Abdominal Vasculature Notes

Question 1

What is an abdominal aortic aneurysm?

Answer 1

Dilatation of the aorta equal to or exceeding 3 cm in diameter; also known as AAA.

Question 2

What is an aneurysm?

Answer 2

A localized widening or dilatation of a blood vessel.

Question 3

What is aortic dissection?

Answer 3

Spontaneous longitudinal separation of the intima and media layers creating a false lumen.

Question 4

What is arterial stenosis? What is it usually caused by?

Answer 4

1. Narrowing or constriction of an artery
2. Usually caused by atherosclerosis, arteriosclerosis, or fibrointimal hyperplasia.

Question 5

What is arteriosclerosis?

Answer 5

Pathological thickening, hardening, and loss of elasticity of the arterial walls.

Question 6

What is an arteriovenous fistula? What is this also known as?

Answer 6

1. An abnormal connection between an artery and vein
2. Also known as arteriovenous shunting.

Question 7

What is atherosclerosis?

Answer 7

Disorder characterized by yellowish plaques of lipids and cellular debris in the medial and intimal layers of the arterial walls.

Question 8

What is a berry aneurysm?

Answer 8

Small saccular aneurysm primarily affecting the cerebral arteries.

Question 9

What is an ectatic aneurysm?

Answer 9

Dilatation of an artery compared with a more proximal segment; in the abdominal aorta, the ectatic dilatation does not exceed 3.0 cm.

Question 10

What is a fusiform aneurysm?

Answer 10

Characterized by a uniform dilatation of the arterial walls; most common type of abdominal aortic aneurysm.

Question 11

What is mesenteric ischemia?

Answer 11

Decrease in arterial supply to the intestinal system.

Question 12

What is a mycotic aneurysm?

Answer 12

A saccular dilatation of a blood vessel caused by a bacterial infection.

Question 13

What is a pseudoaneurysm? What is this also known as?

Answer 13

1. Dilatation of an artery as a result of damage to one or more layers of the arterial wall caused by trauma or aneurysm rupture
2. Also known as pulsatile hematoma.

Question 14

What is a saccular aneurysm?

Answer 14

Dilatation of an artery characterized by a focal outpouching of one arterial wall; most often caused by trauma or infection.

Question 15

What are the functions of the vascular system?

Answer 15

Arteries and arterioles carry blood away from the heart to organs and tissues to ensure oxygenation and metabolism.

Question 16

What are the exceptions in the vascular system? (arteries)

Answer 16

Pulmonary artery and umbilical arteries in the fetus.

Question 17

What is the role of arterioles? What are they responsible for?

Answer 17

1. Main controllers of blood pressure and blood flow
2. Responsible for waveform morphology.

Question 18

What do capillaries do?

Answer 18

Connect the arterial and venous systems and exchange nutrients and waste.

Question 19

What do veins and venules do?

Answer 19

Carry oxygen depleted blood toward the heart.

Question 20

What are the exceptions for veins?

Answer 20

Pulmonary vein and umbilical vein of the fetus.

Question 21

What is the structure of venous walls compared to arterial walls?

Answer 21

Venous walls are thinner and less elastic compared with arterial walls.

Question 22

What is the tunica adventitia?

Answer 22

Outer layer of a blood vessel, comprised of elastic tissue surrounded by a thin fibrous layer.

Question 23

What is the tunica media?

Answer 23

Middle muscle layer of a blood vessel, comprised of collagenous fiber and smooth muscle.

Question 24

What is the tunica intima?

Answer 24

Inner layer of a blood vessel, composed of three layers giving it a smooth surface.

Question 25

What is the origin of the abdominal aorta?

Answer 25

Originates at the diaphragm and courses inferiorly until it bifurcates into the right and left common iliac arteries.

Question 26

What are the terminal branches of the abdominal aorta?

Answer 26

Common iliac arteries.

Question 27

What does the common iliac artery bifurcate into?

Answer 27

External and internal (hypogastric) iliac arteries.

Question 28

What does the external iliac artery become after passing beneath the inguinal ligament?

Answer 28

Common femoral artery.

Question 29

What does the internal iliac artery bifurcate into?

Answer 29

Anterior and posterior divisions.

Question 30

What is the celiac axis?

Answer 30

First major branch of the abdominal aorta, arising from the anterior aspect.

Question 31

What does the celiac axis branch into? 3

Answer 31

Splenic, left gastric, and common hepatic arteries.

Question 32

What is the superior mesenteric artery (SMA)?

Answer 32

Second major branch of the abdominal aorta, arising from the anterior surface inferior to the celiac axis.

Question 33

What does the SMA supply? 6

Answer 33

1. Jejunum 2. Ileum 3. Cecum 4. Ascending colon 5. Portions of the transverse colon 6. Head of the pancreas.

Question 34

What is the location of the main renal arteries? (R + L)

Answer 34

1. Right renal artery arises from the anterior lateral aspect 2. Left renal artery arises from the posterior lateral aspect.

Question 35

How do the gonadal arteries course in relation to the psoas muscles?

Answer 35

Course parallel to the psoas muscle into the pelvis.

Question 36

What is the inferior mesenteric artery (IMA)? Where is it located on the abdominal aorta?

Answer 36

Last major branch of the abdominal aorta, superior to the aortic bifurcation.

Question 37

What does the IMA supply? 4

Answer 37

1. Left transverse colon 2. Descending colon 3. Upper rectum 4. Sigmoid.

Question 38

Where does the inferior phrenic artery arise from? What does it supply?

Answer 38

1. Arises from the anterior aspect of the abdominal aorta 2. Supplying the inferior portion of the diaphragm.

Question 39

What do lumbar arteries supply?

Answer 39

Abdominal wall and spinal cord.

Question 40

Where is the median sacral artery located in relation to the inferior mesenteric artery and the aortic bifurcation?

Answer 40

Located inferior to the inferior mesenteric artery and superior to the aortic bifurcation.

Question 41

What is the gastroduodenal artery (GDA)? Where is it located?

Answer 41

1. Branch of the common hepatic artery 2. Located between the superior portion of the duodenum and the anterior surface of the pancreatic head.

Question 42

What is the common hepatic artery? What is it termed now?

Answer 42

1. A branch of the celiac axis that gives rise to the gastroduodenal artery 2. Now termed the proper hepatic artery.

Question 43

What does the left gastric artery supply?

Answer 43

Supplies the left side of the lesser curvature of the stomach.

Question 44

What is the inferior vena cava (IVC)?

Answer 44

Formed at the junction of the right and left common iliac veins, carrying oxygen-depleted blood from the body to the right atrium.

Question 45

What are the main venous tributaries of the IVC? 6

Answer 45

1. Lumbar veins 2. Right gonadal vein 3. Renal veins 4. Right suprarenal vein 5. Inferior phrenic vein 6. Hepatic veins.

Question 46

What do common iliac veins drain?

Answer 46

Blood from the lower extremities and pelvis.

Question 47

What is the role of renal veins?

Answer 47

Course anterior to the renal arteries and drain blood from the kidneys.

Question 48

What do hepatic veins do?

Answer 48

Lie at the boundaries of the hepatic segments and course toward the IVC.

Question 49

What does the MPV drain? How much blood does it supply to the liver? (5)

Answer 49

1. Drains the gastrointestinal tract 2. Pancreas 3. Spleen 4. Gallbladder 5. Providing approximately 70% to 75% of the liver’s blood supply.

Question 50

Where does the splenic vein join? what does it form?

Answer 50

Joins the superior mesenteric vein to form the main portal vein.

Question 51

What does the superior mesenteric vein form with the splenic vein? How does it course with in terms of the SMA?

Answer 51

Courses parallel to the superior mesenteric artery and joins the splenic vein to form the main portal vein.

Question 52

What is the normal adult diameter of the abdominal aorta?

Answer 52

10 mm or less.

Question 53

What causes an increase in the caliber of the abdominal aorta?

Answer 53

Inspiration and following a meal.

Question 54

What organs drain into the abdominal aorta? 3

Answer 54

1. Spleen 2. Pancreas 3. Portion of the stomach.

Question 55

Where is the abdominal aorta located? (in relation to the left kidney, Left renal artery + vein, neck/body of the pancreas)

Answer 55

1. Anterior to the left kidney 2. Anterior to left renal artery and vein 3. Posterior to the neck/body of the pancreas.

Question 56

What is the course of the superior mesenteric vein?

Answer 56

Courses parallel to the superior mesenteric artery.

Question 57

What does the superior mesenteric vein join to form?

Answer 57

The main portal vein.

Question 58

What is the normal adult diameter of the superior mesenteric vein?

Answer 58

10 mm or less.

Question 59

What does the inferior vena cava lie adjacent to?

Answer 59

The abdominal aorta.

Question 60

What is the size of the normal abdominal aorta?

Answer 60

Should not exceed 3 cm in diameter.

Question 61

What is the typical diameter of the inferior vena cava?

Answer 61

Usually less than 2.5 cm, should not exceed 3.7 cm.

Question 62

What is the sonographic appearance of the abdominal aorta?

Answer 62

Anechoic tubular structure with thin hyperechoic wall margins.

Question 63

What is the recommended fasting time for adults before an ultrasound of the renal arteries?

Answer 63

6 to 8 hours.

Question 64

What transducer frequency is recommended for adults?

Answer 64

3.0 to 5.0 MHz.

Question 65

What patient position is usually used for examination?

Answer 65

Supine position.

Question 66

What should be documented when evaluating an abdominal aortic aneurysm?

Answer 66

Measurements from outer edge to outer edge in the anterior posterior and transverse planes.

Question 67

What is a common risk factor for abdominal aortic aneurysm?

Answer 67

Arteriosclerosis.

Question 68

What is the average growth rate of an abdominal aortic aneurysm?

Answer 68

2 mm/year.

Question 69

What is the clinical finding of an abdominal aortic aneurysm?

Answer 69

Pulsatile abdominal mass.

Question 70

What is the sonographic finding of an abdominal aortic aneurysm?

Answer 70

Typically fusiform-shaped dilatation of the aorta.

Question 71

What is the risk of rupture for an abdominal aortic aneurysm measuring 6 cm?

Answer 71

16% within 5 years.

Question 72

What is a pseudoaneurysm?

Answer 72

Trauma to the arterial wall permits the escape of blood into surrounding tissues.

Question 73

What is the clinical finding of a ruptured aneurysm?

Answer 73

Severe abdominal pain and hypotension.

Question 74

What is the sonographic finding of a ruptured aneurysm?

Answer 74

Asymmetrical or unilateral paraaortic hypoechoic mass.

Question 75

What is the typical appearance of an abdominal aortic dissection?

Answer 75

Thin hyperechoic membrane within the aorta.

Question 76

What is a common symptom of mesenteric ischemia?

Answer 76

Postprandial pain.

Question 77

What is a common finding in arteriovenous shunts?

Answer 77

Presence of a bruit or 'thrill'.

Question 78

What can cause edema in the inferior vena cava?

Answer 78

Thrombosis.