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What are the vessel layers?

Tunica Intima, tunica media, tunica adventitia

1

Where does the abdominal aorta begin?

The diaphragm

2

What are the branches of the Celiac axis?

Which is not seen in ultrasound?

Hepatic artery, left gastric artery, splenic artery.

Left gastric is not seen on ultrasound.

3

Banana peel sign refers to...

Renal arteries.

4

What are the branches of the abdominal aorta?

Celiac axis, SMA, rt & lt renal arteries, IMA, bifurcation rt & lt common iliac arteries.

5

Right renal artery courses

Posterior to IVC

6

What is atherosclerosis?

What are risk factors?

What could it cause?

How does it appear on ultrasound?

Alteration of vessel wall due to lipid deposits.

Smoking, HTN, diabetes, hyperlipidemia

May cause aneurysm

Vessel looks tortuous and may have Ca+

7

What is ectasia?

Vessel dilation (aorta >3cm)

8

What is an aneurysm?

What are clinical findings of an aneurysm?

What are the types of aneurysms?

Which type is the most common?

What is the most common location?

What is the most common cause of aneurysm?

What are the risk factors?

When are elective repairs performed?

Focal vessel enlargement,

pulsatile abdominal mass, may have bruit

Dumbell, bulbous, saccular, fusiform

Fusiform (has uniform dilation)

Inferior to the renal arteries

Atherosclerosis

Tobacco use, HTN, vasc disease, COPD, male, > 60 yrs, family hx

Aneurysms > 5.5cm

A true aneurysm involves all 3 layers of aorta.

A false aneurysm is a pseudoaneurysm, mc in groin from catheters inserted through common femoral artery during arteriographic procedures.

9

What are AAA rupture symptoms/findings?

What is the mortality rate with surgery on a ruptured aneurysm?

What happens if the AAA is 6-7cm?

US findings

Back pain, hypotension, falling hematocrit.

50%.

Rupture rate dramatically increases.

Aneurysm w. free fluid

10

What is dissection?

Tear in the intimal lining of the arterial wall.

11

What is the Standard and DeBakey classifications of dissection?

In what part of the aorta increases mortality rate with dissection?

Causes

Symptoms

US findings

Standard:
A-ascending aorta
B-not asc aorta

DeBakey:
I-entire aorta
II-asc aorta
III-desc aorta

Asc aorta inc mortality rate

Male, 40-60 yrs, HTN, pregnancy, aortic valve disease, CHD, Cushing's syndrome, trauma, Marfan syndrome

Pain, n/v, paralysis, blind, coma, confusion, absent extremity pulse

Linear flap with motion. Acute or chronic (has clot in false lumen)

12

What is an aortic graft?

Used to repair an aneurysm. A guided wire inserted through femoral artery up to aorta.

13

IVC

Expands with inspiration. < 2 cm, terminates at rt atrium

14

Left renal vein courses

Anterior to aorta and posterior to SMA

15

Portal splenic confluence contains

Splenic vein, SMV, main portal vein

16

Mickey Mouse sign / Portal Triad

CBD (rt ear), MPV (face), HA (lt ear)

17

What is Budd Chiari syndrome?

Thrombosis of hepatic veins or IVC

18

What is portal vein HTN?

What are causes?

Signs/symptoms

US findings

Increase in portal venous pressure

Cirrhosis, hepatitis, ETOH abuse, PV thrombus, Budd Chiari, schistosomiasis

Ascites, gi bleed, dec renal function, dec coagulation

Portal vein diam >13mm, hepatofugal flow, patent umbilical vein, collaterals, ascites, splenomegaly, sm nodular liver

19

Portal vein thrombosis

Clot in PV, dec blood flow, low level echoes in PV

Echogenic material within lumen, inc PV diam, portosystemic collateral circulation, cavernous transformation

Filter placed in IVC to catch thrombosis before reaching the heart

20

Hepatic veins

Right, middle, left
Pulsatile

21

Arteries vs Veins

Arteries carry blood away from the heart. Arteries are pulsatile.

Veins carry blood to the heart. Veins expand with inspiration. Veins have a larger diameter. Veins have valves.

22

What is vasa vasorum

Tiny arteries & veins that supply vessel wall

23

Sections of Aorta

Root (3 cusp prevents back flow to heart), asc aorta, aortic arch (brachiocephalic, lt common carotid, lt subclavian), desc aorta, abdominal aorta (celiac trunk, SMA, renals, IMA)

24

Size of aorta, level of iliac bif, iliac size.

Men 23 mm, women 19 mm

Bifurcates L4. Iliac diam < 1.2 cm

25

What is mesenteric insufficiency?

Risk

Symptoms

US findings

Lack of blood flow to GI tract. Must ID 2 stenosis in either celiac, SMA, IMA, hep art.

Smoking, HTN, coronary artery disease, renal insufficiency, diabetes

Post prandial pain. Wt loss, epigastric bruit, n/v/d

High resistant blood flow after eating. Stenosis in 2 vessels.

26

What is a major branch of the common hepatic artery?

Gastroduodenal artery

27

What vessel passed anterior to the uncinate process of the pancreas?

SMV

28

What artery changes from high to low resistant when a patient eats?

SMA

29

IVC and hepatic vein enlargement wth a normal liver is due to

Right sides heart failure