Vascular system

Question 1

arteries divide into smaller branches, the smallest of which are the ______

Answer 1

arterioles

Question 2

the arterioles lead into the ______, which are minute vessels that branch and form a network where the exchange of materials between blood fluid takes place

Answer 2

capillaries; then it is collected in the small veins or venules that unites with large vessels to return blood to the heart

Question 3

the artery consists of what 3 layers?

Answer 3

tunica intima (inner), tunica media (middle), and tunica adventitia (external layer)

Question 4

the ______ comprises the tiny arteries and veins that supply the walls of blood vessels

Answer 4

vasa vasorum

Question 5

what are the 5 sections of the aorta?

Answer 5

root of the aorta, ascending aorta and arch, descending aorta, abdominal aorta and abdominal aortic branches, and bifurcation of the aorta into iliac arteries

Question 6

the systemic circulation leaves the ____ ventricle of the heart by way of the aorta (where the root of the aorta is)

Answer 6

left

Question 7

after the aorta arises from the left ventricle, it ascends posterior to the main ______ artery to form the ascending aorta

Answer 7

pulmonary

Question 8

the ascending aorta arises a short distance from the ventricle and arches superiorly to form the aortic arch at the level of the ______ junction

Answer 8

sternoclavicular

Question 9

what 3 branches arise from the superior border of the aortic arch to supply the head, neck, and upper extremities?

Answer 9

brachiocephalic, left common carotid, and left subclavian arteries

Question 10

from the aortic arch, the aorta descends posteriorly along the back wall of the heart, where it pierces the diaphragm to become the ______

Answer 10

abdominal aorta

Question 11

the ______ aorta enters the abdomen through the aortic opening of the diaphragm anterior to the 12th thoracic vertebra in the retroperitoneal space

Answer 11

descending

Question 12

the aorta lies ______ to the left lobe of the liver, the body of the pancreas, the gastroesophageal junction, the pylorus, and the splenic vein

Answer 12

posterior

Question 13

at the level of ______ the aorta bifurcates into the right and left common iliac arteries

Answer 13

fourth lumbar vertebra

Question 14

the diameter of the abdominal aorta measures less than ______ in men and ______ in women, with a gradual tapering to ______ after it proceeds inferiorly to the bifurcation

Answer 14

2.3cm; 2cm; 10 to 15mm

normal is less than 3cm

Question 15

the small ______ arteries arise from the lateral walls of the aorta to supply the undersurface of the diaphragm

Answer 15

phrenic (surgical intervention or trama to these arteries may cause limited movement of the diaphragm)

Question 16

the ______ is the first anterior branch of the aorta, arising 1 to 2 cm inferior to the diaphragm

Answer 16

celiac trunk

Question 17

the celiac trunk gives rise to what 3 vessels?

Answer 17

splenic, hepatic, and left gastric arteries

Question 18

the ______ is the second anterior branch of the aorta, arising approximately 2 cm from the celiac trunk

Answer 18

superior mesenteric artery; just inferior to that is the left and right renal arteries

Question 19

the small ______ artery arises anteriorly near the bifurcation

Answer 19

inferior mesenteric

Question 20

if bowel or gas is overlaying the aorta, roll the patient into a ______ and scan along the left lateral flank with the transducer directed toward the spine

Answer 20

right lateral decubitus

Question 21

if the abdomen is very concave, the patient may be instructed to ______ his abdomen (push muscle out)

Answer 21

extend

Question 22

how do you measure the aorta?

Answer 22

perpendicular to the vessel from outer layer to outer layer

Question 23

the iliac arteries should measure less than ______ in transverse AP diameter

Answer 23

1.2 cm; if measured greater than 3 cm surgical repair is needed

Question 24

most aneurysms develop inferior to the ______ vessels near the bifurcation of the aorta

Answer 24

renal

Question 25

the size of the aorta increases up to ______ in the 7th and 8th decades

Answer 25

25%

Question 26

______ occurs when the aorta increases in both long and trans (diffuse dilation), causes the distal aorta to "kink" usually anterior and to the left

Answer 26

ectasia

Question 27

______ or atheroma, is a vascular wall disorder characterized by the presence of lipid deposits in the intima, over time the plaque causes narrowing

Answer 27

arteriosclerosis (can create embolus or local thrombus; most commonly associated with the development of an aneurysm) can make walls echogenic and calcified

Question 28

an ______ is defined as a permanent localized dilation of an artery with an increase in diameter greater than 1.5 times its normal diameter

Answer 28

aneurysm; surgery should be considered when greater than 5cm

Question 29

what are the risk factors of an aneurysm?

Answer 29

tobacco use, hypertension, and vascular disease

Question 30

30% to 60% of patients with an abdominal aortic aneurysm are ______

Answer 30

asymptomatic

Question 31

______ for treatment are a less invasive approach to the repair of an aneurysm

Answer 31

endovascular stent grafts; its placed through two small incisions in the abdomen

Question 32

the ______ extent of the aneurysm as it relates to the origin of the renal vessels, should be measured

Answer 32

longitudinal

Question 33

aneurysms may be classified as a _____ aneurysm (lined by all three layers of the aorta) or as a _____ aneurysm (pseudoaneurysm/not lined by all three layers)

Answer 33

true (forms when the tensile strength of the wall decreases); false (pulsatile hematoma that results from leakage of blood into the soft tissue abutting the punctured artery)

Question 34

the most common presentation of an atherosclerotic aneurysm is a _____ aneurysm of the distal aorta at the aortic bifurcation

Answer 34

fusiform; represents a gradual transition between normal and abnormal (football-like)

Question 35

a _____ aneurysm shows a sudden transition between normal and abnormal and is somewhat spherical and larger (5 to 10cm) than fusiform

Answer 35

saccular

Question 36

the term _____ applies to the figure-eight appearance of the aneurysm, where one may see more than one protrusion of the vessel

Answer 36

dumbbell

Question 37

what are the classic symptoms of a ruptured aortic aneurysm?

Answer 37

abdominal pain, shock, and an expanding abdominal mass; the most common site is the lateral wall inferior to the renal vessels; compression of the renal artery can cause hypertension and renal ischemia

Question 38

location of an aneurysm in relation to the renal arteries is important and evaluation of both ______

Answer 38

kidneys

Question 39

a defect in the vessel intimal wall must exist along with internal weakness for a _____ to occur

Answer 39

dissection; may occur secondary to cystic medial necrosis (weakening of the arterial wall), to hypertension, or to the inherited disease Marfan's syndrome. color flow doppler could detect flow into the false channel

Question 40

the most dangerous type of dissection ______ because it can block the coronary arteries (blocking blood to the heard)

Answer 40

type 1 and 2

Question 41

the sonographer should look for a dissection _____ or recent channel

Answer 41

flap (demonstrated in M-mode as a fluttering within the lumen) with dissection hemorrhage occurs between the middle and outer thirds of the media

Question 42

during evaluation of a graft look for _____ at the ends of the graft, aneurysm formation, or pseudoaneurysm development; fluid collection may develop at the graft site

Answer 42

stenosis

Question 43

clinical signs of ______ are explained on the basis of altered hemodynamics produced by a high-velocity shunt leading to increased blood volume, venous pressure, and cardiac output with cardiac failure and cardiomegaly

Answer 43

arteriovenous fistulas; if lower trunk and leg edema is present, along with a dilated inferior vena cava this should be suspected

Question 44

what does the common hepatic artery branch into?

Answer 44

proper hepatic artery (goes into the liver through the porta hepatis) and the gastroduodenal artery (courses along the upper border of the head of pancreas)

Question 45

the duodenum and part of the stomach are supplied by the ______ and ______

Answer 45

grastoduodental and right gastric artery

Question 46

the ______ is a small branch supplying the caudate lobe and left lobe of the liver

Answer 46

left hepatic artery

Question 47

the ______ supplies the gallbladder via the cystic artery and the liver

Answer 47

right hepatic artery

Question 48

the ______ artery is a small branch of the celiac trunk, goes to the esophagus and then descends along the lesser curvature of the stomach

Answer 48

left gastric artery; supplies the lower third of the esophagus and the upper right of the stomach

Question 49

the _____ artery is the largest of the three branches of the celiac trunk; forms the superior border of the pancreas, divides into the left gastroepiploic artery and the short gastric artery (supplies the fundus of the stomach)

Answer 49

splenic

Question 50

the ______ runs posterior to the neck of the pancreas and anterior uncinate process; then branches into the mesentery and colon

Answer 50

Superior mesenteric artery; 5 main branches, inferior pancreatic artery, duodenal artery, colic artery, ilecolic artery, and intestinal artery(all supplying the small bowel)

Question 51

____ artery distributes arterial blood to the descending colon, sigmoid colon, and rectum; it has 3 main branches the left colic, sigmoid, and superior rectal arteries

Answer 51

inferior mesenteric artery

Question 52

a ______ aneurysm occurs in the SMA, hepatic and splenic arteries, gastroduodenal arteries, or inferior mesenteric artery

Answer 52

splanchnic

Question 53

______ arteries are paired small vessels that arise from the lateral wall of the aorta to supply the undersurface of the diaphragm

Answer 53

phrenic

Question 54

the ______ artery courses posterior to the IVC and anterior to the vertebral column to enter the hilus of the kidney

Answer 54

right renal; longer than the left

Question 55

the ______ courses from the aorta directly into the hilus of the kidney

Answer 55

left renal artery

Question 56

renal artery stenosis may present clinically as _____, its due to athersclerotic disease or fibromuscular hyperplasia

Answer 56

hypertension

Question 57

the ______ artery arises inferior to the renal arteries and courses long the psoas muscle to the respective gonadal area

Answer 57

gonadal

Question 58

____ lumbar arteries are usually present on each side of the aorta; supplies the muscle, skin, bone, and spinal cord

Answer 58

four

Question 59

the _____ is formed by the union of the common iliac veins posterior to the right common iliac artery at the level of the 5th lumbar vertebra

Answer 59

inferior vena cava; it enters the diaphragm at the level of the 8th thoracic vertebra to enter the right atrium of the heart

Question 60

the patient should be instructed to hold their breath when scanning the IVC, this causes the patient to perform a slight _____ maneuver toward the end of inspiration. which dilates it

Answer 60

valsalva; may expand IVC to 2 to 3 cm

Question 61

in the adult patient, the normal IVC usually measures _____ and shows respiratory variations

Answer 61

less than 2 cm

Question 62

______ of the IVC is noted in several pathologies, including right ventricular heart failure, congenital heart disease, constrictive pericarditis, tricuspid disease, and right heart obstructive tumors

Answer 62

dilation; tumors or thrombus maybe found in the IVC and cause obstruction

Question 63

what 3 pairs of cardinal veins form the IVC?

Answer 63

posterior cardinal (6weeks), subcardinal-prerenal segment (7weeks), and supracardinal-postrenal segment (8weeks)

Question 64

the most common type of double inferior vena cava is the left IVC joins the _____, which crosses the midline at this normal level to join the right IVC

Answer 64

left renal vein; less than 3% incidence

Question 65

_____ condition results from the failure of union of the hepatic veins and the right subcardinal vein; can include azygos

Answer 65

infrahepatic interruption of the IVC; interruption of the IVC connection to the heart is associated with acyanotic or cyanotic congenital heart disease, abnormalities of cardiac position, and abdominal situs with asplenia and ploysplenia

Question 66

in patients with right ventricular failure, the IVC does not _____ with expiration

Answer 66

collapse

Question 67

with enlargement of the liver, the IVC is _____ rather than displaced

Answer 67

compressed; masses in the caudate lobe or right lobe may elevate the IVC; same with the pancreatic portion and lower segment

Question 68

the ultrasound appearance of an IVC tumor is a single or multiple _____ nodules along the wall; it may be distended and filled with the tumor

Answer 68

echogenic; most common tumor is renal cell carcinoma usually from the rt kidney

Question 69

______ within the IVC appears as a homogeneous mass, presents with leg edema, low back pain, pelvic pain, gastrointestinal complaints, and renal and liver abnormalities

Answer 69

thrombosis; use color doppler to see if it is occluded

Question 70

surgical and angiographic placement of transvenous filters into the IVC has been used to prevent recurrent _____ in patients who cannot tolerate anticoagulants

Answer 70

embolization; most common origin of pulmonary emboli is venous thrombosis from the lower extremities; preferred location of the filer is in the iliac bifurcation

Question 71

______ within the IVC appears as a homogeneous mass, presents with leg edema, low back pain, pelvic pain, gastrointestinal complaints, and renal and liver abnormalities

Answer 71

thrombosis; use color doppler to see if it is occluded

Question 72

surgical and angiographic placement of transvenous filters into the IVC has been used to prevent recurrent _____ in patients who cannot tolerate anticoagulants

Answer 72

embolization; most common origin of pulmonary emboli is venous thrombosis from the lower extremities; preferred location of the filer is in the iliac bifurcation

Question 73

______ flows from the kidney posterior to the superior mesenteric artery and anterior to the aorta to enter the lateral wall of the IVC

Answer 73

left renal vein; larger than the right renal vein; visualized as a circular structure coursing between the SMA and the aorta on long image

Question 74

renal vain ______ is seen in the dehydrated or septic infant; may also be seen in adults with multiple renal abnormalities

Answer 74

obstruction

Question 75

with ______ the patient presents with flank pain, hematuria, flank mass, and proteinuria, this condition may be associated with maternal diabetes and transient high blood pressure

Answer 75

renal vein obstruction; may seen clumps of echoes in kidney, with surrounding echo-free space, decrease in renal size

Question 76

the _____ are the largest visceral tributaries of the IVC; shows pulsatile flow

Answer 76

hepatic veins; the right vein drains into the right lobe, the middle vein into the caudate lobe, the left into the left lobe

Question 77

the _____ vein enters the left renal vein; the _____ vein enters into the IVC

Answer 77

left gonadal; right gonadal (same with the suprarenal veins)

Question 78

the _____ are the largest visceral tributaries of the IVC; shows pulsatile flow

Answer 78

hepatic veins; the right vein drains into the right lobe, the middle vein into the caudate lobe, the left into the left lobe

Question 79

the _____ is formed posterior to the pancreas by the union of the superior mesenteric vein and splenic veins at the level of L2

Answer 79

portal vein; its trunk is 5 to 7 cm in length; drains into the IVC via the hepatic veins

Question 80

the portal vein carries blood from the _____ to the liver by means of its 2 main breaches; the right and left portal veins

Answer 80

intestinal tract; it has an anastomosis with the esophageal veins, rectal venous plexus, and superficial abdominal veins

Question 81

what is the portal triad?

Answer 81

branches of the portal vein, hepatic artery, and bile duct contained within a connective tissue sheath

Question 82

_____ begins at the hilum of the spleen, where it is formed by the union of several veins, then joint by the short gastric and left gastroepiploic veins

Answer 82

splenic vein; runs along the posterioromedial border of the pancreas; joins the SMV posterior to the neck of the pancreas to form the portal vein; drains from the stomach, spleen, and pancreas

Question 83

_____ begins at the ileocolic junction, within the root of the mesentery of the small intestine to the right of the superior mesenteric artery

Answer 83

superior mesenteric vein; passes anterior to the 3rd part of the duodenum and posterior to the neck of the pancreas and anterior border of the uncinate process

Question 84

the _____ drains the left third of the colon and upper colon and ascends retroperitoneally along the left psoas muscle; it begins midway down the anal canal as the superior rectal vein

Answer 84

IMV