Flashcards in Vascular Test 1 Deck (153):
what is the function of the heart?
the circulatory system transports gases and nutrients to the tissue and transports waste products away from the tissue
what are the three parts of the vessel walls?
What is the tunica intima?
delicate connective tissue
What is the tunica media?
smooth elastic muscle
middle layer of a blood vessel
helps regulate flow by controlling diameter
What is the tunica externa/adventitia?
loose connective tissue
smooth muscles and elastic tissue
What are the vasa vasorum?
the small blood vessels that supply the walls of the aorta and vena cava
What are capillaries?
small vessels connecting the arterial and venous systems
nutrients pass through capillaries into the body
What are the major arteries of the systemic circulation?
Describe the aorta Root - LVOT (left ventricle outflow tract)
leaves the left ventricle
three cusps on the aortic valve
coronary arteries arise from the cusps
Describe the aorta - ascending aorta portion
arches to form the aortic arch
to the right:
brachiocephalic -> right subclavian, right common carotid
to the left right off of the arch:
left common carotid
aorta - descending
enters the abdomen through the opening of the diaphragm
Describe the aorta - abdominal
largest artery in the body
slightly left of the vertebral column
transverse = circular structure
becomes more anterior distally
What is the diaphragmatic crura?
tendinous structures that extend inferiorly from the diaphragm to attach to the vertebral column.
forms a tether for muscular contraction
What is the abdominal aortas measurement?
normal diameter 2-3 cm no more than 3cm
can be less than normal but not bigger (for adults)
What are some scanning techniques for the Aorta?
best anatomic landmark
patient in the supine position
longitudinal- hollow tube anterior to spine but in the retroperitneum
may need to apply pressure and angle the transducer due to gas or air if recent endoscopic evaluation
use breathing techniques
extend abd technique
roll patient rld
What are some indications that the aorta needs to be scanned?
pulsatile mass (felt by touch)
AAA on plain film (abd aortic aneurysm on x-ray)
F/U AAA (Follow Up AAA)
Abd bruit (brewy...can hear with stethoscope abnormal sound)
hemodynamic compromise in the lower legs (aorta US to see if there is a problem above the legs even though leg pain...cannot scan legs only aorta)
aorta measurements (prox --> iliacs)
What are the phrenic arteries?
arise from the lateral walls of the aorta to supply the diaphragm
Where does the celiac trunk/axis live?
first ANTERIOR BRANCH in the abdomen
Celiac "trunk" or "axis"
What is the SMA (superior mesenteric artery)?
second ANTERIOR BRANCH off of the aorta in the abdomen
just posterior to the celiac trunk
runs parallel to the aorta, posterior to the neck/body of the pancreas
supplies the small intestine and proximal colon
Right and Left Renal arteries
lateral branches off of aorta below SMA
inferior mesenteric artery
anterior near bifurcation
Paired branches of the aorta ( on both sides)
common iliac arteries
What arteries do we see?
Celiac Axis (trunk)
branch of the right hepatic artery
feeds the gallbladder
What sign will you see on US when doing the Celiac Trunk?
Seagull sign... because the trunk is short it splits into the hepatic and splenic arteries quickly.
Gastroduodenal Artery (GDA)
transverse-circular structure in ANTERIOR head of pancreas (one of the "eyes of the worm")
CBD circular structure in posterior head of pancreas
GDA is not IN the pancreas but behind it (appears in the pancreas on US)
Other than the Gastroduodenal artery, what other branches come off of the common hepatic artery?
the Left Hepatic artery
the Right Hepatic artery
What is the largest branch off of the Celiac Axis/Trunk?
the Splenic Artery (SA)
What is the smallest branch of the Celiac Axis?
Left Gastric Artery
what are the unpaired branches of the aorta?
What are the anterior branches of the aorta?
What are the lateral branches of the aorta?
common iliac arteries
when scanning a vessel how do you determine it's name?
find it's origin and it's endpoint = name
Where is the portal confluence?
large anechoic area under the pancreas
What makes up the portal confluence?
The area where the superior mesenteric vein and the splenic vein meet
They run posterior to the pancreas and form the portal vein
How does the SMA look on US?
Longitudinal: tublular structure coursing parallel to anterior aorta
Transverse: circular structure anterior to aorta and posterior to pancreas body
halo- surrounded by highly reflective echoes
What is SMA/IMA intestinal angina?
medical condition in which lack of blood causes severe chest pains
Right renal artery vs left renal artery
Posterior to IVC
posterior to the vein before entering the hilum
courses directly into the hilum
How do you scan the Renal Arteries?
Best Seen in transverse
RRA courses posterior to IVC
Use color Doppler to aid visualization
low resistance flow
What causes Renal Artery Stenosis?
determined on US with color and Doppler - looking for a stenosis or narrowing of the renal artery (hard to do because you can't see the artery from the Ao all the way to the kidney)
What are Renal Arteriovenous Fistulas?
They can be congenital or aquired
Appear as a cluster of tubular structures
They create a connection between artery and vein
What is a fistula?
a connection between and artery and a vein
Arteries we can possibly see and need to look for...
what are the major veins of the systemic circulation?
common iliac veins
What are some reasons to scan the IVC?
F/U filter placement....history of DVT
Hx renal tumor - every time you see a significant mass on the kidney, you would check the IVC to check to see if the tumor has spread. check the renal vein as well
Why does the IVC dilate?
Heart problems cause the IVC to dilate
right ventricular heart failure
congestive heart failure
right heart obstructive tumor
when the right side of the heart has problems it pushes the blood back into the IVC
What can cause obstruction in the IVC?
renal cell carcinoma
complete thrombosis = life threatening can lead to a pulmonary emboli, or venous thrombosis (fix with a surgically placed filter)
Why is the IVC Dilated that is not from the heart?
cirrhosis (liver is course, fluid around it, irregular borders, causes pressure = dilated vein)
What causes the IVC to be compressed?
Later stage of pregnancy - edema of the feet and ankles
malignant retroperitoneal tumors
hepatic or pancreatic masses
What are some abnormalities of the IVC?
interruption of the IVC
What does the IVC look like on ultrasound?
looks like a hammock for the liver
What are the Renal Veins?
Drains the kidneys, urters and adrenals
RRV courses anterior off of the IVC
LRV courses between the aorta and SMA
LRV comes anterior to the Ao but posterior to the SMA (under it)
How to you scan the Renal Veins?
RRV best seen in transverse, anterior to the renal artery
LVR best seen in transverse anterior to the aorta and posterior to the SMA
What are the Hepatic Veins?
How do the Hepatic Veins look on US?
Makes the bunny sign in the liver
See drawing from lecture
fat near IVC and thin out as they go into liver
What are the major veins of the hepatic - portal system?
What is the portal vein?
It the the union of the superior mesenteric vein and the splenic vein
(SMV and SV)
Where is the main portal vein formed?
posterior to the pancreas
How do we scan the Main portal vein?
Best seen in transverse as a tubular structure from pancreas head to liver
diameter changes with resiration and valsalva
normal diameter < 13mm
What is the Portal triad?
common bile duct
transverse view on US make Mickey Mouse sign (look for IVC to get this picture, IVC will be large and long-ish)
WHAT IS the difference between the hepatic veins and the portal veins?
Thick reflective walls (radicals - edges of the portal veins - they are echogenic)
flow toward liver
triphasic (blood flow has a scalloped look to it)
increase in diameter as they near IVC
flow away from liver
drain cephalad toward the diaphragm
What are some reasons to scan hepatic veins and portal veins?
Hepatic veins: Congestive Heart Failure (CHF), liver disease
Portal Veins: liver disease, portal HTN (hypertension)
Where does the splenic vein originate?
originates at the splenic hilum
courses posterior to the pancreas
How do we US the splenic vein?
seen in transverse as a tubular structure posterior to the body and tail of the pancreas
How do we see the superior mesenteric vein on US?
best seen in longitudinal as a tubular structure to the right of the SMA
transverse seen as a circular structure
What vessels take blood away from the heart?
Which vessels are smaller in diameter? larger?
Which vessels have the faster moving blood, arteries or veins?
Which vessels have greater elasticity, arteries or veins?
Which vessels have no change with respiration? arteries or veins?
Which vessels are collapsible?
Which vessels take blood to the heart?
Which vessels have slower moving blood, arteries or veins?
Which vessels have slower moving blood and valves, arteries or veins?
which vessels have little elasticity?
which vessels have a larger diameter, arteries or veins?
Which artery is the trunk artery?
where does the aorta sit in the body?
slightly left of the vertebral column
When scanning the aorta, how does it appear in the transverse plane?
circular anechoic structure
What happens to the size and location of the aorta as it moves down the body?
size: gradual tapering
location: becomes more anterior distally
What three branches come off of the celiac trunk?
Common Hepatic artery
Left Gastric artery
Is blood flow high or low resistance into the celiac axis/trunk?
Low resistance blood flow
What surrounds the celiac trunk?
Surrounded by liver, spleen, IVC, and pancreas
In relation to the celiac trunk what happens to the PSV (peak systolic velocity) after eating?
Nothing...it remains unchanged.
Which artery travels along hte superior border of the head of the pancreas?
The common hepatic artery
Which branch of the common hepatic artery (CHA) enters into the liver?
Proper Hepatic artery
Which artery supplies the pancreas and the duodenum?
the Gastroduodenal artery...which is a branch of the common hepatic artery.
What does the left hepatic artery supply?
the caudate and left lobe
what does the right hepatic artery supply?
supplies the right lobe of the liver
supplies the gallbladder via the cystic artery
Where does the splenic artery's tortuous course take it?
superior and posterior to the body and proximal tail of the pancreas
What organs does the splenic artery supply?
fundus of the stomach
What is the blood flow resistance in the splenic artery?
How does the Left Gastric Artery travel in the body?
anterior and cephalad
What does the Left Gastric Artery supply?
Where in the body do you find the Superior Mesenteric Artery?
anterior branch of the aorta
1-2 cm below the Celiac Axis
How does the SMA run in the body?
parallel to the aorta
posterior to the neck/body of the pancreas
What does the SMA supply?
What is the blood flow resistance in the SMA?
Preprandial: high resistance flow
Postprandial: low resistance flow
When scanning the SMA how does it appear in transverse plane?
anterior to the aorta
posterior to the pancreas body
surrounded by highly reflective echoes
Where in the body do you find the renal arteries?
1-3 cm inferior to the SMA off of the lateral sides of the aorta
What artery courses posterior to the IVC?
The RRA (right renal artery)
Which artery courses anterior to the psoas muscle
Left Renal Artery (LRA)
LRA also runs anterior to the Ao and Posterior to the SMA
What do the renal arteries supply?
What pathology do we look for when we scan renal arteries and find a problem?
HTN (hypertension) due to renal artery stenosis
Where do we find the common iliac arteries?
at the bifurcation of the aorta
What do the common iliac arteries supply?
What size do the common iliac arteries measure?
What do the common iliac arteries branch into?
What does the internal iliac artery supply?
What does the external iliac artery supply?
Which vein is the trunk vein?
What part of the heart does the IVC empty into?
the right atrium
Where do you find the IVC in the body?
courses to the right of the aorta
Anterior to the duodenum and pancreas
From where does the IVC return blood?
Which has lower pressure the aorta or IVC?
Can you collapse the IVC?
yes...veins are collapsible
What are the pairs of veins that come off of the IVC?
aka Retroperitoneum tributaries
common iliac veins
Who has thinner walls...aorta or IVC?
What happens to the IVC's diameter if you inhale?
the diameter of the IVC increases
What happens to the IVC's diameter if you exhale?
the diameter decreases
What is the Valsalva maneuver?
patient is asked to bear down as if having a bowel movement...this causes dilation
What is the normal size of the IVC?
what kind of thrombosis is found in the IVC?
What does the Right Hepatic Vein do?
drains right lobe
divides right lobe into anterior and posterior segments
What does the Left Hepatic Vein do?
drains left lobe
divides left lobe into medial and lateral segments
What does the middle hepatic vein do?
drains caudate lobe
divides liver into right and left lobes
What happens to the hepatic veins when you breathe?
diameter and flow vary with respiration
What happens to the hepatic veins as they approach the IVC?
they increase in size
What do the veins of the hepatic - portal system drain?
Delivers blood to the liver to clean it
What does the main portal vein branch into?
right and left portal veins
What happens to the blood from the portal vein after it traverses the liver?
it drains into the IVC via the hepatic veins
Where does the main portal vein enter the liver?
at the PORTA HEPATIS (then splits into rhv and lhv branches)
Which vein supplies up to one half of the oxygen to the hepatocytes?
main portal vein
Where is the main portal vein in relation to the IVC?
anterior to the IVC
Why would you measure the main portal vein?
measured with suspected portal hypertension
cannot be larger than 13mm or 1.3cm
What does the splenic vein join to form the MPV (main portal vein)?
the SMV (superior mesenteric vein)
What does the splenic vein drain?
Where does the superior mesenteric vein originate?
at the mesentery
Where does the superior mesenteric vein join the splenic vein and what do they form?
joins SV: posterior to the neck of the pancreas
forms: main portal vein
What does the superior mesenteric vein drain?
the small intestine and proximal colon
Where do we find the inferior mesenteric vein in the body?
arises from colon
ascends to the left of the IMA
joins splenic vein posterior to the body of the pancreas
What does the IMV drain?
not usually seen
Which artery is the largest principal artery?
which vessel arises from the left ventricle?
Which vessel distributes blood to the organs and limbs?
True or False
in most cases the branch of the vessel is named after the organ it is feeding?
What are the five sections of the aorta?
Root - LVOT
descending abdominal - retroperitoneum
What is the position of the arteries to veins above the umbilicus?
arteries are posterior to veins
What is the position of the arteries to veins below the umbilicus?
the arteries are anterior to the veins
What are the gonadal veins?
testicular and ovarian
**left - empties into LRV**
right - empties into the IVC
not usually seen
What surrounds the aorta through the diaphragm?
the diaphragmatic crura