Quiz 2 review pt 1

Question 1

What is the function of the circulatory system?

Answer 1

Transports gases, nutrients, & other essential substances to the tissues & transports waste products from the cells to the appropriate sites for excretion.

Question 2

What are the three layers of the vessel walls?

Answer 2

Tunica intima (inner), tunica media (middle), tunica adventitia (outer).

Question 3

Arteries carry what kind of blood and in what direction? Which arteries are different?

Answer 3

Arteries carry oxygenated blood away from the heart.

Pulmonary arteries carry deoxygenated blood to the lungs.

Question 4

Veins carry what kind of blood and in what direction? Which veins are different?

Answer 4

Veins carry deoxygenated blood toward the heart.

Pulmonary veins carry oxygenated blood from the lungs to the heart.

Question 5

How do veins appear on ultrasound?

Answer 5

Thin-walled, oval, larger diameter, and compressible.

Question 6

What do valves do?

Answer 6

Prevent backflow of blood.

Question 7

What are capillaries?

Answer 7

Capillaries are the exchange vessels. They are microscopic and have only one wall—tunica intima—allowing substances to pass through quickly.

They connect arterioles to venules.

Question 8

After blood is passed through capillaries, it is then collected where?

Answer 8

Venules.

Venules then unite to form larger vessels.

Question 9

True or False? Aorta changes in size with respiration.

Answer 9

False.

Only veins do.

Question 10

What are the 5 sections of the aorta?

Answer 10

Root, ascending, descending, abdominal, bifurcation.

Question 11

Which sections are part of the aortic arch?

Answer 11

The root and ascending aorta.

Question 12

What are the 3 vessels (in order) that come off the aortic arch?

Answer 12

Brachiocephalic, Left common carotid artery, Left subclavian.

Question 13

What are the branches of the abdominal aorta?

Answer 13

Celiac axis/trunk (1-2 cm from diaphragm), Superior mesenteric artery (1-2 cm from CA), Renal arteries, Inferior mesenteric artery.

Question 14

What are the branches of the CA?

Answer 14

Left gastric artery, Splenic artery, Common hepatic artery.

Question 15

The internal iliac artery is also called?

Answer 15

Hypogastric artery.

Question 16

Where does the root of the aorta arise from?

Answer 16

Left ventricle of the heart.

Question 17

What kind of flow resistance does the SMA have?

Answer 17

High resistance.

Question 18

What does the phrenic artery supply?

Answer 18

Diaphragm.

Question 19

What are clinical reasons to perform aortic exam?

Answer 19

Pulsatile mass, abdominal pain radiating to the back, abdominal bruit, hemodynamic compromise in the lower legs.

Question 20

What is the most common cause of AAA?

Answer 20

Arteriosclerosis (97%).

Atherosclerosis is a type.

Question 21

A true aneurysm involves?

Answer 21

All 3 layers of the vessel wall.

Question 22

What are the two main types of AAA? Which is more common?

Answer 22

Fusiform (most common), Saccular.

Question 23

Where do AAA usually begin?

Answer 23

Below renal arteries (infrarenal).

Question 24

When will a patient with AAA need surgery?

Answer 24

If greater than 5 cm.

Question 25

Difference between fusiform and saccular aneurysm?

Answer 25

Fusiform is a gradual dilation & can dilate on both sides; saccular is spherical (5-10 cm) outpouching, partially or completely filled with thrombus.

Question 26

Where does a berry aneurysm occur?

Answer 26

In the brain (1-1.5 cm).

Question 27

Risk factors for AAA?

Answer 27

Tobacco, Hypertension, Vascular disease, COPD, Family history.

Question 28

What are the 3 most common symptoms of AAA?

Answer 28

Palpable abdominal mass, Back pain, Drop in hematocrit.

Question 29

At what point is the aorta considered aneurysmal?

Answer 29

3 cm.

Question 30

How do you measure the aorta?

Answer 30

Outer wall to outer wall.

Question 31

Where does thrombus usually occur in the aorta?

Answer 31

Along anterior or anterolateral wall.

Question 32

What is ectatic aorta?

Answer 32

Bulgy in areas but diameter is less than 3 cm.

Question 33

Internal echoes in the aorta can indicate?

Answer 33

Thrombus.

Question 34

What are S/S of a ruptured AAA?

Answer 34

Excruciating abdominal pain, shock, expanding abdominal mass.

Question 35

What is a pseudoaneurysm?

Answer 35

A false aneurysm. ## Footnote It's a pulsatile hematoma that results from leakage of blood into soft tissues from punctured artery; occurs after procedure & common in the groin.

Question 36

What kind of flow pattern do pseudoaneurysms have?

Answer 36

To & fro (bidirectional) flow pattern.

Question 37

How do we repair pseudoaneurysms?

Answer 37

2 methods: Thrombin injection, Compression of neck.

Question 38

What is an aortic dissection?

Answer 38

When the intima pulls away from the aortic wall. ## Footnote Blood makes its way between the layers of the wall causing separation.

Question 39

Where do aortic dissections usually occur?

Answer 39

Aortic arch (thoracic aorta) 90%.

Question 40

What are the types of dissection? Which has a high mortality?

Answer 40

Type 1, Type 2 (Marfans), Type 3. ## Footnote Type 1 & 2 have high mortality; Type 3 has better prognosis.

Question 41

Marfan's syndrome usually occurs at which part of AO?

Answer 41

Ascending AO.

Question 42

What are some pseudo-pulsatile abdominal masses?

Answer 42

Enlarged lymph nodes (most common), retroperitoneal tumor/sarcoma, huge fibroid uterus, pancreatic cancer.

Question 43

What is RPF?

Answer 43

Retroperitoneal Fibrosis. ## Footnote Also called Ormond's disease.

Question 44

What is AVF? What causes AVF?

Answer 44

Arteriovenous Fistulas. ## Footnote It's an abnormal connection between an artery and a vein, usually secondary to trauma; can be complication to arteriosclerotic AAA.

Question 45

What does RAS stand for?

Answer 45

Renal Artery Stenosis.

Question 46

Splenic artery is tortuous & therefore can experience what in its waveform?

Answer 46

Spectral broadening.

Question 47

What vessels come together to form the IVC?

Answer 47

Common iliac veins.

Question 48

What are the major tributaries of the IVC?

Answer 48

Hepatic veins (right, middle, left), renal veins (left & right).

Question 49

True or False? Portal system has no connection with systemic veins.

Answer 49

True.

Question 50

The renal veins originate _______ to the renal arteries.

Answer 50

Anterior.

Question 51

What are the largest tributaries of the IVC?

Answer 51

Hepatic veins.

Question 52

Where do the hepatic veins originate?

Answer 52

Liver. ## Footnote They drain blood from liver into the IVC.

Question 53

How do the HV's change in size as they travel to the IVC?

Answer 53

They increase in size.

Question 54

The IVC runs ______ to the portal system.

Answer 54

Posterior.

Question 55

Where is the dome of the liver located?

Answer 55

Superior, closest to diaphragm.

Question 56

What vessels form the PV?

Answer 56

SMV, SV, IMC.

Question 57

Where does the portal venous system carry blood from?

Answer 57

Intestines and spleen.

Question 58

Which vessels do the ascending lumbar veins become and where do those vessels drain?

Answer 58

They are branches of the CIVs. ## Footnote Superior to the diaphragm, they become the azygos vein (right) & hemiazygos (left) & both drain into the SVC.

Question 59

What is the main tributary of the PV?

Answer 59

SMV.

Question 60

Which vessels form the portal triad?

Answer 60

PV, CHA, CBD.

Question 61

What are the two main findings in portal venous?

Answer 61

Portal vein hypertension, portal vein thrombus.

Question 62

What is the biggest risk with thrombus in the IVC?

Answer 62

It can travel to the lungs and PE can occur.

Question 63

What is RCC?

Answer 63

Renal cell carcinoma. ## Footnote Most common primary kidney tumor (usually on right side).

Question 64

What is an IVC filter? Where is it usually placed?

Answer 64

A 'clot trap' used to prevent thrombus from traveling into lungs. ## Footnote Usually placed at iliac bifurcation.

Question 65

What are potential complications of IVC filters?

Answer 65

It can migrate and perforate IVC, duodenum, aorta, ureter, hepatic vein.

Question 66

What are the 5 specific sonographic findings of acute renal vein thrombosis?

Answer 66

1. Dilated and echo-filled renal vein 2. Absence of intrarenal venous flow 3. An enlarged kidney 4. Hypoechoic renal parenchyma 5. Highly resistive renal artery waveform.

Question 67

A single liver cell is called?

Answer 67

Hepatocyte.

Question 68

The microscopic lobules of the liver =

Answer 68

Functional units.

Question 69

Phagocytes are also called?

Answer 69

Macrophages.

Question 70

The RLL should not measure out to be more than ____ cm.

Answer 70

17.

Question 71

What part of the liver lies between the fossa of the IVC and ligamentum venosum?

Answer 71

The caudate lobe.

Question 72

True or False? The caudate lobe can increase in size when the LLL or RLL decrease in size?

Answer 72

True.

Question 73

What connects the umbilical vein to the IVC?

Answer 73

Ductus venosus.

Question 74

What is a normal variant of the liver?

Answer 74

Reidel's lobe. ## Footnote It is when the RLL extends below the lower pole of RK (seen more in women).

Question 75

Which part of the liver does not have peritoneal tissue?

Answer 75

The bare area—where the porta hepatis is—it is also a common location for abscess.

Question 76

How do ligaments and fissures appear on ultrasound and why?

Answer 76

Appear echogenic or hyperechoic because of the presence of collagen & fat within and around structures.

Question 77

The MLF divides the liver into?

Answer 77

Right and left (anterior RLL & medial LLL).

Question 78

The falciform ligament divides the liver into?

Answer 78

Medial and lateral LLL.

Question 79

The ligamentum teres runs within?

Answer 79

The falciform ligament.

Question 80

What does the ligamentum venosum separate? What is this a remnant of?

Answer 80

Separates the caudate lobe from lateral LLL. ## Footnote Remnant of umbilical vein.

Question 81

Portal veins are ____-segmental.

Answer 81

Intra.

Question 82

Portal veins have what kind of blood flow?

Answer 82

Hepatopetal.

Question 83

What can cause the portal veins to have hepatofugal flow?

Answer 83

Portal vein hypertension.

Question 84

How to tell the difference between portal veins and hepatic veins on ultrasound?

Answer 84

Portal veins have more echogenic walls than HVs.

Question 85

What does power doppler look for?

Answer 85

Presence/absence of blood flow.

Question 86

Hepatic veins are _____-segmental.

Answer 86

Inter.

Question 87

Which hepatic vein is the largest? Which is the smallest?

Answer 87

Right- largest, Left- smallest.

Question 88

Portal veins ____ the liver while hepatic veins ____ the liver.

Answer 88

Supply; drain.

Question 89

What are the functions of the liver?

Answer 89

Metabolic regulation, secretes bile, stores iron and certain vitamins, detoxifies many drugs and poisons.

Question 90

Difference between hepatic vs obstructive disease?

Answer 90

Hepatocellular disease: liver cells are the immediate problem, diffuse disease process, usually treated medically w/ supportive measures and drugs. ## Footnote Obstructive disorders: bile excretion is blocked, usually treated surgically.

Question 91

Which LFT is elevated with HCC?

Answer 91

AFP.

Question 92

What is the best method for evaluating liver disease?

Answer 92

Biopsy.

Question 93

Which lab test is more specific to liver?

Answer 93

ALT.

Question 94

Which lab test can elevate mono, hepatitis, cirrhosis, obstructive jaundice & in cardiac and skeletal muscle damage?

Answer 94

LDH (lactate dehydrogenase).

Question 95

When PTT is increased, what does that mean for blood?

Answer 95

It takes longer for blood to clot.

Question 96

What does exophytic mean?

Answer 96

Mass hanging off organ.

Question 97

Echogenicity from least to greatest:

Answer 97

Renal cortex, liver, spleen, pancreas, renal sinus.