep vein, Left hep vein Head- ivc

Right renal artery runs ____ to ivc

Posterior

Ivc runs directly ____ to caudate lobe

Posterior

Blood clot formed in a vessel

Thrombus

What is TIPS?

Transjugular intrahepatic portosystemic shunt - helps blood to flow from PV to HV - used on patients with liver disease and portal hypertension

When dye is injected into vessels and take x rays as it moves thru veins

Venography