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Abdomen > Vascular > Flashcards

Vascular Flashcards

0
Q

Where does the abdominal aorta begin?

A

The diaphragm

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1
Q

What are the vessel layers?

A

Tunica Intima, tunica media, tunica adventitia

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2
Q

What are the branches of the Celiac axis?

Which is not seen in ultrasound?

A

Hepatic artery, left gastric artery, splenic artery.

Left gastric is not seen on ultrasound.

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3
Q

Banana peel sign refers to…

A

Renal arteries.

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4
Q

What are the branches of the abdominal aorta?

A

Celiac axis, SMA, rt & lt renal arteries, IMA, bifurcation rt & lt common iliac arteries.

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5
Q

Right renal artery courses

A

Posterior to IVC

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6
Q

What is atherosclerosis?

What are risk factors?

What could it cause?

How does it appear on ultrasound?

A

Alteration of vessel wall due to lipid deposits.

Smoking, HTN, diabetes, hyperlipidemia

May cause aneurysm

Vessel looks tortuous and may have Ca+

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7
Q

What is ectasia?

A

Vessel dilation (aorta >3cm)

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8
Q

What is an aneurysm?

What are clinical findings of an aneurysm?

What are the types of aneurysms?

Which type is the most common?

What is the most common location?

What is the most common cause of aneurysm?

What are the risk factors?

When are elective repairs performed?

A

Focal vessel enlargement,

pulsatile abdominal mass, may have bruit

Dumbell, bulbous, saccular, fusiform

Fusiform (has uniform dilation)

Inferior to the renal arteries

Atherosclerosis

Tobacco use, HTN, vasc disease, COPD, male, > 60 yrs, family hx

Aneurysms > 5.5cm

A true aneurysm involves all 3 layers of aorta.

A false aneurysm is a pseudoaneurysm, mc in groin from catheters inserted through common femoral artery during arteriographic procedures.

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9
Q

What are AAA rupture symptoms/findings?

What is the mortality rate with surgery on a ruptured aneurysm?

What happens if the AAA is 6-7cm?

US findings

A

Back pain, hypotension, falling hematocrit.

50%.

Rupture rate dramatically increases.

Aneurysm w. free fluid

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10
Q

What is dissection?

A

Tear in the intimal lining of the arterial wall.

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11
Q

What is the Standard and DeBakey classifications of dissection?

In what part of the aorta increases mortality rate with dissection?

Causes

Symptoms

US findings

A

Standard:
A-ascending aorta
B-not asc aorta

DeBakey:
I-entire aorta
II-asc aorta
III-desc aorta

Asc aorta inc mortality rate

Male, 40-60 yrs, HTN, pregnancy, aortic valve disease, CHD, Cushing’s syndrome, trauma, Marfan syndrome

Pain, n/v, paralysis, blind, coma, confusion, absent extremity pulse

Linear flap with motion. Acute or chronic (has clot in false lumen)

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12
Q

What is an aortic graft?

A

Used to repair an aneurysm. A guided wire inserted through femoral artery up to aorta.

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13
Q

IVC

A

Expands with inspiration. < 2 cm, terminates at rt atrium

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14
Q

Left renal vein courses

A

Anterior to aorta and posterior to SMA

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15
Q

Portal splenic confluence contains

A

Splenic vein, SMV, main portal vein

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16
Q

Mickey Mouse sign / Portal Triad

A

CBD (rt ear), MPV (face), HA (lt ear)

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17
Q

What is Budd Chiari syndrome?

A

Thrombosis of hepatic veins or IVC

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18
Q

What is portal vein HTN?

What are causes?

Signs/symptoms

US findings

A

Increase in portal venous pressure

Cirrhosis, hepatitis, ETOH abuse, PV thrombus, Budd Chiari, schistosomiasis

Ascites, gi bleed, dec renal function, dec coagulation

Portal vein diam >13mm, hepatofugal flow, patent umbilical vein, collaterals, ascites, splenomegaly, sm nodular liver

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19
Q

Portal vein thrombosis

A

Clot in PV, dec blood flow, low level echoes in PV

Echogenic material within lumen, inc PV diam, portosystemic collateral circulation, cavernous transformation

Filter placed in IVC to catch thrombosis before reaching the heart

20
Q

Hepatic veins

A

Right, middle, left

Pulsatile

21
Q

Arteries vs Veins

A

Arteries carry blood away from the heart. Arteries are pulsatile.

Veins carry blood to the heart. Veins expand with inspiration. Veins have a larger diameter. Veins have valves.

22
Q

What is vasa vasorum

A

Tiny arteries & veins that supply vessel wall

23
Q

Sections of Aorta

A

Root (3 cusp prevents back flow to heart), asc aorta, aortic arch (brachiocephalic, lt common carotid, lt subclavian), desc aorta, abdominal aorta (celiac trunk, SMA, renals, IMA)

24
Q

Size of aorta, level of iliac bif, iliac size.

A

Men 23 mm, women 19 mm

Bifurcates L4. Iliac diam < 1.2 cm

25
Q

What is mesenteric insufficiency?

Risk

Symptoms

US findings

A

Lack of blood flow to GI tract. Must ID 2 stenosis in either celiac, SMA, IMA, hep art.

Smoking, HTN, coronary artery disease, renal insufficiency, diabetes

Post prandial pain. Wt loss, epigastric bruit, n/v/d

High resistant blood flow after eating. Stenosis in 2 vessels.

26
Q

What is a major branch of the common hepatic artery?

A

Gastroduodenal artery

27
Q

What vessel passed anterior to the uncinate process of the pancreas?

A

SMV

28
Q

What artery changes from high to low resistant when a patient eats?

A

SMA

29
Q

IVC and hepatic vein enlargement wth a normal liver is due to

A

Right sides heart failure

30
Q

Name causes of prehepatic, intrahepatic, and posthepatic portal HTN

A

Pre: PV thrombus
Intra: cirrhosis, schistosomiasis
Post: Budd Chiari syndrome

31
Q

Renal vein thrombus

A

Renal Tumors, renal allografts, trauma, nephrotic syndrome, ivc or renal vein extrinsic compression

Dilated thrombosed renal vein, absent venous flow in kidney, enlg hypo kidney, high resistant renal artery

32
Q

RI =

A

(S-D) / S

33
Q

Arteriovenous fistula

A

Abnormal connection between artery and vein.

Artery will show low resistance and inc diastoli

Vein shows inc velocity, pulsatility, spectral broadening due to turbulence

34
Q

Placed in IVC to prevent thrombus from lower extremities from entering lungs.

A

IVC filter

US can look at filter location, detect thrombus in filter, IVC perforation with a concurrent hematoma

35
Q

Diaphragm crus is ___ to the aorta

A

Anterior

36
Q

Diaphragm crus is ____ to the celiac axis

A

Superior

37
Q

Diaphragm crus is ___ to the IVC

A

Posterior

38
Q

Diaphragm crus is ___ to the adrenal glands

A

Medial and posterior

39
Q

Left gonadal vein drains gonads into

A

Left renal vein then IVC

40
Q

Rt gonadal vein drains into

A

IVC

41
Q

What is the nutcracker syndrome

A

Obstruction of the left renal vein between the SMA and the aorta.

Dilated parenchymal side of lt renal vein when compared to the caval side. This documents extrinsic compression of left renal vein.

42
Q

Describe main lobar fissure

A

Imaginary line between gb fossa and IVC. Separates rt and lt lobe. Middle hepatic vein is a landmark.

43
Q

Pseudoaneurysm / false aneurysm

A

Trauma, walled off blood, MC in groin, from catheters

44
Q

Renal artery stenosis

A

Kidney < 9cm
Peak velocity > 100 cm/sec
Renal artery to aorta ratio > 3.5
Tardus Parvus wave of segmental renal artery

45
Q

IVC

A 
Rt & Lt suprarenal 
Rt & Lt renal
Rt & Lt gonadal
Inferior phrenic
Hepatic veins
Common iliac veins
46
Q

Aorta

A 
Celiac axis
Superior mesenteric artery 
Inferior mesenteric artery
Inferior phrenic artery
Suprarenal branch of inferior phrenic artery
Suprarenal branch of aorta
Suprarenal branch of renal artery
Left renal artery 
Gonadal artery
Common iliac artery
47
Q

Portal venous gas indicates

A

Bowel infarct in ulcerative colitis or necrotizing enterocolitis

Portal venous gas is seen within liver. Biliary gas is closer to the hilum.

48
Q

Lymphadenopathy “Mantel Sign”

A

Layered appearance over & around abd vessels

Abdomen (15 decks)

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