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Abdominal > Class two > Flashcards

Class two Flashcards

1
Q

What are some aorta-iliac indications?

A
  • Abdominal pain
  • Pulsatile Abdominal mass
  • Abdominal bruit
  • Family Hx of AAA
  • Hx of HTN
  • Hip/buttock claudication
  • Decreased femoral pulse
  • Blue toe syndrome
  • AAA surveillance.
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2
Q

What are two aorta-iliac diseases?

A

Atherosclerosis & aneurysm.

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3
Q

What are some risk factors for aorta-iliac disease?

A
  • Age
  • SMoking
  • HTN
  • Family Hx of AAA
  • Trauma
  • Athersclerosis
  • Hyperlipidemia
  • Male
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4
Q

What are the signs and symptoms of AAA?

A
  • Patients with AAA are often asymptomatic
  • Abdominal pain
  • Body pain
  • Palpable pulsatile abdominal mass upon physical exam
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5
Q

What is the survival rate for a ruptured AAA?

A

10-25%

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6
Q

When does the risk of rupture increase with an AAA?

A

The risk of rupture increase with the size of the aneurysm.

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7
Q

An aneurysm of ____ have a higher incidence of rupture?

A

>5 cm

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8
Q

When is surgical repair recommended for an AAA?

A

It is usally recommended for aneurysms of >5 cm

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9
Q

Most AAA are _____

A

Infrarenal

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10
Q

How should you examine the aorta?

A

Examine the aorta from the diaphragm to the bifurcation.

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11
Q

Where should measurements be taken for the aorta?

A
  • Anterior posterior
  • Outer wall to outer wall.
  • Perpendicular to the long axis of the aorta.
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12
Q

What is the AAA duplex protocal?

A
  • Measure from diapgragm to bifurcation
  • Determine the location of AAA
  • Measure
  • Examine and measure iliac arteries
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13
Q

What should the angle be in a doppler for an aorto-iliac duplex?

A

60°

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14
Q

What is the criteria for an occlusive disease duplex?

A
  • Focal increase in velocity of 2 or more times the proximal adjacent segment.
  • Post-stenotic turbulence
  • Presence of plaque
  • Presence of a thrombus
  • Abnormal doppler signal at CFA
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15
Q

What is the critera for a NORMAL duplex?

A
  • Aortic diameter is approx. 2 cm
  • Aortic tapers distally
  • No intreluminal echoes detected within aort and iliac arteries
  • Color fills vessel lumen
  • Multi-phasic spectral waveforms
  • Uniform PSV
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16
Q

What are the 3 main treatment options for aorto-iliac disease?

A
  1. Medical treatments
  2. Surgical treatments
  3. Endovascular treatments
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17
Q

What does medical treatment conists of?

A
  • Medication
  • Follow-up imaging
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18
Q

What does a surgical treatment conist of?

A

Open repair

19
Q

What does endovascular treatment consist of?

A
  • Percutaneous transluminal angioplasty
  • Stent
  • Endovascular aortic stent graft repair
20
Q

What criteria qualifies for a AAA diagnoses?

A
  • Focal increase in caliber of artery
  • Dilated segment is at least 1.5 to 2x greater than the adjacent unaffected.
  • >3cm=AAA
21
Q

What does ectatic mean?

A

It refers to an abdominal aorta measuring >2 cm and <3 cm of an aorta that doesn’t taper distally.

22
Q

IVC, iliac veins, and abdominal aorta are located where?

A

The retroperitoneum.

23
Q

What is the retroperitoneum?

A

It is space between abdominal cavity and posterior abdominal wall.

24
Q

Where does the IVC receives blood from?

A

It receives blood from all organs and tissues inferior to the diaphragm.

25
Q

What are the risk factors for IVC/iliac vein disease?

A
  • Age
  • Immobility
  • Cancer
  • Hx of DVT
  • Smoking
  • Family Hx
  • May-Thurner disease
  • Clotting disorder
  • Trauma
26
Q

What are some exam indications for a IVC/iliac veins?

A
  • LE pain
  • LE swelling
  • SOB
  • Chest pain
  • Hemopytsis
  • Guided filter insertion
  • Pre and post filter placement
27
Q

What are normal IVC/iliac vein doppler waveforms characteristic?

A
  • Proximal IVC: Cardiac pulsatility, phasic with respiratory variation
  • Distal IVC & Iliac veins: Phasic with respiratory variation
28
Q

What happens to the IVC/iliac respiration variation during inhalation?

A

Deep inhalation decreases venous signal

29
Q

What happens to the IVC/iliac respiration variation during exhalation?

A

Exhalation increases venous signal

30
Q

Why does the venous signal increase and decrease?

A

Due to intrathoracic changes during respiration

31
Q

What is the most common cause of obstruction in the IVC/ IV?

A

Thrombosis.

Thrombosis most often propagates from lower extremity venous thromboembolism.

32
Q

What should you observe in an IVC/IV assessment?

A
  • OBSERVE FOR MASSES AND EXTRINSIC COMPRESSION OF THE VEIN.
  • OBSERVE FOR VENOUS DILATION, VISIBLE THROMBUS
33
Q

What should you evaluate in an IVC/IV assessment?

A
  • EVALUATE LENGTH OF THE ILIAC VENOUS SYSTEM WITH COLOR.
  • EVALUATE AND COMPARE DOPPLER SIGNALS FROM SIDE TO SIDE.
34
Q

What is IVC & Iliac Vein Assessment critera for diagnosing a thrombosis?

A
  • Dilated IVC or iliac vein
  • Presence of echogenic material within vessel lumen
  • Lack of color fill
  • Absent Doppler signal in total occlusion
  • Continuous, non-phasic Doppler signal may indicate partial obstruction
35
Q

What is some other pathology in the IVC/IV?

A
  • Neoplastic Obstruction
  • Extrinsic or intraluminal tumors that invade or compress the IVC
  • May-thurners syndrome
36
Q

What are some examples of extrinsic or intraluminal tumors that invade or compress the IVC?

A
  • Renal cell carcinoma
  • Hepatocellular carcinoma
37
Q

What is May-Thurner syndrome also known as?

A

Iliac vein compression syndrome (IVCS)

38
Q

What is May-Thurner syndrome?

A

It is when the left common iliac vein is compressed by right common iliac artery

39
Q

How is May-Thurner’s syndrome seen on duplex?

A
  • At compression point, increased velocities and/or stenotic flow may be detected
  • Continuous (non-phasic) Doppler signal noted distal to compression site
40
Q

What can May-Thurners syndrome cause?

A
  • Left iliofemoral DVT
  • CVI, which may cause chronic LLE pain and edema
41
Q

What are some 3 IVC anomalies?

A
  • DUPLICATION OF THE INFRARENAL IVC
  • LEFT-SIDED IVC
  • CONGENITAL ABSENCE OF THE INTRAHEPATIC PORTION OF THE IVC
42
Q

Where should an IVC filter be placed?

A

FILTERS SHOULD BE PLACE IN THE IVC DISTAL TO THE RENAL VEINS

43
Q
A

Abdominal (6 decks)

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