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Abdominal Scanning > Abdominal Vasculature > Flashcards

Abdominal Vasculature Flashcards

1
Q

What are the major parts of the abd venous system?

A
  1. IVC
  2. IMV
  3. Renal veins
  4. SMV
  5. splenic vein
  6. portal veins
  7. hepatic veins
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2
Q

How do the venous vessels look in u/s?

A

tube-like structions with well-defined, echogenic walls and an echofree lumn, but the wall of arteries and portal venous structures will be more echogenic than the thinner walled veins.

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3
Q

What are the great vessels of the ventral cavity?

A

IVC and aorta

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4
Q

What is the function of the IVC?

A

to transport deoxygenated blood towards the heart

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5
Q

In real time imaging arteries show…

A

pulsations.

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6
Q

The lumens in the veins open and close with…

A

respiration.

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7
Q

What produces a more variable response with respiration?

A

valsalva maneuver

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8
Q

What happens when a patient does a valsalva maneuver?

A

The vessel distention may be greater when the patient holds his breath after a deep inspiration.

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9
Q

Why are arteries not influenced by respiration?

A

Arterial walls are thick and strong which enables the vesssel to withstand alterations in intra-abdominal pressure.

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10
Q

How is the IVC formed?

A

The IVC arises from the union of the two common iliac veins.

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11
Q

How are the common iliac veins formed?

A

From the union of the internal and external iliac veins

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12
Q

Where does the IVC course?

A

through the retroperitoneum, to the right of the aorta, and anterolateral to the vertebral processes

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13
Q

The IVC lies ___ to the right kidney and ___ to the liver.

A

medial, posterior

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14
Q

What multiple tributaries does the IVC give rise to which can be accessible with u/s through vascular exams?

A

lumbar veins, right suprarenal vein, right gonadal vein

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15
Q

What’s the only vessel posterior to the IVC?

A

right renal artery

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16
Q

What does the venous system contain within the lumen of the vessel that helps the blood move forward?

A

valves

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17
Q

If the valves leak or are damaged, what do we call the flow of blood in those vessels when it goes in reverse or backwards?

A

retrograde flow

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18
Q

T/F? The venous system usually demonstrated pulsatile flow.

A

False. The only time the venous system demonstates pulsatile flow is close to the heart or in right-sided CHF patients.

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19
Q

How does the IVC look in u/s?

A

The IVC is more elliptical than round with smaller AP measurement.

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20
Q

Where does the IVC begin to widen?

A

at the level of the renal veins

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21
Q

What is rouleaux formation?

A

red cell aggregation causing internal echos

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22
Q

When is rouleaux formation observed?

A

rouleaux formation may be observed in any large vein as larger veins have slower flow. Slow flow enhances rouleaux formation.

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23
Q

What are the sections of the IVC?

A

hepatic, pre-renal, renal, post-renal

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24
Q

What is the hepatic section?

A

where the hepatic veins empty into the IVC

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25
Q

Which is the prerenal section?

A

inferior to the hepatic veins, but suprerior to the renal veins

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26
Q

Which is the renal section?

A

where the renal veins and the multiple tributaries are

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27
Q

Which is the post-renal section?

A

extends just inferior to the renal veins until the bifurcation

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28
Q

Why do we look at the IVC?

A

to detect introluminal thrombus or tumor invasion

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29
Q

THe tumor invasion most commonly ocurs in the ___ ___ and extends into the ___.

A

renal veins, IVC

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30
Q

What is the most common tumor to involve the IVC?

A

renal cell carcinoma

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31
Q

What are some normal variants of the IVC?

A

double IVC or left-positioned IVC, or a portion of the vessel may be absent (these are uncommon)

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32
Q

Where do the hepatic veins originate and where do they empty into?

A

originates in the liver and empties into the IVC

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33
Q

the hepatic veins are located ___ to the renal veins.

A

superior

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34
Q

What are the three major hepatic veins?

A

right, middle, and left

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35
Q

Which vein is responsible for draining all the venous blood out of the liver?

A

hepatic vein

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36
Q

Which lobes do the right, left and the middle hepatic vein empty?

A

right lobe, left lobe, and the caudate lobe

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37
Q

The hepatic vein ___ in diameter as they approach the IVC.

A

increases

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38
Q

What causes the playboy bunny/moosehead sign?

A

Transversely the hepatic veins look like anechoic linear structures that empty into the IVC

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39
Q

The hepatic veins exhibit ___, which is a reflection of ___ and ___ activity.

A

pulsatility, cardiac, and respiratory

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40
Q

The flow direction away from the organ is called…

A

hepatafugal

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41
Q

What are the small veins that drain directly into the IVC?

A

caudate lobe veins (occasionally seen on u/s)

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42
Q

Suprarenal veins are also called…

A

adrenal veins (not normally seen on u/s)

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43
Q

From where does the renal vein return blood and where does it empty?

A

kidney, IVC

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44
Q

Renal veins lie ___ to the level of the renal arteries.

A

superior

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45
Q

Left renal vein is ___ than the right renal vein.

A

longer

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46
Q

Which other veins does the left renal vein receive?

A

Left renal vein receives the left gonadal vein and the left suprarenal vein.

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47
Q

THe left renal vein passes posterior to the ___ vein and ___ ___ & ___ prior to entering the IVC.

A

splenic vein, pancreas body & tail

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48
Q

The LRV courses anterior to the ___ and lies between the ___ ___ and the ___.

A

aorta, aortic wall and the SMA

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49
Q

Why does the left renal vein engorge?

A

compression by the SMA and aorta

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50
Q

Where does the LRV appear dilated?

A

prior to crossing inbetween the SMA and aorta

51
Q

Which renal vein is shorter?

A

right renal vein

52
Q

Where does the right gonadal vein drain into?

A

the IVC

53
Q

THe right renal vein may also receive the ___ ___ ___.

A

right suprarenal vein

54
Q

Representing the gender, the gonadal veins are also known as…

A

testicular and ovarian veins

55
Q

Where do the left and right gonadal veins drain into?

A

Left - into the left renal vein

Right - into the IVC inferior to the right renal vein

56
Q

What does the azygos and hemi azygos vein provide?

A

alternate pathway for venous return in the case of IVC obstruction

57
Q

Where is the azgyos vein located?

A

right

58
Q

Where is the hemi azygos vein located?

A

left

59
Q

What can be mistaken for the right crus? How must this mistake be checked?

A

For either the right renal artery or vein, follow the vessels

60
Q

Why won’t the left and right veins be symmetrical?

A

veins’ diameter is very variable

61
Q

Why would the veins appear as large as the IVC?

A

prior to entering the IVC

62
Q

Why would the renal veins and arteries be confusing and what must we do?

A

Renal veins are generally anterior to the renal arteries, however crossing over is not uncommon; using pulsed wave or color doppler would be helpful.

63
Q

What are the reasons for the IVC to get displaced?

A
  1. liver mass
  2. right renal artery aneursym
  3. lymphadenopathy
  4. a tortuous aorta
  5. right renal or adrenal mass
64
Q

What would be a reason to u/s the IVC?

A

to detect intraluminal thrombus or tumor invasion

65
Q

If a tumor is seen in the renal veins, what other vessel would one interrogate and why?

A

Renal vein tumors are most likely to invade the IVC, so look for at the IVC for tumor extension.

66
Q

What is the name of the flow of blood if it’s flowing away from the liver?

A

hepatofugal

67
Q

What is the opposite of hepatofugal?

A

hepatopetal (towards the liver)

68
Q

What 2 veins enter the left renal vein instead of the IVC?

A

left gonadal and left suprarenal veins

69
Q

The ___ ___ system does not enter the IVC.

A

portal venous

70
Q

What is the function of the portal venous system?

A

to deliver blood from the spleen and the gastrointestnal tract to the liver metabolism and detoxification

71
Q

What is the portal venous system made up of?

A
  1. portosplenic confluence
  2. main portal vein
  3. right portal vein with branches
  4. left portal vein with branches
72
Q

Which is the largest vein of the portal venous system?

A

splenic vein

73
Q

T/F? Splenic vein is less tortuous than the splenic artery.

A

True.

74
Q

Where does the splenic vein begin?

A

at the hilum of the spleen

75
Q

The splenic vein passes tranversely to the ___ across the posterior abdominal wall ___ to the splenic artery and ___ to the body and tail of the pancreas.

A

right, inferior, posterior

76
Q

What does the splenic vein drain?

A

Part of the pancreas and stomach, and the spleen

77
Q

What is used as a landmark for locating the pancreas?

A

splenic artery and vein

78
Q

The splenic vein is located ___ to the pancreatic body and tail.

A

superior

79
Q

What vessels form teh portosplenic confluence?

A

SMV, IMV, splenic vein

80
Q

What vessel joins the splenic vein to form the portosplenic confluence?

A

IMV

81
Q

What organs does the IMV drain?

A

The IMV drains the inferior part of the large itestines, primarily the area along the rectum, sigmoid area and the dexcending colon.

82
Q

From its origin, the IMV courses ___.

A

superiorly

83
Q

When is the IMV seen with u/s?

A

When IMV dilates with PHTN

84
Q

Where does the SMV orginiate?

A

SMV originates at the ileocecal valve where the ileum and small intestine join the cecum of the large intestine

85
Q

Where does the SMV course?

A

SMV courses superiorly towards the midline

86
Q

The main portal vein ascends obliquely to the ___ passing posterior to the superior portion of ___, ___, ___ and ___ and anerior to the ___.

A

right, duodenum, common bile duct, proper hepatic artery and GDA, IVC

87
Q

How much blood does the main portal vein supply to the liver?

A

80%

88
Q

How much blood does the hepatic artery supply to the liver?

A

20%

89
Q

How long is the main portal vein and where does it begin?

A

8 cm long, posterior to the pancreatic neck

90
Q

What landmark is used for the pancreatic neck?

A

porto-splenic confluence/SMV

91
Q

The MPV courses ___ and ___ about ___ before it enters the liver.

A

superiorly, laterally, 5-6 cm

92
Q

Where does the MPV enter the liver?

A

porta hepatis

93
Q

After the MPV enters the liver it divides into ___ and ___ ___ ___.

A

right and left portal veins.

94
Q

What vessels make up the porta hepatis?

A

MPV, PHA, CHD

95
Q

Why is the porta hepatis called the mickey mouse sign?

A

In the oblique scanning plane, the three vessels look lke the head and ears of mickey mouse

96
Q

Which portal vein is longer and has a smalled diameter?

A

The left portal vein is longer and has smaller diameter than the RPV.

97
Q

Before entering the left lobe of the liver the LPV gives branches to which lobe?

A

caudate lobe

98
Q

What is the origin of the LPV and where does it course?

A

the MPV, medially

99
Q

The LPV branches into the ___ and ___ segment.

A

medial and lateral

100
Q

WHat does the LPV and its medial and lateral branches look like in a transverse scanning plane? What is the sign called?

A

Horns of a steer - the steer head sign

101
Q

What portal vein is shorter and larger?

A

RPV

102
Q

Which vein originates from the RPV? What does it do before entering the right lobe of the liver?

A

The cystic vein originates from the RPV and gives a branch to the caudate lobe before entering the right lobe of the liver.

103
Q

The RPV courses ___ ___ and then divides into branches called the ___ and ___ segments.

A

right, laterally, anterior and posterior

104
Q

How can the portal vein be distinguished from other structures, especially the hepatic vein?

A

it has highly echogenic walls

105
Q

Why does the portal vein have echogenic walls?

A

high collagen content in the walls

106
Q

Why are the portal veins evaluated?

A

for thrombosis and tumor invasion and for PHTN

107
Q

How must the portal ven be evaluated?

A

with color doppler and duplex doppler and should show blood flowing into the liver (hepatopetal flow)

108
Q

Where does the common hepatic artery arise from? What does it bifurcate into?

A

the celiac axis, the GDA and proper hepatic artery

109
Q

Just prior to the bifurcation the CHA passes ___ to the MPV.

A

anterior

110
Q

Where does the proper hepatic artery begin? Where does it ascend to ?

A

at the bifurcation, the porta hepatis of the liver within the folds of the hepatoduodenal ligament

111
Q

What does the PHA divide into?

A

into the right and left hepatic arteries within the porta hepatis

112
Q

What does the right hepatic artery give rise to?

A

the cystic artery

113
Q

What does the cystic artery supply?

A

the gallbladder, hepatic ducts and part of the CBD

114
Q

T/F? The portal venous system enters the IVC.

A

False

115
Q

What vessel is a definate landmark for locating the pancreas?

A

splenic vein

116
Q

What is the name of the ligament that crosses over the celiac axis?

A

median arcuate ligament

117
Q

What vessel supplies the liver with 80% of its blood supply and originates behind the pancreas neck?

A

MPV

118
Q

What is the steerhead sign?

A

the medial and lateral branches of teh left portal vein

119
Q

What is the mickey mouse sign?

A

the portal triad oblique

120
Q

What segments do the right portal vein branch into?

A

anterior and posterior

121
Q

What does the proper hepatic artery divide into?

A

right and left hepatic artery

122
Q

What vessel does the right hepatic artery give rise to?

A

cystic artery which feeds the gallbladder

123
Q

Where does the cystic vein originate and what does a branch of that vessel feed?

A

It comes off the right portal vein and the branch of the cystic vein feeds the caudate lobe.

Abdominal Scanning (11 decks)

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