Aorta Physiology and Pathology Flashcards
1
Q
1st branch seen off aorta in u/s
A
Celiac Axis
2
Q
What vessels originates from CA
A
Splenic A, L Gastric A, Common Hepatic A
3
Q
Name artery that comes off CA that isnt seen in u/s
A
L Gastric A
4
Q
Name artery that come off the CA that is very tortuous
A
Splenic
5
Q
What vessel runs along the posterior border of the pancreas
A
Splenic Vein
6
Q
What are the 2 branches of the common hepatic artery
A
Superior: Gda
Posterior: Proper hepatic artery
7
Q
Another name for adrenals
A
suprarenals
8
Q
What organs do the gonadal arteries feed
A
Male: Testicles
Female: Ovaries
9
Q
Vessel between Aorta and SMA and accompanying syndrome
A
Left Renal Vein (Nutcracker)
10
Q
Renal arteries are seen best in which scan plane
A
transverse
11
Q
What is the only vessel that runs posterior to the IVC
A
RRA
12
Q
Relationship of SMA to Celiac
A
Inferior
13
Q
2 main structures fed by SMA and IMA
A
colon and pancreas
14
Q
What is most inferior artery off the aorta
A
Median sacral artery
15
Q
Aorta courses sagitally
A
Superior to inferior
16
Q
Aorta runs from
A
posterior to medial
17
Q
Aorta is on left or right of spine
A
left
18
Q
Aorta originates in
A
Left ventricle of the heart at the outflow tract
19
Q
what structure does the aorta pass through to begin being abdominal
A
Diaphragm
20
Q
Can the thoracic aorta be seen in ultrasound
A
No
21
Q
Shape of aorta
A
candy cane
22
Q
Aorta passes anteriorly or posteriorly to the diaphragm
A
posterior
23
Q
The Celiac branches_______to the Aorta
A
anteriorly
24
Q
Other names for Celiac axix
A
Celiac trunk / Celiac artery
25
Feeds left lesser curvature of stomach
LGA
26
Feeds the left greater curvature of the stomach
Splenic artery
27
Feeds the right greater curvature of the stomach
GDA
28
Splenic artery feeds
Spleen, pancreas, greater left of stomach
29
Common Hepatic Artery branches into
Gastroduodenal artery, Proper hepatic artery
30
GDA feeds
Greater right, pancreas and duodenal areas
31
Proper hepatic Artery branches into
left middle and right hepatic arteries
32
Right hepatic artery branches into the
cystic artery
33
Cystic artery feeds the
Gallbladder
34
SMA feeds the
Small Intestines, Ascending Colon, part of Transcending Colon
35
Renal arteries are____________to the SMA
inferior
36
Which renal artery is longer
RRA
37
Gonadal Arteries feed
testicles and ovaries
38
Gonadal start______to the respective organs
anteriorly, they course inferiorly
39
IMA feeds
part of transcending colon, descending colon and rectum
40
Median Sacral Artery feeds
Sacrum
41
Aortic Size
3 cm at largest
42
Aortic courses
Inferior to shallow, decreasing in size
43
Best method to decrease observer variation
Measure A to P
44
3 layers of the vessel
tunica intima
tunica media
tunica adventitia
45
Layer that is thick in arteries
Media
46
Why is media thicker
greater elastisity
47
Primary function of aorta
Bring oxygenated blood to organs to ensure oxygenation and metabolism
48
Systole creates
blood to quickly to be sent in aorta causing expansion
49
Diastole and Aortic Valve closure ensures
wall recoil and the release of stored energy: maintains BP
50
Aorta displays
anechoic with echogenic walls (tubular)
51
Vessels that display pulsivity
Large Vessels
52
What portion is hard to visualize fully across the screen sagitally
Proximal due to curviture
53
Distal portion is
more linear
54
Celiac axis makes what sign with which two arteries
Seagull Splenic A and CHA
55
SMA visualized better in which plane
TRV due to parapancreatic fat surrounding it
56
Renal arteries visualized best in which plane
TRV small curvature branching from Aorta
57
IMA visualized best
not visualized unless pathology
58
Bifurcation best visualized in
TRV level with umbillicus
59
Reason for exam
Look for aneurysms and stenosis
60
What is seagull sign
CHA and SA in trv that represent the wings of a seagull
61
What is the echogenic material around SMA in TRV
parapancreatic fat
62
Which renal artery is longer
right
63
Primary reason to have Aorta Ultrasound
ID aneurysms, ID stenosis
64
Branches affected by
```
Atheroma
Aneurysm
Connective Tissue Disorders: Cystic medial necrosis, Marfans
Rupture
Thrombus
Infection
Displacement
```
65
Atheroma is
solf lipid (plaque) in intima
66
Atheroma is more prevalent in
old males more likely
67
Atheroma is chronic or acute
Chronic, takes years to accumulate
68
Atherosclerosis is
disease in which fatty deposits collect in vessel walls and narrow and impair blood flow
69
Arteriosclerosis is
disease of hardening of the arteries which may lead to coronary arteries hardening causing a myocardial infarction
70
Most common cause of arteriosclerosis
Atherosclerosis
71
Other cause of arteriosclerosis
cigarette smoking
diabetes
htn
increased cholesterol (Athero)
72
Arteriosclerosis: what side of the vessel is most likely affected
posterior
73
Arterio can also affect which vessels
All branches of Aorta and Iliacs
74
What is an aneurysm
Swelling or dilation of a blood vessel, increase in diameter of 50% in a short amount of time
75
3 kinds of aneurysm
True
False (Pseudo)
Dissecting
76
How much more likely are men to have AAA than women
4x
77
3 Symptoms of AAA
```
abdominal pain (constant/come and go)
back pain-radiates to groin or butt
heartbeat feeling in abdomen
```
78
What are the 6 finding in ultrasound that point to AAA
1. increased Aorta diameter >3cm
2. focal dilation
3. lack or normal taper
4. presences of thrombus
5. dissection
6. rupture
79
Annual growth of AAA
.25 cm
80
How often will you need checkup if diagnoses with AAA
1-2 years
81
Survival rate for one year if over 6 cm
50%
82
Risk of rupture if over 7cm
75%
83
Mortality rate if operated on before rupter
5%
84
Mortality rate if operated after rupture
50%
85
What does the sonographer need to analyze with a AAA
1. Maximum true dimentions
2. Shape
3. Location and vessel involvement
4. Wall thickening (soft or hard)
5. Presence of patent
6. Examine kidney involvement
86
What are the 3 types of aneurysm
Berry- brain
Saccular
Fusiform
87
How do we determine if an aneurysm is true
Involves all three layers of the vessel
88
How are pseudo AAA formed
A hole in the vessel scabs and blood fills the gap (angiogram)
89
Size of Berry aneurysm
1-1.5 cm
90
What does berry aneurysm look like
bubble rising from the vessel wall, or berries hanging (mostly in cerebral)
91
Size of saccular
5-10 cm
92
physical attribute of saccular
connected by a NECK to the vessel luman
93
What can saccular be filled with
Thrombus
94
What is the most common type of aneurysm
Fusiform
95
How is the fuciform shaped
Gradual uniform dilation or spindle shaped dilation
96
Is fuciform always evenly distributed
No may be eccentric, one side may be more affected
97
Where do aneurysms most often occure
Distal Aorta
98
What is ectatic aorta
The entire aorta is enlarged without a bulge
99
What is ectatic aorta related to
related to age and htn
100
Is ectatic aorta fatal
not likely
101
How often must one follow up for ectatic aorta
6-12 months
102
How do you treat AAA
SURGERY
103
How do you treat ectatic aorta
not always surgery
104
Treatment for ruptured AAA
SURGERY
105
Mortality rate for rupture
50%
106
What is the most catastrophic of all AAA complications
Rupture
107
Are you likely to be diagnosised with AAA before rupture
NO
108
Symptoms of rupture
```
Sudden abdominal pain radiating to back
paleness
dry mouth, thirst
nausea, vomitting
signs of shock (rapid heart rt, sweating, fainting, dizzines, weakness)
```
109
Choice modality for rupture
CT, but cant have pt unaccessable for that period of time so US
110
Most common site of rupture
Later wall INFRA RENALS
111
Biggest risk factor of rupture
SIZE
112
What is pseudo filled with
fills and then empties with blood
113
What to look for with pseudo
communicating stock
114
In pseudo what holds blood in
the outer layers of vessel or surrounding tissue
115
Cause of pseudo
1. myocartic infarction
2. surgery
3. trauma
4. angiogram interventional proceedures
116
Intervention of pseudo
1. compression
2. thombin injection
3. surgery
117
Most likely intervention
THROMBIN (immediate clot), compression is uncomfortable for the pt
118
What is Dissecting Aneurysm
Seriour where inner layer has tear and blood is trapped inbetween the layers of the aorta
119
What does dissecting aneurysm look like
looks like a second lumen (aorta) beside the first
120
Outcome if outer layers burst
Usually death
121
Why do dissecting aneurysms happen
deterioration of the arterial wall, most commonly associated with HIGH BLOOD PRESSURE
122
How often is high bp present in dissection
2/3
123
Other causes of dissection
1. Hereditary connective tissue disorders- Marfans and Ehlers-Danlos
2. Birth defects
3. Trauma
4. Pregnancy
5. Thoracic dissection coming down to abdominal
124
What is Marfans syndrome
connective tissue with long limbs and fingers
125
Risk factors for Dissection
```
Male
African Americans
40-70
HTN
Known aneurysm
```
126
Symptoms of Dissection rupture
Sudden excrusciating chest and back pain
127
Modality for diagnosing Dissection
CT
MRA
TEE
128
How long before death hits dissection rupture
hours
129
Mortality rate of dissection without intervention
75% in the first 2 weeks
130
What ligament cuts off the celiac axis when engorged
Median arcuate ligament
131
Whats another name for the condition where the CA is crimped by the median arcuate ligament
Celiac Axis Compression Syndrome
132
Purpose of the median arcuate ligament
connect left and right crura of diaphragm
133
Symptoms of Celiac Axis Compression syndrome
1. Weight loss
2. Chronic abdominal pain
3. Bruit in epigastric region
134
What is the flexible material used to repair weaked AAA walls
GRAFTS
135
What are the 4 types of grafts
1. Aorta End to End
2. Aortoiliac
3. Aortobifermoral
4. Fem-Fem
136
What is opening of the graft called
Anastomoses
137
What will you asses with patient who has a graft
1. Ask when it was placed
2. Assess Anastomoses
3. Check stenosis and aneurysm with doppler
4. ID and measure fluid collection
5. Check for distal blood flow
138
Abnormal communication between and artery and a vein
Arteriovenous fistula (congenital-aquired)
139
Symptoms of congenital AV fistula
birth defect
not common
usually lower extremities
140
Causes of aquired AV fistula
usually caused during trauma or surgery
inflamation
neoplasm
141
Symptioms of aquired AV fistula
1. Lower back and abd pain
2. Pulsatile mass with bruit
3. Massive swelling
4. Cardiac decompensation
142
When is AV fistula good
Dialysis
