Quiz 6 Flashcards
where does the aorta enter the abdominal cavity?
hiatus in the diaphragm at the level of T12
where does the aorta run?
- vertically anterior to the spine
- slightly left of midline
what waveform does the aorta exhibit above the renals?
monophasic
what waveform does the aorta exhibit below the renals?
triphasic
where does the aorta bifurcate?
L4 into left and right common illiac arteries
what do the internal illiacs supply?
organs in the pelvis
what do the external illiacs supply?
blood to lower extremeties
what waveform do the iliac arteries exhibit?
high resistant
triphasic waveform
what do the measurements of the aorta do as you go more inferior?
decrease in size
what is the first visceral branch of the aorta?
celiac axis or trunk
how long is the celiac trunk?
2-3 cm long
what does the celiac trunk trifurcate into?
- common hepatic artery
- left gastric artery
- splenic artery
what waveform does the celiac trunk exhibit?
monophasic
what does the common hepatic artery supply?
liver with oxygenated blood
what is a landmark for the anterolateral aspect of pancreas head?
Gastroduodenal artery (GDA)
after the GDA, what does it become?
proper hepatic artery
where does the common hepatic artery course?
- anterior to portal vein
- medial to CBD
what does the common hepatic artery branch into?
right, left, and middle hepatic arteries
what waveform does the common hepatic artery exhibit?
monophasic waveform
which vessel is tortous?
splenic artery
how many branches does the splenic artery branch into?
6 branches
what waveform does the splenic artery exhibit?
monophasic waveform
where does the SMA arise?
anterior to aorta 1 cm inferior to celiac trunk
where does the SMA run to the pancreas?
posterior to body of pancreas
what does the SMA supply?
colon
what waveform does the SMA exhibit?
- high resistance when fasting
- low resistant monophasic post prandial
where does the RRA arise from the aorta and where does it run?
anteriolateral and more superior than the left and runs posterior to IVC as it courses inferiorly
where does the LRA arise from the aorta and where does it run?
left lateral aspect of aorta and follows posterior lateral course
where do the gonadal arteries arise from the aorta?
-anterior aspect
-inferior to renal arteries
(not visualized on US)
what does the IMA supply?
some of colon and most of small intestine
not usually seen on US
where do the lumbar arteries arise off the aorta?
laterally from the right and left side of the aorta and supplies the lumbar region
where is the confluence of the common illiac veins to form the IVC?
L4
where does the IVC lie in the body?
slightly right
what is the function of the IVC?
carries deoxygenated blood into the right atrium of the heart
when does the IVC increase in size?
respiration
when does the IVC decrease in size?
decease with the valsalva maneuver
what type of waveform is the IVC?
phasic waveform
where do the right gonadal veins drain?
directly into the IVC below renal veins
where do the left gonadal veins drain?
drains into the left renal vein
which renal vein is longer?
left renal vein
where is the RRV located in relation to the RRA?
RRV is anterior
what is the course of the LRV?
follows a course anterior to the aorta and posterior to SMA before entering the IVC
what are the last tributaries prior to entering the Rt atrium?
hepatic veins
what is the waveform of the hepatic veins?
exhibit a pulsatile, phasic flow pattern that is reflective of the heart motion and respiration
what veins are apart of the portal venous system?
- splenic vein
- IMV
- SMV
- MPV
- Intrahepatic portal veins
where does the splenic vein run?
posterior surface of the body and tail of pancreas
what does the IMV drain?
small intestine and some colon
what does the SMV drain?
colon and some small intestine
where is the portal confluence formed?
posterior to the pancreas neck
what waveform does the portal vein exhibit?
low resistant monophasic waveform
what walls are more echogenic than hepatic veins?
intrahepatic portals because of collagen in walls
in the resting state what waveform do the peripheral vessels display?
high resistant triphasic flow
what is the direction of flow in the hepatic artery?
hepatopedal
what waveforms do hepatic arteries demonstrate?
low resistance and high diastolic flow velocities
what is normal hepatic arterial PSV is a fasting adult?
30-40 cm/s
what is the normal hepatic arterial EDV in a fasting adult?
10-15 cm/s
where may a replaces right hepatic artery arise from?
SMA
what is resistive index?
measure of pulsatile blood flow that reflects resistance to blood flow paused distal to site of meaasurement
what is used for hepatic arterial evaluation?
RI (PSV-EDV/PSV)
what is the usual RI in normal HA and post transplant individuals?
0.55-0.8
when is arterial RI most often assessed?
during evaluation of a liver transplant
when does the RI increase?
diastolic flow decreases and absent or reversed diastolic flow (RI of 1)
when are hepatic arterial complications significant?
post liver transplant patients
where does the biliary tree derive its blood supply from after transplantation?
hepatic arteries
what can hepatic arterial complications lead to after transplantation?
- biliary ischemia
- biliary strictures
- necrosis
- abscesses
- allographt failure
where does RLHA arise from?
left gastric artery
where does the RRHA arise from?
SMA
which hepatic artery is more common?
replaced right hepatic artery
where does the RRHA travel?
posterior to the PV
what does the celiac axis supply?
liver
spleen
stomach
what is the only major artery that nourishes the abdominal digestive organs that does not have a similarly named vein?
celiac axis
what is the normal velocity peak systolic waveform in celiac axis?
118-200 cm/s
what is the normal end diastolic waveform in the celiac axis?
3-75 cm/s
what is the celiac artery flow pattern?
sharp upstroke
monophasic waveform
left gastric artery branches
- esophageal branch
- stomach branch
common hepatic artery branches
- proper hepatic artery
- right gastric artery
- GDA
splenic artery branches
- dorsal pancreatic artery
- short gastric arteries
- left gastro-omental artery
- greater pancreatic artery
what is the waveform of the vena cava?
varies according to the specific segment sampled
what is the flow in the proximal inferior vena cava influenced by?
influenced by the activity of the right atrium and shows back-pressure changes identical to those seen in hepatic venous flow
what is the flow in the distal inferior vena cava influenced by?
cardiac activity has a lesser effect on flow velocities and variations in thoracic or abdominal pressure cause greater variability in forward flow
what should the diameter of the vena cava not exceed?
2.5 cm
where is the body do the hepatic veins converge into the IVC?
just below the diaphragm
what do the hepatic veins drain?
all the liver except the caudate lobe
pulsations of the right atrium are transmitted directly where?
into the inferior vena cava and hepatic veins
do the IVC and hepatic veins contain valves?
no
what is the normal hepatic vein waveform?
its undulating and mirrors motion of the right heart
when may the hepatic veins dialate?
in the even of right heart failure cause congestion within the liver
what does the waveform of hepatic veins look like?
a “W”
what is the larger first pulse below the baseline in a hepatic vein?
ventricular systole
what is the smaller second pulse below the baseline in a hepatic vein?
ventricular diastole
what is the short pulse above the baseline in a hepatic vein?
atrial contraction
how much does the PV supply the incoming blood to the liver?
70%
what is the normal blood flow velocity in the PV?
13-23 cm/s (average 18cm/s)
flow velocity in PV is somewhat _______
phasic because of rocking motion of the liver caused by motion of heart moves the PV under doppler SV or because of respiration
if there is reversal of flow (hepatifugal) flow of the portal vein, what could this mean?
portal hypertension
what is the normal measurement of the PV?
under 13mm in diameter
otherwise it suggests portal hypertension
where is slight respiration variation common?
splenic vein
what is a normal diameter of the splenic vein?
under 10 mm
otherwise it suggests porta hypertension
what does reversal of blood flow suggest with the splenic vein?
advanced portal hypertension
sinistral
splenic vein thrombosis -indicating it is left sided
what is cavernous transformation?
acute or chronic hepatocellular disease can block the flow of blood throughout the liver causing it to back up into the hepatic portal circulation
what occurs because of cavernous transformation?
- blood pressure in the hepatic circulation to increase (portal hypertension)
- thrombus forms in the portal vein due to stasis
what relives pressure for cavernous transformation?
collateral veins are formed that connect to the systemic veins, bypassing the thrombus (known as varicose veins)
where is varicose veins common?
- esophagus
- stomach
- rectum
what could happen if a varicose vein ruptures?
cause massive bleeding that may result in dealth
how much blood is filtered through the kidneys?
up to a third of total cardiac output
where is the renal artery located in relation to the renal vein?
renal artery above the renal vein
what are the most common renovascular anomaly
supernumerary renal arteries (two or more arteries to a single kidney)
what is the normal renal artery waveform?
rapid upstroke in systole with continuous forward flow in diastole
- low resistant
- monophasic
what is the normal PSV is renal arteries?
under 150-180 cm/s
what is the RI of renal arteries?
under 0.7
talking about renal arteries and inside the kidneys, what happens to EDV and PSV?
PSV and EDV is lower within the kidney
what is the RI with interlobar and arcuate arteries?
0.4-0.7 RI
