Quiz 2 review pt 1 Flashcards
What is the function of the circulatory system?
Transports gases, nutrients, & other essential substances to the tissues & transports waste products from the cells to the appropriate sites for excretion.
What are the three layers of the vessel walls?
Tunica intima (inner), tunica media (middle), tunica adventitia (outer).
Arteries carry what kind of blood and in what direction? Which arteries are different?
Arteries carry oxygenated blood away from the heart.
Pulmonary arteries carry deoxygenated blood to the lungs.
Veins carry what kind of blood and in what direction? Which veins are different?
Veins carry deoxygenated blood toward the heart.
Pulmonary veins carry oxygenated blood from the lungs to the heart.
How do veins appear on ultrasound?
Thin-walled, oval, larger diameter, and compressible.
What do valves do?
Prevent backflow of blood.
What are capillaries?
Capillaries are the exchange vessels. They are microscopic and have only one wall—tunica intima—allowing substances to pass through quickly.
They connect arterioles to venules.
After blood is passed through capillaries, it is then collected where?
Venules.
Venules then unite to form larger vessels.
True or False? Aorta changes in size with respiration.
False.
Only veins do.
What are the 5 sections of the aorta?
Root, ascending, descending, abdominal, bifurcation.
Which sections are part of the aortic arch?
The root and ascending aorta.
What are the 3 vessels (in order) that come off the aortic arch?
Brachiocephalic, Left common carotid artery, Left subclavian.
What are the branches of the abdominal aorta?
Celiac axis/trunk (1-2 cm from diaphragm), Superior mesenteric artery (1-2 cm from CA), Renal arteries, Inferior mesenteric artery.
What are the branches of the CA?
Left gastric artery, Splenic artery, Common hepatic artery.
The internal iliac artery is also called?
Hypogastric artery.
Where does the root of the aorta arise from?
Left ventricle of the heart.
What kind of flow resistance does the SMA have?
High resistance.
What does the phrenic artery supply?
Diaphragm.
What are clinical reasons to perform aortic exam?
Pulsatile mass, abdominal pain radiating to the back, abdominal bruit, hemodynamic compromise in the lower legs.
What is the most common cause of AAA?
Arteriosclerosis (97%).
Atherosclerosis is a type.
A true aneurysm involves?
All 3 layers of the vessel wall.
What are the two main types of AAA? Which is more common?
Fusiform (most common), Saccular.
Where do AAA usually begin?
Below renal arteries (infrarenal).
When will a patient with AAA need surgery?
If greater than 5 cm.
Difference between fusiform and saccular aneurysm?
Fusiform is a gradual dilation & can dilate on both sides; saccular is spherical (5-10 cm) outpouching, partially or completely filled with thrombus.
Where does a berry aneurysm occur?
In the brain (1-1.5 cm).
Risk factors for AAA?
Tobacco, Hypertension, Vascular disease, COPD, Family history.
What are the 3 most common symptoms of AAA?
Palpable abdominal mass, Back pain, Drop in hematocrit.
At what point is the aorta considered aneurysmal?
3 cm.
How do you measure the aorta?
Outer wall to outer wall.
Where does thrombus usually occur in the aorta?
Along anterior or anterolateral wall.
What is ectatic aorta?
Bulgy in areas but diameter is less than 3 cm.
Internal echoes in the aorta can indicate?
Thrombus.
What are S/S of a ruptured AAA?
Excruciating abdominal pain, shock, expanding abdominal mass.
What is a pseudoaneurysm?
A false aneurysm.
It’s a pulsatile hematoma that results from leakage of blood into soft tissues from punctured artery; occurs after procedure & common in the groin.
What kind of flow pattern do pseudoaneurysms have?
To & fro (bidirectional) flow pattern.
How do we repair pseudoaneurysms?
2 methods: Thrombin injection, Compression of neck.
What is an aortic dissection?
When the intima pulls away from the aortic wall.
Blood makes its way between the layers of the wall causing separation.
Where do aortic dissections usually occur?
Aortic arch (thoracic aorta) 90%.
What are the types of dissection? Which has a high mortality?
Type 1, Type 2 (Marfans), Type 3.
Type 1 & 2 have high mortality; Type 3 has better prognosis.
Marfan’s syndrome usually occurs at which part of AO?
Ascending AO.
What are some pseudo-pulsatile abdominal masses?
Enlarged lymph nodes (most common), retroperitoneal tumor/sarcoma, huge fibroid uterus, pancreatic cancer.
What is RPF?
Retroperitoneal Fibrosis.
Also called Ormond’s disease.
What is AVF? What causes AVF?
Arteriovenous Fistulas.
It’s an abnormal connection between an artery and a vein, usually secondary to trauma; can be complication to arteriosclerotic AAA.
What does RAS stand for?
Renal Artery Stenosis.
Splenic artery is tortuous & therefore can experience what in its waveform?
Spectral broadening.
What vessels come together to form the IVC?
Common iliac veins.
What are the major tributaries of the IVC?
Hepatic veins (right, middle, left), renal veins (left & right).
True or False? Portal system has no connection with systemic veins.
True.
The renal veins originate _______ to the renal arteries.
Anterior.
What are the largest tributaries of the IVC?
Hepatic veins.
Where do the hepatic veins originate?
Liver.
They drain blood from liver into the IVC.
How do the HV’s change in size as they travel to the IVC?
They increase in size.
The IVC runs ______ to the portal system.
Posterior.
Where is the dome of the liver located?
Superior, closest to diaphragm.
What vessels form the PV?
SMV, SV, IMC.
Where does the portal venous system carry blood from?
Intestines and spleen.
Which vessels do the ascending lumbar veins become and where do those vessels drain?
They are branches of the CIVs.
Superior to the diaphragm, they become the azygos vein (right) & hemiazygos (left) & both drain into the SVC.
What is the main tributary of the PV?
SMV.
Which vessels form the portal triad?
PV, CHA, CBD.
What are the two main findings in portal venous?
Portal vein hypertension, portal vein thrombus.
What is the biggest risk with thrombus in the IVC?
It can travel to the lungs and PE can occur.
What is RCC?
Renal cell carcinoma.
Most common primary kidney tumor (usually on right side).
What is an IVC filter? Where is it usually placed?
A ‘clot trap’ used to prevent thrombus from traveling into lungs.
Usually placed at iliac bifurcation.
What are potential complications of IVC filters?
It can migrate and perforate IVC, duodenum, aorta, ureter, hepatic vein.
What are the 5 specific sonographic findings of acute renal vein thrombosis?
- Dilated and echo-filled renal vein 2. Absence of intrarenal venous flow 3. An enlarged kidney 4. Hypoechoic renal parenchyma 5. Highly resistive renal artery waveform.
A single liver cell is called?
Hepatocyte.
The microscopic lobules of the liver =
Functional units.
Phagocytes are also called?
Macrophages.
The RLL should not measure out to be more than ____ cm.
17.
What part of the liver lies between the fossa of the IVC and ligamentum venosum?
The caudate lobe.
True or False? The caudate lobe can increase in size when the LLL or RLL decrease in size?
True.
What connects the umbilical vein to the IVC?
Ductus venosus.
What is a normal variant of the liver?
Reidel’s lobe.
It is when the RLL extends below the lower pole of RK (seen more in women).
Which part of the liver does not have peritoneal tissue?
The bare area—where the porta hepatis is—it is also a common location for abscess.
How do ligaments and fissures appear on ultrasound and why?
Appear echogenic or hyperechoic because of the presence of collagen & fat within and around structures.
The MLF divides the liver into?
Right and left (anterior RLL & medial LLL).
The falciform ligament divides the liver into?
Medial and lateral LLL.
The ligamentum teres runs within?
The falciform ligament.
What does the ligamentum venosum separate? What is this a remnant of?
Separates the caudate lobe from lateral LLL.
Remnant of umbilical vein.
Portal veins are ____-segmental.
Intra.
Portal veins have what kind of blood flow?
Hepatopetal.
What can cause the portal veins to have hepatofugal flow?
Portal vein hypertension.
How to tell the difference between portal veins and hepatic veins on ultrasound?
Portal veins have more echogenic walls than HVs.
What does power doppler look for?
Presence/absence of blood flow.
Hepatic veins are _____-segmental.
Inter.
Which hepatic vein is the largest? Which is the smallest?
Right- largest, Left- smallest.
Portal veins ____ the liver while hepatic veins ____ the liver.
Supply; drain.
What are the functions of the liver?
Metabolic regulation, secretes bile, stores iron and certain vitamins, detoxifies many drugs and poisons.
Difference between hepatic vs obstructive disease?
Hepatocellular disease: liver cells are the immediate problem, diffuse disease process, usually treated medically w/ supportive measures and drugs.
Obstructive disorders: bile excretion is blocked, usually treated surgically.
Which LFT is elevated with HCC?
AFP.
What is the best method for evaluating liver disease?
Biopsy.
Which lab test is more specific to liver?
ALT.
Which lab test can elevate mono, hepatitis, cirrhosis, obstructive jaundice & in cardiac and skeletal muscle damage?
LDH (lactate dehydrogenase).
When PTT is increased, what does that mean for blood?
It takes longer for blood to clot.
What does exophytic mean?
Mass hanging off organ.
Echogenicity from least to greatest:
Renal cortex, liver, spleen, pancreas, renal sinus.
