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Abdomen Section 1 > Aorta > Flashcards

Aorta Flashcards

1
Q

Cardiocasvular system

A

first system to begin to function in the embryo

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2
Q

Aorta developement

A

from mesodermal cells

angioblasts during 3rd week

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3
Q

vessel determination

A

location in relation to heart

arteries or veins

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4
Q

3rd week development

A

2 dorsal aortas

extensions of 2 endocardial heart tubes

quickly fuse into singel vessel

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5
Q

first single aorta

A

many branches to feed embryo

branches become lumbar arteries

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6
Q

common iliac artery developement

A

develope from intersegmental arteries

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7
Q

vitelline artery

A

branches anteriorly from aorta and extends into the yolksac

celiac artery

SMA

IMA

develope from this

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8
Q

umbilical artery

A

branches off the anterior aorta

gives rise to the internal iliac arteries

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9
Q

Aorta

A

carries blood from heart

enclosed in sheath containing nerve and vein

3 layers

tunica intima

tunica media

tunicat adventitia

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10
Q

tunica intima

A

inner vessel wall

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11
Q

tunica media

A

middle vessel wall

arteries have thicker to allow for great elasticity

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12
Q

tunica adventitia

A

outer vessel wall

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13
Q

Aorta sections

A

root

ascending

descending

abdominal and branches

bifurcation

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14
Q

Aortic root section

A

arises from left ventricle

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15
Q

Aorta ascending

A

arises short distance from root

forms aortic arch

supplies blood to head and upper extremities

3 branches arise from arch

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16
Q

Aorta descending

A

after aortic arch

posterior along back wall of heart

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17
Q

Aorta abdominal

A

supplies blood to all soft tissue organs in abdomen

starts after passing through diaphragm

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18
Q

Aortic bifurcation

A

into iliac arteries

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19
Q

Arteries arising from aortic arch

A

brachiocephalic

commom carotid

subclavian

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20
Q

Anatomy of Abdominal aorta

A

endters through aortic hiatus of diaphragm

descends anteriorly and slightly left of vertebral bodies

posterior and left of gastroesophogeal junction

flanked on either side by diaphragmatic crura

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21
Q

Aortic branches

A

Celiac Trunk

SMA

Left & Right Renal A

Left & Right Gonadal A

Root of IMA

Left & Right Common Iliac

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22
Q

Aortic bifurcation

common iliac arteries

A

at L4 into iliac arteries

5cm long

run anterior with corresponding veins

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23
Q

common iliac artery bifurcation

A

internal and external iliac arteries

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24
Q

Celiac trunk

A

common hepatic artery

left gastric artery

splenic artery

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25
Q

common hepatic artery

A

forms proper hepatic artery and GDA

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26
Q

left gastric artery

A

supplies stomach and esophagus

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27
Q

splenic artery

A

largest branch

forms gastroepiploic artery

supplies stomach and spleen

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28
Q

SMA

A

arises 1cm inferior to celiac trunk

5 main branches that feed small intestines, inferior pancreatic, duodenal, colic, ileocolic and intestinal arteries

each branch has 10-16 branches

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29
Q

IMA

A

arises at L3 or L$

proceeds left and supplies colon and rectum

3 main branches

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30
Q

3 branches of the IMA

A

left colic

sigmoid

superior rectal

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31
Q

indications for aortic ultrasound

A

pulsatile abd mass

hemodynamic compromise in lower limbs

abd pain

abd bruit

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32
Q

acoustic window for aorta

A

midline, left flank with patient supine

right lat decubitus and along lateral edge of rectus abd muscle to evaluate iliacs

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33
Q

aorta assessment

A

visualize entire aorta and branches

disections of atheromatous stenoses, aneurysmas, disections or other pathological process

measurements, including dilated segments

adjacent organs and structures

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34
Q

normal aorta measurements

A

tapers from cranial to caudal

  1. 5 to 1.8cm
  2. 5 at diaphragm
  3. 0 midline
  4. 8 distal

95% of people aorta less than 2.3 in men, 1.9 in women

increases with age

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35
Q

aorta in systole

A

acts as resevoir in response to pulsitile flow received from left ventricle

36
Q

aorta in distole

A

decreases in size by discharging blood to rest of ciculation

considered high resistance flow in aorta

37
Q

high resistance blood flow

A

shart increase in antegrade velocity during systole

sharp decrease in velocity and brief period of reversed flow in distole

38
Q

low resistance blood flow

A

main aortic branches to

kidneys

liver

postprandial bowel

39
Q

Goals of Doppler aorta

A

validate entire aorta and branches by determining patency

detect atheromatous stenoses, aneurysms, dissections or other pathology

characterize abnormalities with spectral doppler

determine high/low resistance in vessels to determine if possibility of pathological process

40
Q

Stenosis

A

doppler shows increased pulsatility proximal

increased systolic/diastolic velocities

turbulence immediately after

41
Q

Atheromatous disease

arteriosclerosis

A

vascular wall disorder with presence of lipid deposits in intima

atheromatous plaque is soft, porridge like material that may discharge into the vessel causing distal embolus or local thrombus or both

palques cause mural irregularity and narrowing of the vessel lumen with distal ischemia

42
Q

Atheromatous disease factors

A

incidence increases with age

affects more men than women

involves aorta and iliac arteries and branches

most common on posterior wall in aorto-iliac area

43
Q

atheromatous disease associations

A

smoking

diabetes mellitus

hypertension

increased levels of low density lioprotein of serum cholesterol

44
Q

atheromatous disease signs

A

significant lower limb pain

ectasia occurs when aorta increases in length and diameter causing it to kink usually anteriorly and left

45
Q

arterial thromus

A

very new=hypoechoic 1 hr or so

newer clot=hyperechoic due to fibrinogin

old clot=hypoechoic with debris

46
Q

Aneurysm

A

swelling in bloos vessel eith focal or diffuse

2 types

true

false (pseudo)

47
Q

True aneurysm

A

all 3 layers affected

48
Q

pseudoaneurysm

A

does not affect all 3 layers

49
Q

Predispostion to aneurysm

A

Marfan’s syndrome

ehlers-danlose syndrome

annuloaortic extasia

famlial aortic dissection

intimomeidal mucoid degeration

MOST true are idiopathic

50
Q

Pseudoaneurysms description

A

blood escapes through a hole in intima but is contained in deeper layers of aorta by adjacent tissue

most are round or oval proituberances from the artery

blood circulates in and out with cardiac cycle

can be cause by infection, trauma, surgery or interventional procedures

51
Q

abdomial aorta aneurysm

AAA

A

95% are infrarenal

30-60% are assymptomatic

may have ab, leg or back pain

higher ince=idence in Men over 60

incidence of AAAis 70-90% in men over 65

52
Q

complications of AAA

A

rupture

thromsosis

dissection

distal embolism

infection

obstruction and invasion of adjacent structures

53
Q

Most common complications of AAA

A

branch artery occlusions or stenosis

most common in IMA and renal arteries

54
Q

Dissecting aneurysm

A

type of pseudoaneurysm

blood leaves lumen through intimal defect and course as variable distance in the wall and reenters aorta farther distal in the arterial system

55
Q

aortic rupture

A

most catastrophic of AA complications

mortality rate at least 50%

some contained in the retroperitoneum and are chronic

retroperitoneal fluid collections are the most common findings

56
Q

mural thrombus AAA

A

prevalent in most large AAA

thrombus poorly attached and friable meaning it can be distant source of emboli

thrombus has no bearing on whether the AAA will rupture or not

57
Q

inflammatory AA

A

variant of atherosclerotic AAA

wall of aneurysm is thickened and surrounded by fibrosis

surgical repair has high mortality rate

pain present in 84%

58
Q

Sonographic appearance of AAA

A

focal dilation of aorta larger than 3cm

elongate as the grow

most deflect to left or kink anteriorly or both

aventitia is generallly echogenic from adjacent fibrofatty tissue

mural thrombus is usually low to med echogenicity and makes up most of wall

intimal lining may be smooth or irregula with calcifications

59
Q

AAA measurement

A

measure outer to outer

maximum true lenght and width and transvers dimensions

document locatoin include suprarenal extension or iliac involvement

document wall type: calcified plaque, flowing blood, soft plaque or well established plaque

60
Q

AAA analysis

A

patent channel should be documented

look for dissection

look at both kidneys checking flow of renal arteries, especially if kidney is shrunken of if patient has hypertension

61
Q

Descriptive terms for AAA

A

Bulbous

fusiform

saccular

dumbell

62
Q

Bulbous AAA

A

sharp junction between normal and abnormal

63
Q

Fusiform AAA

A

gradual transition between normal and abnormal

64
Q

Saccular AAA

A

sharp sudden transition between normal and abnormal

65
Q

Dumbell AAA

A

figure 8 appearance

66
Q

Repair of AAA

A

surgery with aortic grafts

many factors to weight in repair decision

arterial grafts very echogenic and textured

native aorta usually wrapped around graft, may see fluid between aorta and graft

67
Q

Iliac and suprarenal Aneurysms

A

patients with iliac have higher incidence of aneurysms elsewhere in body

trauma, syphili and mycotic disease shoujld all be considered if aneurysms are found suprarenally

68
Q

Dissections

A

defect in intima and internal weakness in wall must exist

most are idiopathic

begins in thorax and extends into the abdomen

less than 5% begin in abdomen

69
Q

Dissection relations

A

marfan’s disease

pregnancy

bicuspid aortic valve

trauma

focal stenoses

hypertension

70
Q

Types of dissections

A

Type 1

Type 2

Type 3

71
Q

Type 1 dissection

A

begins at root of aorta and may extend entire length of arch, descending aorta and even inot the abdominal aorta

most dangerour kind

72
Q

Type 2 dissection

A

starts at left subclavian artery and extends down towards the descending aorta

it may or may not extend in to the abdominal aorta

associated with Marfan’s disease

73
Q

Type 3 dissection

A

begins at the descending aorta and extends into the abdominal aorta

may block renal arteries

74
Q

aneurysm infection

A

may invade a precediong aneurysm and produce a focal abcess

septic emboli often associated with valvular heart disease often cause the disease

75
Q

pseudoaneuryms

arteriorvenous fistula

A

most result at site of angiographic puncture or at site or surgical anastomosis

hs a neck to aneurysm

during systole can see blood enter and diastole can see turbulent blood flow with color doppler

can be treated with ultrasound guided thrombin injection

76
Q

Celiac/mesenteric arteries

A

artery has high resistive pattern at its origin with a small amount of reversed early diastolic flow

as go more distally it loses the reversed flow component

splenic and hepatic areteries are usually low resistance

splenic artery is tortuous

77
Q

SMA

A

blood flow pattern depends on whether patient is fasting or has eaten

fasting pattern is high resistance

eaten pattern is low resistance

low resistance pattern in most prominent 45 min after eating

78
Q

Intestinal Ischemia

A

deficiency in blood delivery to bowel

usually has a significant narrowing or obstruction of both the celiac axis and SMA

79
Q

Splanchic aneurysm

A

aneuryms in the hepatic artery, plenic artery, SMA, GDA, IMA

may be saccular or fusiform

can be congenital, artherosclerotic, post trauma, mycotic or inflammatory

80
Q

Renal arteries

A

22% have 2 to one kidney

should show low resistance waveform

velocities should decrease as once goes farther into kidney

81
Q

Renal artery stenosis

A

produces rare but treatable cause of hypertension

may be due to atherosclerotic disease or fibromuscular hyperplasia (rare disease affecting young women)

RA stenosis is treatable with angioplasty

82
Q

Reanl aneurysms

AV fistulas

A

mostly acquired

may be post trauma or post large bore needle biopsy

usually pseudoaneurysms

1/4 are congenital

produce a mosaic color in kidney (doppler image)

83
Q

Aneurysm measurements

A

Abdominal > 3 cm

Common iliac >2cm

Popliteal >1cm

25% of popliteal also have AAA

84
Q

rupture risk in AAA in 5 yrs

A

5 cm=5%

6cm=16%

7cm=75%

85
Q

clinical findings of aortic rupture

A

decreased hemocrit

hypotension

pulsitile abd mass

abd bruit

back pain

abd pain

lower extremity pain

86
Q

aortic grafts

A

tube graft

aortoiliac graft

aoto-bifemoral graft

wrapped-native aorta is opened longitudinally and the graft is placed inside

Abdomen Section 1 (10 decks)

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