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Flashcards in Vascular Test 1 Deck (153):
0

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

1

what are the three parts of the vessel walls?

tunica intima
tunica media
tunica externa/adventitia

2

What is the tunica intima?

endothelial cells-lumen
delicate connective tissue
elastic tissue
inner layer

3

What is the tunica media?

smooth elastic muscle
middle layer of a blood vessel
helps regulate flow by controlling diameter

4

What is the tunica externa/adventitia?

loose connective tissue
smooth muscles and elastic tissue
outer layer

5

What are the vasa vasorum?

the small blood vessels that supply the walls of the aorta and vena cava

6

What are capillaries?

small vessels connecting the arterial and venous systems

nutrients pass through capillaries into the body

7

What are the major arteries of the systemic circulation?

aorta
celiac axis
sma
renal
ima
common iliac

8

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

9

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
left subclavian

10

aorta - descending

enters the abdomen through the opening of the diaphragm

11

Describe the aorta - abdominal

largest artery in the body

slightly left of the vertebral column

transverse = circular structure

gradual tapering

becomes more anterior distally

12

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

13

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)

14

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

15

What are some indications that the aorta needs to be scanned?

abd pain

pulsatile mass (felt by touch)

AAA on plain film (abd aortic aneurysm on x-ray)

F/U AAA (Follow Up AAA)

trauma

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)

16

aorta measurements (prox --> iliacs)

prox 2.0-2.6cm

mid 1.6-2.4cm

distal 1.1-2.0cm

iliacs 0.6-1.4cm

17

What are the phrenic arteries?

arise from the lateral walls of the aorta to supply the diaphragm

18

Where does the celiac trunk/axis live?

first ANTERIOR BRANCH in the abdomen

Celiac "trunk" or "axis"


19

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

20

Right and Left Renal arteries

lateral branches off of aorta below SMA

21

IMA

inferior mesenteric artery

anterior near bifurcation

22

Paired branches of the aorta ( on both sides)

Suprarenal artieris
*RENAL ARTERIES*
gonadal arteries
lumbar arteries
common iliac arteries

23

What arteries do we see?

Celiac Axis (trunk)
SMA

24

cystic artery

branch of the right hepatic artery

feeds the gallbladder

25

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.

26

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)

27

Other than the Gastroduodenal artery, what other branches come off of the common hepatic artery?

the Left Hepatic artery

the Right Hepatic artery

28

What is the largest branch off of the Celiac Axis/Trunk?

the Splenic Artery (SA)

29

What is the smallest branch of the Celiac Axis?

Left Gastric Artery

30

what are the unpaired branches of the aorta?

celiac axis
SMA
IMA

31

What are the anterior branches of the aorta?

celiac axis
SMA
IMA

32

What are the lateral branches of the aorta?

renal arteries
common iliac arteries

33

when scanning a vessel how do you determine it's name?

find it's origin and it's endpoint = name

34

Where is the portal confluence?

large anechoic area under the pancreas

35

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

36

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

37

What is SMA/IMA intestinal angina?

medical condition in which lack of blood causes severe chest pains

38

Right renal artery vs left renal artery

Right:
Longer
Posterior to IVC
posterior to the vein before entering the hilum

Left:
Shorter
courses directly into the hilum

39

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

40

What causes Renal Artery Stenosis?

Hypertension

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)

41

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

42

What is a fistula?

a connection between and artery and a vein

43

Arteries we can possibly see and need to look for...

Aorta
celiac
common hepatic
gastroduodenal
splenic
SMA
Renal
Common iliac

44

what are the major veins of the systemic circulation?

IVC
hepatic veins
renal veins
common iliac veins

45

What are some reasons to scan the IVC?

abdominal pain

palpable mass

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

46

Why does the IVC dilate?

Heart problems cause the IVC to dilate

right ventricular heart failure

congestive heart failure
constrictive pericarditis
tricuspid disease
right heart obstructive tumor

when the right side of the heart has problems it pushes the blood back into the IVC

47

What can cause obstruction in the IVC?

Distended vessel

renal cell carcinoma

wilm's tumor

complete thrombosis = life threatening can lead to a pulmonary emboli, or venous thrombosis (fix with a surgically placed filter)

48

Why is the IVC Dilated that is not from the heart?

hepatomegaly

increased pressure

cirrhosis (liver is course, fluid around it, irregular borders, causes pressure = dilated vein)

49

What causes the IVC to be compressed?

Later stage of pregnancy - edema of the feet and ankles

malignant retroperitoneal tumors

hepatic or pancreatic masses

50

What are some abnormalities of the IVC?

Congenital:

double IVC

interruption of the IVC

51

What does the IVC look like on ultrasound?

looks like a hammock for the liver

anechoic

52

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)

53

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

"Nutcracker" sign

54

What are the Hepatic Veins?

largest tributaries

RHV
LHV
middle hv

55

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

56

What are the major veins of the hepatic - portal system?

SMV

IMV

Splenic vein

Portal Vein



57

What is the portal vein?

It the the union of the superior mesenteric vein and the splenic vein
(SMV and SV)

58

Where is the main portal vein formed?

posterior to the pancreas

59

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

60

What is the Portal triad?

Portal vein

hepatic ARTERY!!

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)

61

WHAT IS the difference between the hepatic veins and the portal veins?

Portal Veins:

Thick reflective walls (radicals - edges of the portal veins - they are echogenic)

constant diameter

flow toward liver

Hepatic:

thin walls

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

62

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)

63

Where does the splenic vein originate?

originates at the splenic hilum

courses posterior to the pancreas

64

How do we US the splenic vein?

seen in transverse as a tubular structure posterior to the body and tail of the pancreas

65

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

66

What vessels take blood away from the heart?

Arteries

67

Which vessels are smaller in diameter? larger?

smaller: arteries

larger: veins

68

Which vessels have the faster moving blood, arteries or veins?

arteries

69

Which vessels have greater elasticity, arteries or veins?

arteries

70

Which vessels have no change with respiration? arteries or veins?

arteries

71

Which vessels are collapsible?

veins

72

Which vessels take blood to the heart?

veins

73

Which vessels have slower moving blood, arteries or veins?

veins

74

Which vessels have slower moving blood and valves, arteries or veins?

veins

75

which vessels have little elasticity?

veins

76

which vessels have a larger diameter, arteries or veins?

veins

77

Which artery is the trunk artery?

the aorta

78

where does the aorta sit in the body?

slightly left of the vertebral column

79

When scanning the aorta, how does it appear in the transverse plane?

circular anechoic structure

80

What happens to the size and location of the aorta as it moves down the body?

size: gradual tapering

location: becomes more anterior distally

81

What three branches come off of the celiac trunk?

Common Hepatic artery

Left Gastric artery

Splenic artery

82

Is blood flow high or low resistance into the celiac axis/trunk?

Low resistance blood flow

83

What surrounds the celiac trunk?

Surrounded by liver, spleen, IVC, and pancreas

84

In relation to the celiac trunk what happens to the PSV (peak systolic velocity) after eating?

Nothing...it remains unchanged.

85

Which artery travels along hte superior border of the head of the pancreas?

The common hepatic artery

86

Which branch of the common hepatic artery (CHA) enters into the liver?

Proper Hepatic artery

87

Which artery supplies the pancreas and the duodenum?

the Gastroduodenal artery...which is a branch of the common hepatic artery.

88

What does the left hepatic artery supply?

the caudate and left lobe

89

what does the right hepatic artery supply?

supplies the right lobe of the liver

supplies the gallbladder via the cystic artery

90

Where does the splenic artery's tortuous course take it?

superior and posterior to the body and proximal tail of the pancreas

91

What organs does the splenic artery supply?

the spleen

pancreas

fundus of the stomach

92

What is the blood flow resistance in the splenic artery?

low resistance

93

How does the Left Gastric Artery travel in the body?

anterior and cephalad

94

What does the Left Gastric Artery supply?

the stomach

the pylorus

95

Where in the body do you find the Superior Mesenteric Artery?

anterior branch of the aorta

1-2 cm below the Celiac Axis

96

How does the SMA run in the body?

parallel to the aorta

posterior to the neck/body of the pancreas

97

What does the SMA supply?

small intestine

proximal colon

98

What is the blood flow resistance in the SMA?

Preprandial: high resistance flow

Postprandial: low resistance flow

99

When scanning the SMA how does it appear in transverse plane?

circular structure

anterior to the aorta

posterior to the pancreas body

surrounded by highly reflective echoes

100

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

101

What artery courses posterior to the IVC?

The RRA (right renal artery)

102

Which artery courses anterior to the psoas muscle

Left Renal Artery (LRA)

LRA also runs anterior to the Ao and Posterior to the SMA

103

What do the renal arteries supply?

Kidneys

adrenals

ureters

104

What pathology do we look for when we scan renal arteries and find a problem?

renal tumor

HTN (hypertension) due to renal artery stenosis

105

Where do we find the common iliac arteries?

at the bifurcation of the aorta

106

What do the common iliac arteries supply?

legs

pelvis

107

What size do the common iliac arteries measure?

<1.2cm

108

What do the common iliac arteries branch into?

internal iliac

external iliac

109

What does the internal iliac artery supply?

the pelvis

buttocks

110

What does the external iliac artery supply?

the legs

111

Which vein is the trunk vein?

The IVC

112

What part of the heart does the IVC empty into?

the right atrium

113

Where do you find the IVC in the body?

courses to the right of the aorta

Anterior to the duodenum and pancreas

114

From where does the IVC return blood?

abdomen

pelvis

lower limbs

115

Which has lower pressure the aorta or IVC?

IVC

116

Can you collapse the IVC?

yes...veins are collapsible

117

What are the pairs of veins that come off of the IVC?

aka Retroperitoneum tributaries

common iliac veins

lumbar veins

gonadal veins

renal veins

suprarenal veins

hepatic veins

118

Who has thinner walls...aorta or IVC?

IVC

119

What happens to the IVC's diameter if you inhale?

the diameter of the IVC increases

120

What happens to the IVC's diameter if you exhale?

the diameter decreases

121

What is the Valsalva maneuver?

patient is asked to bear down as if having a bowel movement...this causes dilation

122

What is the normal size of the IVC?

< 2.0cm

123

what kind of thrombosis is found in the IVC?

pulmonary emboli

venous thrombosis

124

What does the Right Hepatic Vein do?

drains right lobe

divides right lobe into anterior and posterior segments

125

What does the Left Hepatic Vein do?

drains left lobe

divides left lobe into medial and lateral segments

126

What does the middle hepatic vein do?

drains caudate lobe

divides liver into right and left lobes

127

What happens to the hepatic veins when you breathe?

diameter and flow vary with respiration

128

What happens to the hepatic veins as they approach the IVC?

they increase in size

129

What do the veins of the hepatic - portal system drain?

GI tract

spleen

pancreas

gallbladder

Delivers blood to the liver to clean it

130

What does the main portal vein branch into?

right and left portal veins

131

What happens to the blood from the portal vein after it traverses the liver?

it drains into the IVC via the hepatic veins

132

Where does the main portal vein enter the liver?

at the PORTA HEPATIS (then splits into rhv and lhv branches)

133

Which vein supplies up to one half of the oxygen to the hepatocytes?

main portal vein

134

Where is the main portal vein in relation to the IVC?

anterior to the IVC

135

Why would you measure the main portal vein?

measured with suspected portal hypertension

cannot be larger than 13mm or 1.3cm

136

What does the splenic vein join to form the MPV (main portal vein)?

the SMV (superior mesenteric vein)

137

What does the splenic vein drain?

stomach

spleen

pancreas

138

Where does the superior mesenteric vein originate?

at the mesentery

139

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

140

What does the superior mesenteric vein drain?

the small intestine and proximal colon

141

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

142

What does the IMV drain?

distal colon

not usually seen

143

Which artery is the largest principal artery?

the aorta

144

which vessel arises from the left ventricle?

the aorta

145

Which vessel distributes blood to the organs and limbs?

the aorta

146

True or False

in most cases the branch of the vessel is named after the organ it is feeding?

true

147

What are the five sections of the aorta?

Root - LVOT

ascending

arch

descending thoracic

descending abdominal - retroperitoneum


148

What is the position of the arteries to veins above the umbilicus?

arteries are posterior to veins

149

What is the position of the arteries to veins below the umbilicus?

the arteries are anterior to the veins

150

What are the gonadal veins?

testicular and ovarian

**left - empties into LRV**

right - empties into the IVC

not usually seen

151

What surrounds the aorta through the diaphragm?

the diaphragmatic crura

152

What is the normal diameter of the abdominal aorta?

2-3 cm