Mini Quiz 3 / Big Monday Test Flashcards
Out of the renal veins, which one is the longest? And why?
Left renal vein because it has further to reach over to the IVC
This is also why the right renal artery is longer than the left renal artery
Where is the left gonadal vein leading into?
The left renal vein
What are the names of the two branches coming off of the common hepatic artery?
Gastroduodenal artery (GDA)
Proper hepatic artery (Artery that feeds the liver)
Where does the phrenic artery bring the blood to?
The diaphragm
What does the Phrenic artery look like?
a V looking antennas at the top of the aorta
The main portal vein and which way the blood should be moving
Enters into the liver
The one in the center connecting everything
Red arrow pointing up
Which vessel drains blood from the large intestines and into the splenic vein
Inferior mesenteric vein
Which vessel brings blood to / feeds the posterior portion of the right liver?
The right posterior portal vein
which vessel brings blood to the lateral portion of the liver?
Portal vein
Which vessel brings blood to the small intestines
Superior mesenteric artery
Left renal vein has 2 veins that go into it, name them.
The left gonadal vein and left adrenal vein that flows into it
Which vessel is the main supplier to the pancreas
Splenic artery
What two vessels make up the portal confluence?
Superior mesenteric vein and splenic vein
What is the name of the vessel that comes directly off of the celiac axis that feeds the liver ?
Common hepatic artery
Sections of the inferior vena cava:
Hepatic
Prerenal
Renal
Postrenal
Common iliac
What quadrant is the liver in
The right upper quadrant
Liver structures:
Portal veins
Hepatic veins
Arteries
Ducts
Hepatic ligaments
Fissures
What is the largest parenchymal organ in the body?
The liver
Where is the diaphragm in relation to the liver
It is superior to it,
On top of it.
What keeps the liver held up from above?
The coronary ligaments
Name of the tight fibrous capsule that surrounds the liver
Glissons capsule
Which capsule surrounds the whole liver except for the bare (back) end ?
Peritoneum capsule /
Peritoneum of the greater sac
What is the main ligament
Coronary ligament
What area is the guideline for scanning?
Midclavicular
What quadrant is the left lobe of the liver in
The left upper quadrant
Where is the dome of the diaphragm / dome of the liver located
The top portion of the liver
Which lobe is the smallest?
The caudate lobe
What is the posterior boundary of the caudate lobe?
The IVC
What is the name of the echogenic line anterior to the IVC
Ligamentum Venosum
What is the name of the connection between the stomach and the liver?
The gastrohepatic
Size of midclavicular line (the normal longitudinal measurement of the right lobe)
13 cm
Sometimes 15-17cm
Size of coronal
15-17 cm
Ligaments and fissures are highly ____________.
Echogenic
Portal veins get _________ as they approach the liver
Smaller
Hepatic veins get __________ as they approach the IVC
Bigger
Right hepatic veins split into
Posterior and anterior
Middle hepatic vein splits into
Right and left
Left hepatic vein splits into what quadrants?
Medial quadrant and lateral
Most dependable place for fluid to collect when in spine
Morrison’s pouch
Hepatopetal
Towards liver
Hepatofugal
Away from liver
The inferior visceral surface of the liver rests on the….
Upper abdominal organs
The caudate lobe is covered by the ….
Peritoneum if the lesser sac
The causal border forms the…
Cephalad margin of the foramen of Winslow
The opening between the greater sac of the peritoneal cavity in the abdomen
Epiploic foramen of Winslow
The right kidney and right adrenal gland lie near the ________________ of the liver
Bare area
The boundaries of the bare area include the
Falciform ligament
The right hepatic vein separates and drains the anterior and posterior segments of the….
Right lobe
The left hepatic vein separates and drains the medial and lateral segments of the ______________ of the liver
Left lobe
The middle hepatic vein separates and drains the….
Right and medial left liver lobes
The hepatic veins subdivide into….
Superior and inferior groups
The smaller inferior veins drain the…
Caudate lobe
And
The posteromedial portion of the right lobe
Portal triads
Portal vein, hepatic artery, the bile ducts, and their divisions
The normal liver should appear ______________ and ______________ throughout
Homogenous and moderately echogenic
The main lobar fissure appreads as a thin, bright line connecting the __________________ to the _______________
Gallbladder neck to the portal vein
The first branch off of the aorta is the
Celiac axis
What portion of the aorta passes through the aortic hiatus of the diaphragm to become the abdominal aorta?
Descending aorta
What relationship does the right renal artery (RRA) have to the inferior vena cava (IVC)?
RRA passes posterior to the IVC
What artery has a low resistance waveform in its normal state?
Celiac artery
Flow into the liver is called:
Hepatopetal flow
Another name for the term that describes pain developing 15 - 30 minutes after eating is:
mesenteric ischemia
describe the path of the SMA?
originates anterior of the aorta and courses inferior to feed the small intestine and colon
The left renal vein courses:
posterior to the SMA and anterior to the aorta to enter the IVC
What is the name of an abnormal finding when performing duplex examination of the abdominal vessels?
high resistance flow in the renal arteries
A renal artery to aortic ratio (RAR) greater than ________ is considered abnormal.
3.5
Which transducer is generally used to interrogate abdominal vessels in an adult?
3 MHZ
A normal Doppler signal in the SMA postprandial should be a:
low resistance waveform
What happens to the Doppler waveform in the celiac axis once a patient has eaten?
remains the same
angiography
contrast agent is used to visualize the anatomy
anatomy on obese patients can be seen
An invasive procedure
can be performed on a post surgical patient
Name a risk factor for venous abdominal vascular disease
liver disease
An infection within an arterial wall causing a dilatation of the vessel walls is termed:
.
mycotic aneurysm
A TIPS procedure is used for the treatment of:
portal hypertension
The sonographic appearance of normal liver parenchyma may be described as
homogeneous with medium-level echoes
The vascular branches seen scattered throughout the liver parenchyma are
portal and hepatic veins.
The portal vein is formed by the confluence of the
splenic and superior mesenteric veins.
portal triad is found at the level of the
___________, and
consists of the _____________
porta hepatis;
hepatic artery, bile duct, and portal vein
The liver is intraperitoneal except for interruptions at the gallbladder fossa, porta hepatis, and falciform ligament, portions around the IVC, and…
the bare area.
The liver is divided into lobes according to _____________
and into
segments according to _____________
anatomy
function
The main lobar fissure of the liver runs between….
runs between the right branch of the portal vein and the neck of the gallbladder.
The caudate lobe is located on which surface of the liver?
Posterior
The right, left, and middle hepatic veins empty into…
The IVC
A longitudinal section of the right and left branches of the portal vein is seen in a…
Transverse scanning plane
Anteroposterior measurement of the adult liver should not be larger
than
15 cm
Which ligament separates the left lobe from the caudate lobe?
Venosum
Segmental lobar anatomy divides the liver into _________ lobes.
Three
The right lobe of the liver is divided into anterior and posterior segments by the…..
Right hepatic vein
The normal liver should have a/an __________________
sonographic appearance.
Homogeneous
Hepatic veins ___________
in size as they drain toward the IVC.
Increase
What percentage of the total blood flow to the liver does the portal system supply?
75%
The common bile duct and the hepatic artery follow a/an __________ course to the portal vein within the liver.
Anterior
Just anterior to the portal vein within the liver lies the…
common bile duct and the hepatic artery.
The splenic vein receives blood from the…
Spleen
The right portal vein is seen coursing ____________ within the liver on our transverse images.
Horizontally
The ________________________ appears as a thin bright line connecting the gallbladder neck to the portal vein
Main lobar fissure
The superior mesenteric vein may be seen coursing toward its junction with the splenic vein at the…
Portal confluence
The _________________ can be visualized on its c-shaped superior course, proximal to the falciform ligament
Left portal vein
The falciform ligament appears _________ shaped in longitudinal and ______________ in axial sections
Sickle
Pyramidal
The main portal vein is visualized at…
It’s origin,
Posteroinferior to the neck of the pancreas.
Distal papillary process of the caudate lobe
a rounded prominence on the anteroinferior of the caudate
The lumen of the cystic duct contains a series of mucosal folds called…
The spiral valves of heister
Bile flows ______________________ through the cystic duct
Freely in both directions
Pressure differences in the biliary system along with the contraction of the gallbladder govern the….
Flow of bile
The _________________________ prevent the cystic duct from overdistending or collapsing
Spiral valves of heister
Bile is produced by the ___________ and is Carried to the gastrointestinal system by the _______________
Liver
Biliary tract
When days and amino acids are ingested, the duodenal mucosa releases ______________________ which is a peptide hormone
Cholecystokinin (CCK)
Bile is composed mostly of __________ and _____________
Water 82%
Bile acids (12%)
A non fasting patient will not have a….
Distended gallbladder
In an empty gallbladder the walls are __________ and may appear _____________ with the central portion containing random echoes
Thicker
Irregular
The walls of a distended gallbladder tend to be…
Well defined, regular, and echo-dense
Normal gallbladder wall thickness is usually ________ or less
3mm
Four landmarks for gallbladder
Portal vein
Right kidney
Duodenum
Main lobar fissure
The main portal vein courses ___________ the liver
Toward
The gallbladder is inferior to the level of the….
Right portal vein branch
The gallbladder is immediately anterior and to the left of the…..
Right kidney
The _____________ is usually sandwiched between the gallbladder and pancreas head
Duodenum
The _________________ is a thin, reflective, vessel that is demonstrated between the portal vein and gallbladder
Main lobar fissure
_______________ helps to form the bed in which the gallbladder lies
Main lobar fissure
Polyps
Floating gallstones
A small sacculation (outpouching) may be seen in some patients in the area of the gallbladder neck is called
Hartmanns pouch
after Henri Hartmann
Cholelithiasis
Gallstones
Bile ducts other than the common duct are usually
Small
The _____________ longitudinal section may be noted as two bright parallel lines separated by 1mm or so of anechoic bile
Common bile duct
The common bile duct is located….
Anterior to the right portal vein
The longitudinal section of the common bile duct can be seen coursing…
Superior to inferior between common hepatic artery and duodenum
The extrahepatic portal triad has become known as
Mickeys sign
The CBD is the ______ ear of the mouse
Right
The proper hepatic artery is the ______ ear of the mouse
Left
The larger __________________ is the face of the mouse
Larger main portal vein
Smalles tributaries empty into
Left renal vein
Several vein locations are _________ to artery location
Parallel
Renal veins empty into…
IVC
Right renal vein empties
Right kidney
The pancreas tail is between the ..
Aorta and sma
Left gonadal vein courses..
Parallel and lateral to ivc
Gonadal vein empties into
Left renal vein
Left suprenal vein empties into
Left renal vein
Right suprarenal vein empties into
The IVC
At level slightly superior to right renal artery
Right hepatic veins empty into
Right lobe of liver
Left hepatic veins empty into
Left lobe of liver
Inferior phrenic vein drains ____________ and empties into lateral aspect of _______
Diaphragm
IVC
Inferior vena cava is formed by
Convergence of common iliac veins
Iliac veins course superiorly through ______________ along anterior right lateral aspect of spine and right of aorta
Retroperitoneum
IVC goes through diaphragm and empties into ..
Right atrium in ♡
_____________ empty into lateral aspect of IVC and horizontally course empty posterior abdominal wall, located bilaterally
Lumbar veins
______________ courses parallel to IVC and empties into anterior lateral aspect of IVC
Right gonadal vein
Retropartitoneal structure coursing superior to inferior to spine (left side)
Aorta
_______________ branches off the anterior lateral aspect aorta and courses superiorly to supply underside of diaphragm
Inferiophrenic arteries
_____________ branches anteriorly from aorta
Celiac artery
______________________ courses horizontal to the right and branches into the Gastroduodenal artery and proper hepatic artery
Common hepatic artery
___________________ Courses inferiorly supplying right great curvature of stomach via right gastriepiploic artery
Gastroduodenal artery
_______________ courses right lateral and superiorly and supplies liver via right, middle, left hepatic artery
Proper hepatic artery
____________ feeds gallbladder and branches from right hepatic artery
Cystic artery
_________________ originates bilaterally from lateral aspect of aorta and courses horizontally from adrenal glands
Suprarenal arteries (adrenal arteries)
Superior mesenteric artery branches from
Anterior aorta
Renal arteries branch from
Lateral aspect aorta
Renal arteries course ____________ and supply the ____________
Horizontally
Kidneys
_______________ are inferior to sma and renal arteries
Gonadal arteries
Gonadal arteries originate anterior of aorta and courses inferiorly to…
Testes/ovaries
Inferior mesenteric artery originated from
Anterior aspect of aorta
Most inferior branch of aorta
Median sacral artery
____________________ supply the pelvis and lower extremities
Common iliac arteries
Lumbar arteries originate ______________ from lateral aspect of _________
Bilaterally
Aorta
What three vessels come off of the aorta anteriorly
Celiac axis
Sma
Ima
What is the Ecogenic linear structure that separates the left lobe of the liver and caudate lobe?
Ligamentum Venosum
Name all the steps of the liver protocol
Left lobe with tip
left lobe with caudate
Liver with IVC
Right lobe with some and pleural space
Right lobe with right kidney
Main portal vein coming into liver at porta hepatis
Other name for quadrate lobe
Superficial lobe
