Chapter 8 Hagen Flashcards
Arteries and Veins contain 3 layers which are what?
Tunica intima- inner layer
Tunica media- middle layer
Tunica adventitia- external layer
What 4 branches of the aorta supply visceral organs and mesentery?
Celiac trunk
Superior mesenteric artery (SMA)
Inferior mesenteric artery (IMA)
Renal arteries
What is the normal Aorta measurement in men?
2.5-2.7 cm
What is the normal Aorta measurement in women?
2.1-2.3 cm
Where do the Phrenic arteries arise from?
Arise from lateral walls of the aorta and supply the undersurface of the diaphragm. (not seen on ultrasound)
Where is the Celiac trunk located?
1st anterior branch, arising 1 to 2 cm inferior to the diaphragm.
What is the proximal Aorta landmark?
The gastroesophageal junction.
What is the mid-Aorta landmark?
Just below SMA
What is the distal Aorta landmark?
Just above the bifurcation.
The celiac trunk splits into what 3 branches?
The common hepatic left gastric and splenic arteries.
What are the five main branches supply the small bowel?
- Inferior pancreatic artery
- Duodenal artery
- Colic artery
- Ileocolic artery
- Intestinal artery
What are the 3 main branches of the Inferior Mesenteric Artery?
Left colic
Sigmoid
Superior rectal arteries
What are the lateral branches of the abdominal Aorta?
Phrenic arteries
Renal arteries
Gonadal artery
Aorta clinical indications: (Reasons a patient may come to you for their ultrasound)
Pulsatile abdominal mass
Abdominal pain radiating to the back
Abdominal bruit
Hemodynamic compromise to the lower legs
Ectasia
diffuse dilation it increases in transverse diameter and vertical length, which causes the distal aorta to “kink” and become tortuous.
Aneurysm
Focal enlargement
Arteriosclerosis
Occurs when the vascular system becomes thick and stiff- leading to restriction of blood flow.
Atherosclerosis
A specific form of arteriosclerosis.
Arteriosclerosis is most commonly associated with the development of a ______.
Aneurysm.
Permanent localized dilation of an artery- usually greater than 3 cm or more than greater than 1.5 times the diameter of the proximal aorta.
Abdominal Aortic Aneurysm
Most Abdominal Aortic Aneurysm are _______.
Infrarenal
Abdominal Aortic Aneurysm risk factors include:
Tobacco use
Hypertension (HTN)
Vascular disease
Chronic Obstructive Pulmonary Disease (COPD)
Family history (Genetic Links- Marfan syndrome and Ehlers-Danlos syndrome)
Abdominal Aortic Aneurysm clinical symptoms include:
Most are asymptomatic
Often found on routine physical exam
May be found during unrelated radiologic or surgical procedure (incidental finding)
Symptoms can come from rupture or expansion of the vessel
An aneurysm may impinge on other adjacent structures or cause an occlusion because of direct pressure causing symptoms
Intense back pain and drop in hematocrit point to ruptured aneurysm
Aneurysm size and treatment
< 4 cm- follow every 6 months
4-5 cm- consider surgery or endovascular aneurysm repair
What is the most important and accurate measurement of the aorta/AAA?
Transverse AP
What information do you feel is important to document when you find a AAA?
Size, location, relationship to renal arteries/iliacs, color flow, symptoms, priors for comparison.
The majority are infrarenal, why would it be important to document the location in relation to the renal arteries?
Involvement in the renal arteries, pressure on the renal arteries could compromise blood flow to the kidneys causing ischemia, compression of the renal artery can cause hypertension, & surgical approach
False aneurysms (pseudoaneurysm)
Not lined by all 3 layers
Pulsatile hematoma that results from leakage of blood through a hole in the intima, but contained by the deeper layers of the aorta
Fusiform aneurysm
most common presentation of an atherosclerotic aneurysm (football-like shape)
Saccular aneurysm
sudden transition between normal and abnormal, typically larger (5-10 cm) than fusiform
Most common site of aneurysm rupture
lateral wall inferior to renal vessels
What are some other masses that can simulate a pulsatile abdominal mass?
Retroperitoneal tumor
Huge fibroid uterus
Paraaortic nodes
Because the mass is adjacent to the aorta, pulsations are transmitted from the aorta to the mass.
Three lateral tributaries of the IVC
Right suprarenal vein (the left suprarenal vein drains into the left renal vein)
Renal veins
Right testicular or ovarian vein
Resistive Index (RI)
determined by comparing peak systole with minimum diastole to determine the vessels impedance
Plug flow
Seen more in large vessels where most cells are moving the same velocity across the vessel. A clear window under systole is present
Flow towards the transducer is a
positive shift and seen above the baseline
Flow away from the transducer is a
negative shift and seen below the baseline
Sample volume
or sample gate should be adjusted to encompass the width of the vessel but not exceed the vessel walls. If it is too large then a noise artifact will appear in your waveform
In a Renal Artery Stenosis, the blood is very ____.
Turbulent
