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DMST ABD 3 > Vascular Diseaes > Flashcards

Vascular Diseaes Flashcards

1
Q

In terms of abdominal vasculature, a variety of conditions can alter blood flow, what are they 5?

A
  1. Increase in vessel pressures
  2. Thrombosis/ Tumour invasion
  3. Athersclerosis
  4. Congenital abnormalities
  5. Aneurysms
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2
Q

Knowing normal blood patterns is what?

A

Key

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3
Q

Label the images in terms of resistance?

A
  1. Left is moderate resistance
  2. Right is high resistance
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4
Q

What is this waveform?

A

Low resistance

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5
Q

These are two waveforms in the SMA, what do these represent? (Prandial)

A
  1. Left: pre-prandial (High resistance)
  2. Right: Post prandial (low resistance)
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6
Q

What is the flow pattern in portal veins? 3 (heptodirection, plasticity, undulations)

A
  1. Hepatopetal
  2. Monophasic
  3. Slight undulations
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7
Q

What is the vascular waveforms in the hepatic veins? 2

A
  1. Phasic
  2. Pulsatile
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8
Q

What does phasic mean?

A

Influenced by respirations

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9
Q

What does pulsatile mean?

A

Influenced by cardiac cycle

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10
Q

What is being sampled here?

A

Hepatic veins

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11
Q

What is the vascular waveform of the IVC? 2

A
  1. Saw tooth pattern
  2. Respiratory changes
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12
Q

What does this image demonstrate? (What’s being sampled)

A

IVC waveform

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13
Q

What are the normal measurements of the Aorta? (Prox+distal)

A
  1. Proximal: ~ 2.0 - 2.5 cm
  2. Distally ~ 1.5cm
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14
Q

Due to the great variability in the size of the aorta from patient to patient, an aorta is considered aneurismal with what?

A

AP diameter of 3cm or greater

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15
Q

What are measurements of the IVC? 2

A
  1. Varies from 5-29mm
  2. Usually less than 25mm
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16
Q

What happens with the IVC when there is inspiration and suspended respiration?

A
  1. IVC decrease
  2. IVC increased
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17
Q

What are four indications for arterial assessment?

A
  1. Pulsatile abdominal mass
  2. Abdominal pain
  3. Abdominal Bruit
  4. Hemodynamic compromised lower limbs
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18
Q

What are 6 kinds of arterial diseases?

A
  1. Atherosclerosis
  2. Aneurysms
  3. Dissections
  4. Pseudo aneurysms
  5. A-V fistula
  6. Stenosis
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19
Q

What is arteriosclerosis?

A

Hardening of the arteries

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20
Q

What is a atheroma?

A

Lipid deposit in the arterial Intima

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21
Q

What is atherosclerosis?

A

Form of arteriosclerosis - large and medium arteries

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22
Q

What is plaque?

A

Platelets forming a cap over a fat deposit

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23
Q

Where are the lipid deposits in atheromatous disease?

A

The Intima

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24
Q

What does atherosclerosis lining altercations do?

A

Lining alterations provokes fibrosis and calcification

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25
Q

What risk factors is atherosclerosis associated with? 3 (what causes it)

A

Hypertension/ smoking/ diabetes

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26
Q

What causes an incidence increase with atherosclerosis?

A

Age

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27
Q

Which gender of individuals are affected with Atherosclerosis?

A

Males > Females

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28
Q

Label the image

A
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29
Q

What does this image demonstrate?

A

Atherosclerosis

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30
Q

Abdominal Aortic Aneurysms are what?

A

Weakening of aortic wall leading to focal dilatation

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31
Q

Which layers of the abdominal aorta are affected by Abdominal aortic aneurysm?

A

All three walls

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32
Q

What is the measurement needed for AAA?

A

3 cm or greater

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33
Q

What is ectasia in terms of AAA?

A

Slight widening of the aorta up to 3 cm

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34
Q

AAA occurs mainly where?

A

In the renal vessels

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35
Q

What are causes (predisposing factors) AAA? 5

A
  1. Atherosclerosis
  2. Syphilis
  3. Systemic infection
  4. Cystic medial necrosis
  5. Other disease (Marfan’s)
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36
Q

Who’s is at risk for AAA? 5

A
  1. Men >60 Y/O
  2. Smoking
  3. Hypertension
  4. Family history (1st degree)
  5. Hypercholesterolemia
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37
Q

What are S/S of AAA? 6

A
  1. Generally asymptomatic
  2. Palpable mass
  3. Incidental finding of X-ray
  4. Low back pain
  5. Abdominal pain
  6. Leg pain
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38
Q

What are two types of Abdominal Aneurysms? 2

A
  1. Fusiform
  2. Saccular
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39
Q

Label the images

A

A. Saccular
B. Fusiform

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40
Q

What is the sonographic appearance of AAA? 4

A
  1. Dilation of the aorta of 3 cm or greater
  2. Typical projection anterior and left
  3. Aortic wall irregularities
  4. Thrombus
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41
Q

What does the thrombus look like on AAA? What is it causes by? 3

A
  1. Medium to low level echoes
  2. Anterior and lateral walls
  3. Caused by slow flow, injury to the vessel altered blood constitutents
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42
Q

What can the thrombus result in with AAA?

A

Emboli

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43
Q

What does this image demonstrate?

A

AAA

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44
Q

Label the images

A
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45
Q

What are some characteristics of Iliac AAA? 2

A
  1. Often bilateral
  2. 2cm or greater
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46
Q

How many cases of aneurysms are related with Popliteal aneurysms? How big must they be?

A
  1. 25% of cases
  2. > 1cm
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47
Q

How do we document and measure AAAs? 2

A
  1. Outer to outer wall
  2. Measure perpendicular to the vessel
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48
Q

What does this image demonstrate?

A

How to measure the AAA

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49
Q

What do we document and Measure AAA? 6

A
  1. Length, width, and AP dimension
  2. Shape - fusiform or saccular
  3. Location in aorta - Infrarenal?
  4. Does it involve the renal or iliac arteries
  5. Describe the wall thrombus
  6. Flow pattern
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50
Q

Why do we need to follow up for abdominal AAA? What is the rate of growth?

A
  1. Rupture can occur but is size related
  2. Average rate of growth is 2-5 mm/year
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51
Q

What happens in terms of follow up if the AAA is increase 2-5 mm/year?

A

serial u/s

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52
Q

What is the Follow-Up like with AAAs that increase in size 10 mm/year

A

Surgery (aortic graft) recommended

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53
Q

If the AAA is 5-6 cm what is recommended in terms of follow up? 2

A
  1. Surgery recommended with good prognosis
  2. At 6 cm, surgery considered imperative
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54
Q

What is the 1 year survival rate if AAA is >7cm? What is the percentage of fatal rupture? What is suggested?

A
  1. 1 year survival 25%
  2. 75% risk of fatal rupture
  3. Surgery - aortic graft
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55
Q

What is the most common complication of AAA? 4

A
  1. stenosis/ occlusion- most common
  2. Rupture- most critical
  3. Dissection
  4. Thrombosis (distal embolism)
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56
Q

What happens if there is an AAA rupture? What is the mortality rate? What is the operative mortality rate?

A
  1. Surgical emergency
  2. Mortality rate: >50%
  3. Operative mortality rate >40-60%
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57
Q

What are S/S’s or AAA rupture? 3

A
  1. Pain
  2. Shock
  3. Expanding abdominal mass
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58
Q

What does AAA ruptures look like on U/S? 3

A
  1. Free fluid in abdomen
  2. Complex fluid collection
  3. Compression/ displacement of structures
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59
Q

What are some treatment options for AAA? 2

A
  1. Traditional graft
  2. Endovascular aortic stent
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60
Q

What are traditional grafts for AAA? 3

A
  1. Surgical bypass graft
  2. Open repair
  3. Flexible graft material (Teflon or dacron)
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61
Q

How invasive is a endovascular aortic AAA stent? How do they work?

A
  1. Less invasive
  2. Stent inserted and balloned out
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62
Q

What does this image demonstrate?

A

Traditional grafts of AAA ruptures

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63
Q

What does this image demonstrate?

A

AAA rupture post graft

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64
Q

What are some complications of surgical repairs with AAA? 7

A
  1. Fluid collections
  2. Hematomas
  3. Seromas
  4. Abscesses
  5. Pseudoaneurysms
  6. Stenosis
  7. Endo leaks (with Endovascular repairs only)
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65
Q

What is a Spanchnic (mesenteric)?

A

Aneurysm in the celiac, SMA, IMA

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66
Q

How common are splanchnic?

A

Rare but life threatening

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67
Q

What is most commonly affected with splanchnic?

A

Splenic most commonly affected

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68
Q

What is the 2nd most affected with splanchnic?

A

Hepatic

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69
Q

What is the least common structure affected by Splanchnic?

A

SMA

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70
Q

What are causes of Splanchnic? 4

A
  1. Congenital
  2. Atherosclerosis
  3. Myocotic
  4. Inflammatory
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71
Q

What are renal aortic branch aneurysm located?

A

Extra renal location

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72
Q

What are causes of Renal Aortic branch aneurysms? 2

A
  1. Atherosclerosis
  2. Polyarteritis
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73
Q

What is the S/S of renal Aortic branch Aneurysms? 3

A
  1. Palpable mass
  2. Hypertension
  3. Hematuria
74
Q

What does Renal Aortic branch aneurysms look like on U/S? What does Doppler demonstrate?

A
  1. Anechoic mass connected to arteries
  2. Doppler demonstrates arterial pulsations
75
Q

Iliac aneurysms affect which demographic?

A

Older men

76
Q

What are some characteristics of Iliac aneurysms? 2

A
  1. Commonly bilateral
  2. Asymptomatic
77
Q

What disorders are iliac aneurysms associated with?

A

AAA and popliteal aneurysms

78
Q

What might Iliac Aneurysms cause?

A

Hydronephrosis

79
Q

How common are mycotic aneurysms?

A
  1. Rare
80
Q

What happens with mycotic aneurysms?

A

Bacteria or fungus invades arterial walls

81
Q

Mycotic aneurysms are associated with aneurysm shape?

A

Saccular aneurysms

82
Q

How easy is it to diagnose mycotic aneurysms on U/S?

A

Difficult alone

83
Q

How common are inflammatory aneurysms?

A

Uncommon

84
Q

What are inflammatory aneurysms?

A

Fibrotic reaction around aneurysms

85
Q

What cavity does inflammatory aneurysms involve?

A

Retroperitoneum

86
Q

What’s the morbidity/ mortality rate with inflammatory aneurysms?

A

High morbidity/ mortality

87
Q

Inflammatory aneurysms are adherent to what? 4 (what groups)

A
  1. Bowel
  2. Ureter
  3. Iliac veins
  4. IVC
88
Q

What does Inflammatory aneurysms look like on U/S?

A

Hypoechoic mantle around aneurysms

89
Q

What are aortic dissections?

A

Intimal tear (and in some cases, a portion of the media)

90
Q

What is created with Aortic dissection?

A

False lumen created: blood flows through vessel wall layers

91
Q

What is aortic dissection related to? Where does it begin?

A

Hypertension and begins in the thorax

92
Q

What symptom does aortic dissection commonly present with?

A

Chest pain

93
Q

What are three types of aortic dissection?

A
  1. Involving Ao arch and moves down Aorta
  2. Marfan’s involves ascending Ao only
  3. Dissection of descending Ao after origin or left subclavian -Most common
94
Q

Label the image

A
95
Q

What are sonographic appearances of aortic dissections? What does Doppler demonstrate?

A
  1. Thin echogenicity within arterial lumen moves with cardiac cycle
  2. Doppler demonstrates blood flow on both sides of flap
96
Q

What does this image demonstrate?

A

Aortic dissection

97
Q

What is Pseudoaneurysm (false)? 2

A
  1. When blood escapes through a tear in wall
  2. Blood contained by surrounding tissue
98
Q

What are causes of pseudoaneurysms? 2

A
  1. Failed graft
  2. Trauma
99
Q

What are sonographic descriptors of Pseudoaneurysms? 5

A
  1. Round or oval protuberance
  2. Blood circulate through in systole
  3. Pulsatile entry jet
  4. Variable waveform
  5. Always identify the neck of the mass
100
Q

What is this an image of?

A

Pseudoaneurysm

101
Q

What is a AV fistula?

A

Abnormal communication between an artery and vein

102
Q

What is a AV fistula?

A

Abnormal communication between an artery and vein

103
Q

How does blood move in a AV fistula?

A

From high pressure to low pressure

104
Q

What is the causes AV fistulas? 2

A
  1. Truama
  2. Complication to aortic aneurysm
105
Q

What is the signs and symptoms of AV fistulas? 3

A
  1. Low back and abdominal pain
  2. Altered hemodynamics
  3. Swelling of lower extremities, dilated veins
106
Q

What AV fistulas look like Sonographically 5

A
  1. Markedly dilated IVC
  2. Pulsation
  3. Irregular wave form
  4. High velocities
  5. Reduced wave form
107
Q

What causes vascular stenosis? 2

A
  1. Varying degrees
  2. Atherosclerotic plaque
108
Q

What are common 2D and doppler findings of vascular stenosis? 4

A
  1. Narrowed lumen
  2. Post- stenotic dilation
  3. At stenosis- increased velocities
  4. Downstream changes
109
Q

What is renal artery stenosis associated with? 2

A
  1. Uncontrollable hypertension
  2. Decreased glomerular filtration rate
110
Q

What does renal artery stenosis cause? 2

A
  1. Ischemic renal damage
  2. Atherosclerotic plaque
111
Q

Where is renal artery stenosis commonly seen?

A

Origin from aorta or within first 2 cm

112
Q

When assessing the IVC, what do we look for? 4

A
  1. Changes with respiration
  2. Compressibility
  3. Echo free lumen
  4. patency
113
Q

In terms of a dilated IVC, calibre increases where?

A

Below point of obstruction

114
Q

What is a dilated IVC associated with? 8

A
  1. Right ventricular failure
  2. Pulmonary hypertension
  3. Pericardial tamponade
  4. Atrial tumor
  5. AV fistulas
  6. Congenital IVC valve
  7. Extrinsic compression
  8. Atherosclerotic heart disease
115
Q

What are s/s for dilated IVCs? 4

A
  1. Abdominal pain
  2. Ascites
  3. Hepatomegaly
  4. Lower extremity edema
116
Q

What are IVC tumors? 3 (what kinds)

A
  1. Primary
  2. Metastatic
  3. Extension
117
Q

What S/S does IVC tumor present with? 3

A
  1. Leg edema
  2. Ascites
  3. Abdominal pain
118
Q

How common are primary IVC tumors? What is an example?

A
  1. Uncommon
  2. Leiomyoma/ leiomyosarcoma
119
Q

Where does metastatic IVC tumors most commonly present?

A

RCC

120
Q

What is the U/S appearance of IVC tumours? 4

A
  1. Intraluminal echogenic foci
  2. Could be isoechoic
  3. Calibre of IVC increased
  4. Loss of respiratory changes
121
Q

What is the prognosis of IVC thrombosis?

A

Life threatening

122
Q

What is the most common abnormality of the IVC?

A

IVC thrombosis

123
Q

IVC thrombosis can spread from where?

A

Another vein

124
Q

What does IVC thrombosis look like on u/s? 3

A
  1. Intraluminal filling defect, expanding the vessel
  2. Echogenicity of thrombus depends on age
  3. Respiratory changes decreased or absent
125
Q

What are s/s of IVC thrombosis ? 5

A
  1. Leg edema
  2. Low back pain
  3. GI complaints
  4. Enlarged liver
  5. Ascites
126
Q

What does colour doppler show for IVC thrombosis? 2

A
  1. No flow to the region of the thrombus
  2. IVC filters may be used for treatment
127
Q

Renal vein thrombosis presents how? 2 (Think about how it affects infants and adults)

A
  1. As a serious complication in dehydrated or septic infants
  2. In adults, a result of: shock, renal tumors, renal transplants or trauma
128
Q

What is renal vein thrombosis associated with?

A

Diabetes and high blood pressure

129
Q

What are renal vein thrombosis s/s? 3

A
  1. Flank pain/mass
  2. Hematuria
  3. Proteinuria
130
Q

How does renal vein thrombosis appear on u/s? 4

A
  1. Enlarged kidney, hypoechoic
  2. Dilated renal vein
  3. Filling defect of variable echogenicity
  4. Decreased or absent venou signal
131
Q

Congenital abnormalities of the IVC most commonly occurs where?

A

At or below the level of the renal veins

132
Q

What are the most common congenital abnormalities of the IVC?

A

Duplication and transposition

133
Q

In terms of the congenital abnormality of the IVC, azygous or hemiazygous continuation occurs where?

A

When the hepatic segment of the IVC fails to develop

134
Q

What is hepatic congestion?

A

Passive edema of the liver secondary to vascular congestion

135
Q

What is hepatic congestion related to?

A

heart failure

136
Q

What causes hepatic congestion? (think blood flow)

A

Blood flow to the right side of the heart is impaired

137
Q

What is the sonographic appearance of acute hepatic congestion? 4

A
  1. Enlarged liver
  2. IVC dilated/ no respiratory change
  3. Hepatic veins - highly pulsatile/ flow reversal
  4. Portal vein flow - pulsatile
138
Q

What is the sonographic appearance of a chronic hepatic congestion? 2

A
  1. Shrunken liver/ hepatic veins distended
  2. LFTs- possible altered
139
Q

What is portal hypertension due to?

A

Increase in portal venous pressures

140
Q

What are two major types of portal hypertension?

A
  1. Presinusoidal
  2. Intrahepatic
141
Q

What does extrahepatic preinusoidal consist of? 2

A
  1. Portal vein/ splenic vein thrombus
  2. Ascites, splenomegaly, Varices
142
Q

What are possible causes of presinusoidal? 6

A
  1. Malignancy
  2. Infection
  3. Inflammation
  4. Trauma
  5. Splenectomy
  6. Hypercoagulable states
143
Q

What is intrahepatic portal hypertension caused by? 2

A

Diseases affecting the portal zones, such as
1. Schistosmiasis
2. Primary bilary cirrhosis

144
Q

What is the most common cause of intrahepatic portal hypertension?

A

Cirrhosis

145
Q

In terms of intrahepatic portal hypertension, when the normal parenchyma is replaced, what happens as a result in terms of flow?

A

Increased resistance to PV flow and obstruction to HV outflow

146
Q

What are some things we see with intrahepatic portal hypertension? 3 (things that indicate)

A
  1. Ascites
  2. Splenomegaly
  3. Collaterals
147
Q

What is the sonographic appearance of portal hypertension? 6

A
  1. Dilated PV in the early stages
  2. Collateral flow
  3. Patent umbilical vein/ coronary vein
  4. Ascites
  5. Splenomegaly
  6. Monophasic&raquo_space;> Biphasic&raquo_space;» Hepatofugal
148
Q

What are examples of some collaterals? 5

A
  1. Gastroesophageal
  2. Paraumbilical
  3. Splenorenal/ gastrorenal
  4. Intestinal
  5. Hemorrhoidal
149
Q

What are some treatment options for portal hypertension? 3

A
  1. Portosystemic shunts
  2. Decompress the PV system
  3. Shunts can be placed surgically or percutaneously
150
Q

What does portosystemic shunts do?

A

Shunts venous blood flow from the congested venous system to a systemic vein

151
Q

What does TIPS stand for?

A

Transjugular intrahepatic portosystemic shunt

152
Q

How is TIPS inserted?

A
  1. Inserted percutaneously via jugular vein
  2. Inserted through HV to PV
153
Q

How does blood flow with TIPS?

A

Blood then flows from portal venous system into the hepatic venous system

154
Q

What is portal vein thrombosis?

A

Clot in the portal venous system

155
Q

What are causes of portal vein thrombosis? 4

A
  1. Malignancy
  2. Infection/ inflammation
  3. Trauma
  4. Splenectomy
156
Q

Why is colour doppler important for portal vein thrombosis? 2

A
  1. Useful in distinguishing benign and malignant thrombi
  2. Acute thrombus may be relatively anechoic - and can be overlooed
157
Q

Portal vein thrombus can result in what?

A

Cavernous transformation

158
Q

How common is Budd- Chiari syndrome?

A

Rare

159
Q

What is Budd-Chiari syndrome?

A

Obstruction of the hepatic veins (varying degree)

160
Q

In terms of Budd chari, besides the Hepatic veins, what else can be involved?

A

IVC

161
Q

What are causes of Budd- Chiari syndrome?4

A
  1. Coagulation/ congenital abnormalities
  2. Trauma
  3. Oral congraceptives
  4. Tumor invasion (HCC)
162
Q

What is the sonographic appearance of Budd-Chiari? 7

A
  1. Stage dependent
  2. Enlargement liver (acute)
  3. Ascites
  4. Poor visualization of hepatic veins
  5. IVC thrombus
  6. Caudate lobe enlarged/ hypoechoic
  7. Hepatic venous flow absent/ reversed
163
Q

What are s/s of Bud-chiari? 3

A
  1. RUQ pain
  2. Hepatomegaly
  3. Occasionally splenomegaly
164
Q

What are infarctions?

A
  1. Sudden interruption of blood supply
  2. May lead to necrosis (tissue death)
165
Q

Splenic infarct is a common cause of what?

A

Focal splenic lesion

166
Q

What is splenic infarct caused by?

A

Occlusion of splenic artery

167
Q

Splenic infarcts presents with sudden what?

A

Onset of LUQ pain

168
Q

Splenic infarct comes with a variety of underlying causes such as what?

A

Sickle cell anemia

169
Q

What does splenic infarcts look like sonographically? 2

A
  1. Hypoechoic, wedge, shaped/ round area
  2. Echogenicity changes with time (Becomes more hyperechoic)
170
Q

What does renal infarctions look like?4

A
  1. Segmental or diffuse
  2. Time dependant
  3. Early: hypoechoic
  4. Resolving: echogenic
171
Q

With renal infarctions how are renal infarctions?

A

Often remains normal

172
Q

What does this image represent?

A

Dilated IVC

173
Q

What does this image represent?

A

IVC thrombus

174
Q

What does this image represent?

A

IVC thrombus in 2D

175
Q

What does this demonstrate?

A
176
Q

Label the image

A
177
Q

What does this image describe?

A

TIPS

178
Q

Label the image

A
  1. Cavernous transformation
  2. Thrombus dilated
179
Q

What does this image represent?

A

Splenic infarct

180
Q
A

DMST ABD 3 (11 decks)

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