C2: Vascular Structures Flashcards
What is the Tunica Intima composed of?
Endothelial lining and elastic tissue
What is the tunica media composed of?
Elastic fibres and smooth muscle
What is the tunica adventitia composed of?
Elastic fibers and collagen fibers
Which vessels range with respiration and muscle contraction?
Vein size varies with respiration and muscle contraction, arteries do not
Where is the lesser sac located in comparison to the AO?
Anterior
Pancreas picture and AO model for other anterior relationships
Where is the crura of the diaphragm located compared to the AO?
Anterior and left
Where is the GE junction located compared to the AO?
Anterolateral
Name all the branches of the AO from superior to inferior
Celiac axis Adrenal arteries SMA Renal arteries Gonadal arteries IMA Lumbar Arteries Medial Sacral Arteries Common Iliac Arteries
How does the left gastric artery travel?
Anteriorly and superiorly from the celiac axis, then along the lesser curve of the stomach
The common hepatic artery branches into which smaller arteries?
Gastroduodenal artery
Right gastric artery
The cystic artery is a branch off of which artery and what does it supply?
Branches from the right hepatic artery and supplies the gallbladder, CBD and hepatic ducts
Which branch if the first branch off of the common hepatic artery?
Right gastric artery
How does the GDA course in the body and with reference to the duodenum?
Courses inferiorly and then Posterior & medial to the duodenum
Which branch of the celiac axis is the largest and which is the smallest?
Largest: splenic artery
Smallest: left gastric artery
The splenic artery provides blood to which body structures?
Pancreas, spleen, and stomach
Where is the SMA located compared to the uncinate and third part of the duodenum?
Anterior
The SMA supplies which body organs?
The right side of the small and large bowel
The RRA courses ________ to the IVC?
Posteriorly
Which renal artery is longer? And which is lower?
RRA is longer
RRA is lower
How do the gonadal arteries branch off the AO?
Anteriorly
What is the last major branch off of the AO?
The IMA
The IMA supplies which organs?
Transverse, descending, sigmoid colon and rectum
Which vessels are anterior?
The CIA or the CIV?
CIA are anterior
Where should the calibers be placed to measure the size of arteries?
Outer walls
AO proximal AP measurement
AO distal AP measurement
Prox: 2-2.5 cm
Dis: 1.5 cm
An AO measurement greater than, or equal to, which value is considered aneurysmal?
3 cm
What should the lilac arteries measure in males and females? And in what plane should be measure?
Males: 1.4-1.5cm
Women: 1.2cm
Trans
List 3 possible acoustic windows for scanning the AO
Sagittal
Sagittal but, move to the L and angle to midline if the patient has gas
Coronal- L coronal for distal AO, R coronal for proximal AO (due to the stomach)
Which crux of the diaphragm is most often seen?
The R crux, the L is not often seen because of the stomach
At what level do the CIVs join to form the IVC?
L5
At what size is the IVC considered dilated?
When it exceeds 3.7cm…. some resources say it’s displayed when it’s larger than 2.5cm
Which tributaries of the IVC aren’t usually seen?
Gonadal veins and lumbar veins
He lumbar veins are tributaries of which larger veins?
Tthe CIV, AND/OR the IVC
How do the lumbar veins course in the body?
They travel lateral to the spine and posterior to the psoas muscles
Where do the hepatic veins drain into the IVC?
Just inferior to the diaphragm
Do the hepatic veins have valves?
No
Do the hepatic veins increase in size as they course towards the IVC?
Yes
Why is it harder to image the hepatic veins with a fatty liver?
Fat is hard to penetrate
How should your probe be placed on the body to image the hepatic veins?
The probe should be placed obliquely towards the right side of the body
The portal venous system drains blood from which areas off the body?
The bowel, spleen, pancreas, gallbladder and bile ducts
Which vein do the portal veins drain into?
The hepatic veins
Does the portal venous system contain valves?
No
The portal venous system is formed by the union of which veins?
The splenic vein, SMV and IMV
How does the splenic vein course in relation to the pancreas?
It is posterior and inferior to the body and tail of the pancreas
Which confluence is a landmark for the neck of the pancreas?
The portal confluence
Where does the superior mesenteric vein originate?
The root of the mesentery
How does the SMV course in the body compared to the SMA?
The SMV is located to the right of the SMA and rungs parallel to the SMA… this is a constant relationship
At what point does the SMV become the Main portal vein?
above the level of the pancreas
What is the average dimension of the MPV and it measures less than what value?
Averages ~11mm
Typically <13mm
How does the MPV course in the body?
Right, superior and oblique from the confluence
The MPV is enclosed by which membrane?
Enclosed by the peritoneum which forms the free margin on the lesser omentum anterior to the epiploic foramen
The MPV supplies what percentage of the livers OXYGEN?
What about % of blood?
50-60% O2
70% blood supply
How does the RPV appear compared to the LPV?
Its shorter and fatter
Is the portal venous system collapsable?
No, its deep within the liver
What type of flow and waveform will the IVC produce?
Phasic flow, bidirectional and pulsatile
Waveform will have a sawtooth pattern
What type of flow will the hepatic veins produce?
Phasic and pulsatile
they flow away from the liver
What type of flow will the renal arteries and veins produce?
Artery: low resistance flow
Vein: Phasic flow
What type of flow will the portal veins produce?
Phasic and continuous flow
What does Hepatopedal/hepatopetal mean?
Flow towards the liver
What does hepatofugal mean?
Flow away from the liver
What type of flow will the AO have?
Moderate resistance flow about the renal arteries
High resistance flow below the renal arteries
When does the CHA become the hepatic artery proper?
After the GDA branches off
