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Abd / SS 2 > Module 3 : Vascular Diseases > Flashcards

Module 3 : Vascular Diseases Flashcards

1
Q

what are 5 conditions that can alter blood flow in and out of organs

A
  • increase in vessel pressures
  • thrombosis/tumor invasion
  • atherosclerosis
  • congenital abnormalities
  • aneurysms
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2
Q

what is the normal aortic waveform pattern prox and distal

A
  • prox = moderate

- distal = high resistance

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3
Q

renal artery normal wave form pattern

A
  • low resistance
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4
Q

sma normal wave form patter prandial and postprandial

A
  • pre prandial = high resistance

- post prandial = low resistance

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5
Q

normal portal venous flow

A
  • hepatopedal

- monophasic flow with slight undulations

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6
Q

hepatic veins and ivc normal flow

A
  • phasic flow
  • influence by the cardiac and respiratory cycles
  • IVC often described as a saw tooth pattern
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7
Q

normal ao prox measuremnt

A

2-2.5cm

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8
Q

normal ao dist measurement

A

1.5cm

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9
Q

at what measurement is the ao considered aneurysmal

A

3cm

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10
Q

ivc size

A

5-29mm (usually less than 25mm)

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11
Q

when is the IVC considered dilated

A

> 3.7cm

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12
Q

what is the IVC size on initial inspiration

A

decreases in size

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13
Q

what is the IVC size on suspended respiration

A

increases in size

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14
Q

4 indications for arterial assessment

A
  • pulsatile abdominal mass
  • abdominal pain
  • abdominal buit
  • hemodynamic compromise of the lower limbs
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15
Q

definiton of arteriosclerosis

A

hardening of arteries

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16
Q

definition of atheroma

A

lipid deposits in arterial intima

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17
Q

atherosclerosis definiton

A
  • form of arteriosclerosis occurring in larger and medium arteries
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18
Q

plaque definiton

A

platelets forming cap over fatty deposits

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19
Q

characteristics of atheromatous disease (atherosclerosis)

A
  • lipid deposits on intimal lining of any artery

- alteration of lining provokes fibrosis and calcification

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20
Q

what 3 things is atherosclerosis associated with

A
  • hypertension
  • smoking
  • diabetes
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21
Q

does incidence of atherosclerosis incense or decrease with age

A
  • increase
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22
Q

does atherosclerosis effect females or males more

A

males

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23
Q

sonographic appearance of atherosclerosis

A
  • wall irregularities
  • tortuous vesels
  • calcifications
  • narrowed vessel lumen
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24
Q

do aneuysms effect only one artery

A
  • no can affect any artery
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25
Q

6 types of aortic aneurysms

A
  • abdominal aortic aneurysms
  • splanchnic artery aneurysms (mesenteric)
  • renal artery aneurysms
  • iliac artery aneurysms
  • mycotic aneurysms
  • inflammatory aneurysms
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26
Q

what is an abdominal aortic aneurysm

A
  • a weakening of the aortic wall that leads to a focal dilatation
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27
Q

what is a true aneurysms

A
  • involves all 3 layers of the artery wall
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28
Q

what is ectasia

A
  • slight widening of the aorta up to 3cm
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29
Q

where does AAA usually occur

A
  • occur mainly below the level of the renal vessels (infrarenal)
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30
Q

5 causes of AAA

A
  • atherosclerosis MOST COMMON
  • syphilis
  • systemic infection
  • cystic medical necrosis
  • other diseases (marfans)
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31
Q

4 increased risk factors for AAA

A
  • men > 60
  • hypertenison
  • family history
  • hypercholesteremia
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32
Q

6 signs and symptoms of AAA

A
  • usually asymptomatic
  • palpable mass
  • incidental finding on X-ray
  • lower back pain
  • abdominal pain
  • leg pain
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33
Q

two types of AAA

A
  • fusiform

- saccular

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34
Q

fusiform AAA

A
  • uniform tubular dilation
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35
Q

saccular AAA

A
  • sac like protrusion towards one side connected to the aortal
  • most often due to trauma or infection
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36
Q

sonographic appearance of a AAA

A
  • dilation of the aorta 3cm or greater
  • aorta projects anterior and left (ivc and spine)
  • wall irregularities
  • ## thrombus on anterior and lateral walls
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37
Q

what is thrombus

A
  • clot attached to the vessel wall

- poorly attached thrombus can result in the release of emboli

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38
Q

what three things cause thrombus

A
  • slowing of the blood stream
  • injury to vessel
  • alterations to the blood constituents
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39
Q

two associated findings with AAA

A
  • iliac artery aneurysms

- popliteal aneurysms

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40
Q

iliac artery aneurysms

A
  • bilateral
  • 2cm or greater
  • usually asymptomatic
  • older men
  • can rupture
  • causes hydronephrosis = compress ureters
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41
Q

popliteal aneurysms

A
  • 25% of cases

- >1cm

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42
Q

protocol for measuring AAA

A
  • place callipers outer to outer wall

- measure perpendicular to the vessel

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43
Q

6 things you want to document with AAA

A
  • length, width and AP dimension
  • shape
  • location in aorta
  • does it involve renal or iliac arteries
  • describe the wall thickening
  • flow pattern
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44
Q

follow up treatment for 3-5cm aneurysm

A
  • increasing in size 2-5mm/year
    + serial ultrasound exams
  • increasing in size 10mm/year
    + surgery aortic graft
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45
Q

follow up and treatment for 5-6cm aneurysm

A
  • surgery with good prognosis

- at 6cm surgery is considered imperative

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46
Q

follow up and treatment for >7cm aneurysm

A
  • 1 year survival rate 25%
  • 75% risk of fatal rupture
  • surgery = aortic graft
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47
Q

4 complications with AAA

A
  • stenosis/occlusion MOST COMMON
  • rupture
  • dissection
  • thrombosis
    + with distal emboli
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48
Q

characteristics of AAA rupture

A
  • surgical emergency
  • mortality rate >50%
  • operative mortality rate >40-60%
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49
Q

signs and symptoms of AAA rupture

A
  • pain
  • shock
  • expanding abdominal mass
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50
Q

sonographic appearance of AAA rupture

A
  • free fluid in abdomen
  • complex fluid collection
  • compression/displacement of surrounding structures
51
Q

two types of AAA repair

A
  • traditional graft

- endovascular aortic stent

52
Q

traditional graft

A
  • surgical bypass graft
  • open repair
  • made by flexible synthetic material (teflon or Dacron)
53
Q

endovascular stent

A
  • less invasive
  • stent inserted and ballooned out
  • more popular and less invasive quicker recovery
54
Q

sonographic appearance of end-vascular stent

A
  • ribbed appearance
  • straight distinct borders
  • increased echoes
  • post op = small layer of fluid normal
  • graft older than 8 years may bee difficult to see
55
Q

6 complications of surgical repair

A
  • fluid collection
  • hematomas seromas
  • abscesses
  • pseudoaneurysms
  • stenosis
  • endoleaks
56
Q

splanchnic artery aneurysms

A
  • celiac, SMA, IMA

- rare but life threatening

57
Q

order of arteries effected by splanchnic artery aneurysms

A
  • splenic artery
  • hepatic artery
  • SMA
58
Q

underlying causes of splanchnic artery aneurysms

A
  • congenital
  • atherosclerosis
  • mycotic (fungal/bacterial)
  • inflammatory
59
Q

sonographic appearance of splanchnic artery aneurysms

A
  • anechoic or complex area continuous with the vessel
  • doppler signal
  • can be mistaken for abscess/cyst/lymph node
60
Q

renal artery aneurysms

A
  • extra renal location
61
Q

common underlying cause of renal artery aneurysms

A
  • athersclerosis

- polyarteritis

62
Q

signs and symptoms of renal artery aneurysms

A
  • palpable mass
  • hypertension (kidneys controls blood pressure)
  • hematuria
63
Q

sonographic appearance of renal artery aneurysms

A
  • anechoic mass connected to artery with doppler signal
64
Q

mycotic aneurysms

A
  • rare
  • due to bacterial or fungal infection
  • most are saccular with asymmetric wall thickening
  • difficult to diagnose with ultrasound alone
65
Q

inflammatory aneurysms

A
  • uncommon
  • dense fibrotic reaction around the aneurysm
  • involves retroperitoneum
  • high morbidity and mortality rate
  • adherent to bowel, ureter, iliac veins and IVC
66
Q

sonographic appearance of inflammatory aneurysms

A
  • dilated aorta
  • wall thick
  • hypo echoic mantle around aorta
67
Q

what is an aortic dissection

A
  • tear of the intimal lignin got the aorta (and sometimes media)
  • false lumen created as blood pulsates through the vascular wall layers
  • begins at the thorax
  • presents typically with chest pain
68
Q

what are ao dissections related to

A
  • hypertension
69
Q

3 types of aortic dissections

A
  • involving aortic arch and movie down the aorta
  • marfans
    + ascending ao only
  • dissection of descending ao after origin of left subclavian
    + MOSR COMMON
70
Q

sonographic appearance of ao dissection

A
  • thin, linear, echogenicity within the arterial lumen
    + flap moves with cardiac cycle
  • doppler
    + demonstrates blood flow on both sides of the flap
71
Q

what is a psuedoaneurysms

A
  • blood escapes through a tear in the vessel wall and Is contained by surrounding tissues
72
Q

causes of pseudo aneurysms

A
  • failed graft
  • post angiogram
  • trauma
73
Q

sonographic appearance of pseudoaneurysms

A
  • round/oval appearnce
  • blood circulates through in systole
  • pulsatile jet entry
  • variable waveform
  • always identify neck of mass
74
Q

treatment of pseudoanerysm

A
  • ultrasound guided compression
  • ultrasound guided thrombin injection
    + cause blood to clot off
  • monitored with color doppler imaging
75
Q

what is an arteriovenous AV fistula

A
  • abnormal communication between and artery and vein
  • blood moves from high to low pressure
  • most secondary to trauma, can be complication to aortic aneurysm
76
Q

clinical presentation of AV fistula

A
  • lower back and abdominal pain
  • hemodynamics altered
  • swelling of lower trunk and extremities
  • dilated veins
77
Q

sonographic appearance of AV fistula

A
  • dilated IVC
  • pulsatile IVC
  • irregular waveform high velocites
  • reduced distal arterial flow
78
Q

vascular stenosis

A
  • can occur in varying degree

- caused by atherosclerotic plaque

79
Q

common 2D and doppler findings of vascular stenosis

A
  • narrowed lumen
  • post stenotic dilation
  • increased velocities at stenosis
  • downstream changes
80
Q

renal artery stenosis

A
  • associated with incontrollable hypertension
  • decreased glomerular filtration rate
  • causes ischemic renal damage
  • commonly at the origin from the aorta within the first 2cm
81
Q

4 things to look for when assessing the IVC

A
  • changes with respiration
  • compressibility
  • echo free lumen
  • patency
82
Q

what is a dilated IVC

A
  • caliber increases below the point of obstruction
83
Q

what is a dilated IVC associated with

A
  • right ventricular failure
84
Q

4 signs and symptoms of dilated IVC

A
  • abdominal pain
  • ascites
  • hepatomegaly
  • lower extremity edema
85
Q

characteristics of ivc tumors

A
  • primary metastatic or extension

- present with leg edema, ascites and abdominal pain

86
Q

primary IVC tumors

A
  • uncommon
  • leiomyoma/leiomyosarcoma
    + tumor of smooth muscle
87
Q

metastatic ivc tumors

A
  • most commonly RCC
88
Q

sonographic appearance of ivc tumors

A
  • intraluminal ehcogenic foci
  • can be isoechoic or heterogeneous
  • caliber of ivc increased
  • loss of respiratory changes
89
Q

characteristics of IVC thrombus

A
  • life threatening
  • MOST COMMON ABNORMALITY OF IVC
  • spreads from other veins
90
Q

sonographic appearance of IVC thrombosis

A
  • intraluminal filling defect expanding the vessel
  • echogenicity of the thrombus depends on its age
  • respiratory changes decreased or absent
  • color doppler is useful will show no flow in the region of the thrombus
  • IVC filters used for treatment
91
Q

signs and symptoms of IVC thrombus

A
  • leg edema
  • lower back pain
  • GI complaints
  • enlarged liver
  • ascites
92
Q

renal vein thrombosis characteristics

A
  • serious complication in a dehydrated state or septic infant
  • in adults occur as result of shock, renal tumor, renal transplants or trauma
  • associated with diabetes and high blood pressure
93
Q

3 signs an symptoms of renal vein thrombosis

A
  • flank pain/mass
  • hematuria
  • proteinuria
94
Q

sonographic appearance of renal vein thrombosis

A
  • enlarged kidney hypo echoic
  • dilated renal vein
  • filing defects of variable echogenicty
  • decreased or absent venous signal
95
Q

congenital abnormalities of the IVC

A
  • most occur at or below level of the renals
96
Q

what are the most common congenital abnormalities of IVC

A
  • duplication and transposition
97
Q

when does azygous/hemiazygous abnormality occur

A
  • when hepatic segment of the IVC fails to develop
98
Q

three types of congenital IVC abnormality

A
  • transposition
  • duplication
  • azygous continuation
99
Q

what is hepatic congestion

A
  • passive edema of liver secondary to vascular congestion
  • related to heart failure
  • blood flow to the right side of heart is impaired
100
Q

sonographic appearance of acute hepatic congestion

A
  • enlarged liver
  • IVC dilated/ no respiratory changes
  • hepatic veins = highly pulsatile, flow reversal
  • portal vein flow = pulsatile
101
Q

sonographic appearance of chronic hepatic congestion

A
  • shrunken liver
  • hepatic veins distended
  • LFT may be altered
102
Q

what is portal hypertension

A
  • due to increase portal venous pressure

- 2 types based on whether hepatic vein pressure are normal or elevated

103
Q

2 types of portal hypertension

A
  • presinusoidal
    + normal hepatic vein pressure
  • intraheptaic
    + abnormal hepatic vein pressure
104
Q

2 types of presinusoidal hypertension

A
  • extrahepatic

- intrahepatic

105
Q

extra hepatic presinusoidal hypertension

A
  • PV and SV thrombosis
  • results in ascites, splenomegaly, varices
  • possible causes
    + malignancy, infection, inflammation, trauma, splenectomy, hypercoaguable states
106
Q

intrahepatic presinusoidal hypertension

A
  • caused by diseases affecting the portal zones
    + schistosomiasis (panc infection)
    + primary biliary cirrhosis
107
Q

intrahepatic portal hypertension

A
  • most common in western world = cirrhosis
  • normal liver parenchyma is replaced which leads to increased resistance to PV flow and obstruction of HV outflow
  • results in ascites, splenomegaly, collaterals
108
Q

sonographic appearance of both types of portal hypertension

A 
- dilated PV in the early stages
  \+ upper limit of normal 13mm
- collateral flow
- patent umbilical vein/coronary vein 
- ascites
- splenomegaly 
- monophasic >> biphasic>> hepatofugal
109
Q

5 most common collateral routes

A 
- gastroesophageal 
  \+ fatal hemorrhage 
- paraumbilical 
  \+ leads to caput medusa
- splenorenal/gastrorenal
- intestinal 
- hemorrhoidal
110
Q

what is portal vein thrombosis

A
  • clot in portal venous system

- can result in cavernous transformation

111
Q

causes of portal vein thrombosis

A
  • malignancy
  • infection/inflammation
  • trauma
  • splenectomy
112
Q

why is color doppler important for portal vein thrombosis

A
  • useful in distinguishing benign and malignant thrombi

- acute thrombus may be relatively anechoic

113
Q

what is cavernous transformation

A
  • formation of venous channels around a thrombodes vein portal vein
114
Q

what is Budd chairi syndrome

A
  • rare

- obstruction of hepatic veins with possible IVC occlusion

115
Q

causes of Budd chiari syndrome

A
  • coagulation/congenital abnormalites
  • trauma
  • ORAL CONTRACEPTIVES
  • tumor invasion
116
Q

sonographic appearance of Budd chiari

A
  • stage dependant
  • enlarged liver (acute)
  • poor visualization of hepatic veins
  • thrombus in IVC
  • caudate lobe enlarged/hypoechoic
  • HV flow absent or reversed
117
Q

signs and symptoms of Budd Chiari

A
  • RUQ
  • hepatomegaly
  • occasionally splenomegaly
118
Q

treatment of portal hypertension

A
  • portosystemic shunts
119
Q

portisystemic shunts characteristic

A
  • shunts venous blood flow from congested venous system to a systemic vein
  • decompress PV system
  • can be placed surgically or percutaneously
  • TIPS
120
Q

TIPS shunt

A
  • trans jugular intrahepatic portosystemic shunt
  • stent inserted percutaneously via jugular vein
  • inserted HV to PV
  • blood flows from PV system into hepatic venous system
121
Q

what is an infarction

A
  • sudden interruption of blood supply that may lead to encores
122
Q

splenic infarct

A
  • common cause of focal splenic lesions
  • caused by occlusion of the splenic artery
  • sudden onset of LUQ pain
  • underlying causes = sickle cell anemia
123
Q

sonographic appearance of splenic infarct

A
  • hypo echoic wedge shaped round area

- echogenicity changes over time (becomes hyperechoic)

124
Q

renal infarct

A
  • can be segmental or diffuse
  • appearance is time dependant
    + early = hypo
    + late = hyper
  • renal function often remains normal

Abd / SS 2 (7 decks)

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