Aorta/IVC/PV Flashcards
Which organ system is the first system to be functional in the embryo?
cardiovascular system
T or F: the embryonic heart and aorta form at different times
False.
The embryonic heart and aorta form at the same time.
When does the embryonic heart and aorta start beating?
22 days
What happens to the embryonic aorta during the 3rd week?
The embryonic aorta begins as 2 dorsal AOs that fuse into 1 AO
What is the vitelline artery complex?
It is made up of vitelline arteries that carry blood from the AO to the yolk sac
A tube that connects the yolk sac to the digestive tract of a developing embryo
vitelline duct/yolk stalk
What is another name for the vitelline duct?
yolk stalk
What are the 3 layers of blood vessels?
- tunica intima
- tunica media
- tunica adventitia
What is the name of the inner layer of a blood vessel?
tunica intima
What is the name of the middle layer of a blood vessel?
tunica media
What is the name of the outer layer of a blood vessel?
tunica adventitia
Which blood vessel layer consists of endothelial tissue?
tunica intima
Which blood vessel layer consists of elastin, smooth muscle fibers, collagenous tissue, and provides the strength of arteries?
tunica media
Which blood vessel layer consists of loose connective tissue and vast vasorum?
tunica adventitia
What is the vasa vasorum?
It is the tiny arteries and veins that supply the blood vessel walls
(It is the vessels of vessels)
List the order in which the blood flows into each of the blood vessels from the heart and back
- Aorta
- Arteries
- Arterioles
- Capillaries
- Venules
- Veins
- IVC
Which is larger in diameter: arteries or veins?
Veins
What carries blood away from the heart to other organs?
Arteries
Does abdominal AO pulsation change with respirations?
No
What is the largest artery of the body?
Aorta
List the sections of the aorta
- aortic root
- ascending AO
- aortic arch
- descending AO
- abdominal AO
- iliac bifurcation
Which portion of the AO is inferior to the diaphragm?
abdominal AO
List the branches of the abdominal AO in descending order
- phrenic arteries
- CA
- SMA
- renal arteries
- RT/LT gonadal arteries
- IMA
- lumbar arteries
What branches are located laterally on the abdominal AO?
phrenic arteries, renal arteries
What branches are located anteriorly on the abdominal AO?
CA, SMA, IMA
What branch is located anteriolaterally on the abdominal AO?
RT/LT gonadal arteries
CA?
celiac axis
SMA?
superior mesenteric artery
IMA?
inferior mesenteric artery
What branch is located posteriolaterally on the abdominal AO?
lumbar arteries
What is the typical prox AO measurement?
3.0 cm
What is the typical mid AO measurement?
2.0 cm
What is the typical dist AO measurement?
1.2 cm
Where does the AO anatomically course?
courses slightly left of the vertebral column
What structures does the AO lie posterior to?
- LT lobe of the liver
- body of pancreas
- the gastroesophageal junction (GEJ)
- pylorus of the stomach
- splenic vein
T or F: Arteries have valves
False.
Veins have valves to ensure blood flows in one direction towards the heart.
What arises from the LT ventricular outflow tract of the heart; has 3 semilunar cusps that prevent blood from flowing back into the heart?
aortic root
What arises a short distance from the ventricle and courses superiorly to form the aortic arch?
ascending aorta
Three arterial branches arise from the superior border of the aorta to supply the head, neck, and upper extremities
aortic arch
From the aortic arch, the AO descends posterior to the heart through the thoracic cavity
descending aorta
After the AO pierces the diaphragm, the thoracic AO becomes known as what?
abdominal AO
What is the typical measurement for the iliacs?
1.0 cm
Where does the AO bifurcate into the right and left iliacs?
At the 4th lumbar vertebrae near the umbilicus
Where is the diaphragmatic crura located?
it surrounds the prox abdominal AO as it projects through the diaphragm into the abdomen
What is the diaphragmatic crura?
the tendinous structures that attach/anchor the diaphragm to the vertebral column.
T or F: the abdominal AO pierces the diaphragm and courses between the RT and LT crura
True.
What is the first anterior branch of the AO?
CA
What originates approx. 2.0cm inferior to the diaphragm?
CA
What has been known to compress the CA?
median arcuate ligament
What is the CA responsible for?
supply oxygenated blood to the liver
What are the 3 branches of the CA?
- common hepatic artery
- splenic artery
- left gastric artery
On US: this vessel branches off the CA and courses to the RT of the abdomen at almost 90 degrees
common hepatic artery
On US: this vessel branches off the CA and takes a tortuous course horizontally to the left of the body as it forms the superior border of the tail of the pancreas
splenic artery
What is the largest vessel of the CA branches?
splenic artery
What vessel branches off the CA and is rarely seen by ultrasound?
left gastric artery
LGA
left gastric artery
CHA
common hepatic artery
What is the splenic artery responsible for?
supplies oxygenated blood to the spleen and tail of pancreas
What is the LGA responsible for?
supplies oxygenated blood to the esophagus and stomach
What does the CHA branch into?
- GDA
- PHA
GDA
gastroduodenal artery
PHA
proper hepatic artery
What does the PHA branch into?
- RHA
- RGA
- LHA
RGA
right gastric artery
RHA
right hepatic artery
LHA
left hepatic artery
What is the LHA responsible for?
supplies the caudate and left of the liver
What does the RHA branch into?
cystic artery
What is the RHA and cystic artery responsible for?
supplies GB and liver
What is the GDA responsible for?
supplies duodenum and parts of the stomach
What comes off anteriorly of the AO approx. 1.0cm inferior to the CA?
SMA
What does the SMA feed?
- small intestine
- cecum
- ascending colon
- transverse colon
What pathology should be considered if the distance of the SMA to the AO is severe or > 11mm?
lymphadenopathy
Where does the SMA run?
The SMA runs posterior to the neck of the pancreas and anterior to the uncinate process
This vessel has 5 branches and each of those branches consists of 10-16 branches all of which supply the small bowel
SMA
What do the renal arteries feed?
kidneys
What vessels arise laterally from the AO at the 3rd lumbar vertebrae, just inferior to the SMA?
renal arteries
T or F: The left renal artery is longer than the right renal artery
False.
The right renal artery is longer than the left renal artery.
What vessel courses posterior to the IVC, anterior to the spine, and posterior to the renal vein?
RRA
RRA
right renal artery
LRA
left renal artery
What vessel courses from the AO directly into the LT kidney?
LRA
What vessel arises anteriorly off the abdominal AO at about the 4th lumbar vertebrae, and very difficult to identify on US?
IMA
What does the IMA feed?
- LT transverse colon
- descending colon
- sigmoid colon
- rectum
What do the common iliacs branch into?
external and internal iliacs
What does the internal iliac supply?
- pelvic viscera
- peritoneum
- buttocks
- sacral canal
What does the external iliac become?
common femoral artery
What does the external iliac supply?
ipsilateral lower extremity
What vessels arise from the lateral AO walls and feed the diaphragm?
phrenic arteries
What vessels arise anterolateral inferior to the renal arteries and course along the psoas muscle until they reach the designated gonadal destination?
RT and LT gonadal arteries
What do the RT and LT gonadal arteries feed?
Testicles or ovaries
What vessels are usually 4 arteries that are present on each side of the AO and travel posterolateral?
lumbar arteries
What do the lumbar arteries feed?
- muscle
- skin
- bone
- spinal cord
What type of transducer do we use for aortic ultrasound?
2-4 MHz curvilinear transducer
What is a typical pt prep for aortic ultrasound?
NPO for 8 hours
What lab values are indicative of an aortic ultrasound?
- increased WBCs
- decrease in hematocrit (rupture)
What occurs when the arterial vascular system becomes stiff and thickened, and results in higher blood pressure?
arteriosclerosis
What is a condition in which the aortic wall becomes irregular with plaque build-up?
atherosclerosis
AAA
abdominal aortic aneurysm
T or F: true aneurysms can involve 1, 2, or all 3 layers of the vessel wall
False.
True aneurysms involve all 3 layers of the vessel wall.
What is an abdominal aortic aneurysm?
it is a localized dilation of the abdominal AO, usually greater than 3 cm in diameter, that involves all 3 layers of the wall
What is a localized dilation of the abdominal AO, usually greater than 3 cm in diameter, that involves all 3 layers of the wall
AAA
How does a AAA occur?
the force of blood pushing against the walls combined with wall injury/damage causes weakness and the walls aneurysm
What is more common for an aneurysm: abdominal AO or thoracic AO?
abdominal AO
Where does the majority of aneurysms occur?
below the renal arteries
What is Marfan syndrome?
an inherited disorder that affects connective tissue that support and anchor your organs and other structures in your body
What is Ehlers-Danlos syndrome?
a group of disorders that affect connective tissues that support organs, structures, and other tissues
An abdominal aneurysm located below the renal vessels?
infrarenal
An abdominal aneurysm located above the renal vessels?
suprarenal
An abdominal aneurysm located between the renal vessels?
pararenal
What and where is the most common AAA?
infrarenal, fusiform in the dist AO
What are the two possible shapes of aneurysms?
saccular or fusiform
What aneurysm shape is connected with a mouth, more of a sudden transition, and may or may not contain thrombus
saccular
What aneurysm shape is football-like, more of a smooth transition, and more common?
fusiform
How can AAA’s be fixed?
grafts
How are AAA grafts placed?
endovascularly or open surgery
What is a mild, diffusely enlargement of the AO?
ectatic AO
What is it when blood escapes through a hole in the vessel wall, but is contained within adjacent tissue?
pseudoaneurysm
How is a pseudoaneurysm treated?
- physical compression for 20 minutes
- solution injection to clot it off
What is the sonographic appearance of a pseudoaneurysm?
a “feeding vessel” to a heterogeneous mass and a to-fro spectral tracing
What kinds of trauma can cause a pseudoaneurysm?
- accident
- surgery
- heart cath
- angiography
What is it when the intimal wall of the AO separates and appears as a flap in the lumen of the AO?
aortic dissection
T or F: Aortic dissections do not have a true lumen, only a false lumen
False.
Aortic dissections have a true lumen and a false lumen.
What is the mortality rate of an aortic rupture?
50%
What are the clinical indications and lab values for an aortic rupture?
- excruciating back pain
- shock
- expanding abdominal mass
- decrease in hematocrit
Is US used for aortic ruptures?
No, because time is so essential CT is the gold standard
The aneurysm is thickened and surrounded by fibrosis and adhesions?
inflammatory AO aneurysm
aneurysm caused by infection?
mycotic aneurysm
abnormal connection from an artery to a vein?
arteriovenous fistula
presents clinically as HTN, from renal artery plaque or fibromuscular dysplasia; looks like a string of pearls on CT?
renal artery stenosis
Where the exchange of materials between blood and tissue take place?
capillaries
T or F: capillaries have multiple layers
False.
Capillaries only have 1 layer
What aides venous blood return?
- muscle contraction
- respiration
T or F: blood pressure is higher in the IVC
False.
Blood pressure is higher in the arterial system.
Where does the IVC form?
at the 4th lumbar vertebrae where the common iliac veins come together
On US, when does the IVC get bigger, when the pt is breathing normally or when they take a deep breath and hold it?
deep breath and hold it
Where are the hepatic veins located?
They originate between the segments of the liver and drain posteriorly into the IVC at the level of the diaphragm
T or F: hepatic veins are surrounded by echogenic reflectors
False.
Hepatic veins are NOT surrounded by echogenic reflectors; portal veins ARE.
Which one is longer: the right renal vein or left renal vein?
left renal vein
T or F: pts with RT-sided heart failure will have decreased pulsatility?
False.
pts with right-sided heart failure will have increased pulsatility
Where does the RT gonadal vein drain into?
IVC
Where does the LT gonadal vein drain into?
LRV
LRV
left renal vein
RRV
right renal vein
(On US) This kind of pathology appears as solid material of varying echogenicity within the IVC lumen and may be partially filling or completely filling the IVC
IVC thrombosis
What is thrombosis of the hepatic veins in the liver?
Budd Chiari syndrome
What kind of pathology do these clinical findings suggest:
- RUQ pain
- ascites
- hepatomegaly
Budd Chiari syndrome
Formation of a clot in the vein that drains blood from the kidney
Renal vein thrombosis
What does an IVC filter do?
traps emboli from migrating to the heart and lungs
What is the entrance/gateway of major veins, arteries, and ducts going into and out of the liver?
Porta hepatis
Flow directed away from the liver
hepatofugal
Flow directed toward the liver
hepatopetal
What 3 vessels come together to form the main portal vein?
- splenic vein
- IMV
- SMV
IMV
inferior mesenteric vein
SMV
superior mesenteric vein
What does the MPV branch into?
RPV and LPV
What does the RPV branch into?
anterior and posterior right portal veins
What does the LPV branch into?
medial and lateral left portal veins
Formation of venous collaterals around a portal vein thrombosis?
Cavernous transformation of the portal vein
Increased venous resistance throughout the liver due to liver disease
portal venous HTN
What supplies blood to the liver?
- portal veins
- hepatic arteries
What vessels and ducts form the portal triad?
- hepatic artery
- portal vein
- common bile duct
