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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
What risk factors is atherosclerosis associated with? 3 (what causes it)
Hypertension/ smoking/ diabetes
26
What natural factor causes an incidence increase with atherosclerosis?
Age
27
Which gender of individuals are affected with Atherosclerosis?
Males > Females
28
Label the image
29
What does this image demonstrate?
Atherosclerosis
30
Abdominal Aortic Aneurysms are what?
Weakening of aortic wall leading to focal dilatation
31
Which layers of the abdominal aorta are affected by Abdominal aortic aneurysm?
All three walls
32
What is the measurement needed for AAA?
3 cm or greater
33
What is ectasia in terms of AAA?
Slight widening of the aorta up to 3 cm
34
AAA occurs mainly where?
In the renal vessels
35
What are causes (predisposing factors) AAA? 5 (conditions that lead to AAA)
1. Atherosclerosis 2. Syphilis 3. Systemic infection 4. Cystic medial necrosis 5. Other disease (Marfan’s)
36
Who’s is at risk for AAA? 5
1. Men >60 Y/O 2. Smoking 3. Hypertension 4. Family history (1st degree) 5. Hypercholesterolemia
37
What are S/S of AAA? 6
1. Generally asymptomatic 2. Palpable mass 3. Incidental finding of X-ray 4. Low back pain 5. Abdominal pain 6. Leg pain
38
What are two types of Abdominal Aneurysms? 2
1. Fusiform 2. Saccular
39
Label the images
A. Saccular B. Fusiform
40
What is the sonographic appearance of AAA? 4
1. **Dilation of the aorta of 3 cm or greater** 2. Typical projection anterior and left 3. Aortic wall irregularities 4. Thrombus
41
What does the thrombus look like on AAA? What is it causes by? 3
1. Medium to low level echoes 2. Anterior and lateral walls 3. Caused by slow flow, injury to the vessel altered blood constitutents
42
What can the thrombus result in with AAA?
Emboli
43
What does this image demonstrate?
AAA
44
Label the images
45
What are some characteristics of Iliac AAA? 2
1. Often bilateral 2. 2cm or greater
46
How many cases of aneurysms are related with Popliteal aneurysms? How big must they be?
1. 25% of cases 2. >1cm
47
How do we document and measure AAAs? 2
1. Outer to outer wall 2. Measure perpendicular to the vessel
48
What does this image demonstrate?
How to measure the AAA
49
What do we document and Measure AAA? 6
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
50
Why do we need to follow up for abdominal AAA? What is the rate of growth?
1. Rupture can occur but is size related 2. Average rate of growth is 2-5 mm/year
51
What happens in terms of follow up if the AAA is increase 2-5 mm/year?
serial u/s
52
What is the Follow-Up like with AAAs that increase in size 10 mm/year? (What is recommended)
Surgery (aortic graft) recommended
53
If the AAA is 5-6 cm what is recommended in terms of follow up? 2
1. Surgery recommended with good prognosis 2. At 6 cm, surgery considered imperative
54
What is the 1 year survival rate if AAA is >7cm? What is the percentage of fatal rupture? What is suggested?
1. 1 year survival 25% 2. 75% risk of fatal rupture 3. Surgery - aortic graft
55
What is the most common complication of AAA? 4
1. **stenosis/ occlusion- most common** 2. Rupture- most critical 3. Dissection 4. Thrombosis (distal embolism)
56
What happens if there is an AAA rupture? What is the mortality rate? What is the operative mortality rate?
1. Surgical emergency 2. Mortality rate: >50% 3. Operative mortality rate >40-60%
57
What are S/S’s or AAA rupture? 3
1. Pain 2. Shock 3. Expanding abdominal mass
58
What does AAA ruptures look like on U/S? 3
1. Free fluid in abdomen 2. Complex fluid collection 3. Compression/ displacement of structures
59
What are some treatment options for AAA? 2
1. Traditional graft 2. Endovascular aortic stent
60
What are traditional grafts for AAA? 3
1. Surgical bypass graft 2. Open repair 3. Flexible graft material (Teflon or dacron)
61
How invasive is a endovascular aortic AAA stent? How do they work?
1. Less invasive 2. Stent inserted and balloned out
62
What does this image demonstrate?
Traditional grafts of AAA ruptures
63
What does this image demonstrate?
AAA rupture post graft
64
What are some complications of surgical repairs with AAA? 7
1. Fluid collections 2. Hematomas 3. Seromas 4. Abscesses 5. Pseudoaneurysms 6. Stenosis 7. Endo leaks (with Endovascular repairs only)
65
What is a Spanchnic (mesenteric)?
Aneurysm in the celiac, SMA, IMA
66
How common are splanchnic?
Rare but life threatening
67
What organ is most commonly affected with splanchnic?
Splenic most commonly affected
68
What organ is the 2nd most affected with splanchnic?
Hepatic
69
What is the least common structure affected by Splanchnic?
SMA
70
What are causes of Splanchnic? 4
1. Congenital 2. Atherosclerosis 3. Myocotic 4. Inflammatory
71
Where are renal aortic branch aneurysm located?
Extra renal location
72
What are causes of Renal Aortic branch aneurysms? 2
1. Atherosclerosis 2. Polyarteritis
73
What is the S/S of renal Aortic branch Aneurysms? 3
1. Palpable mass 2. Hypertension 3. Hematuria
74
What does Renal Aortic branch aneurysms look like on U/S? What does Doppler demonstrate?
1. Anechoic mass connected to arteries 2. Doppler demonstrates arterial pulsations
75
Iliac aneurysms affect which demographic?
Older men
76
What are some characteristics of Iliac aneurysms? 2 (s/s and which side affected)
1. Commonly bilateral 2. Asymptomatic
77
What disorders are iliac aneurysms associated with? 2
1. AAA 2. Popliteal aneurysms
78
What symptom might Iliac Aneurysms cause?
Hydronephrosis
79
How common are mycotic aneurysms?
1. Rare
80
What happens with mycotic aneurysms?
Bacteria or fungus invades arterial walls
81
Mycotic aneurysms are associated with aneurysm shape?
Saccular aneurysms
82
How easy is it to diagnose mycotic aneurysms on U/S?
Difficult alone
83
How common are inflammatory aneurysms?
Uncommon
84
What are inflammatory aneurysms?
Fibrotic reaction around aneurysms
85
What cavity does inflammatory aneurysms involve?
Retroperitoneum
86
What’s the morbidity/ mortality rate with inflammatory aneurysms?
High morbidity/ mortality
87
Inflammatory aneurysms are adherent to what? 4 (what organ groups)
1. Bowel 2. Ureter 3. Iliac veins 4. IVC
88
What does Inflammatory aneurysms look like on U/S?
Hypoechoic mantle around aneurysms
89
What are aortic dissections?
Intimal tear (and in some cases, a portion of the media)
90
What is created with Aortic dissection?
False lumen created: blood flows through vessel wall layers
91
What is a s/s is aortic dissection related to? Where does it begin?
1. Hypertension 2. Begins in the thorax
92
What s/s does aortic dissection commonly present with?
Chest pain
93
What are three types of aortic dissection?
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
Label the image
95
What are sonographic appearances of aortic dissections? What does Doppler demonstrate?
1. Thin echogenicity within arterial lumen moves with cardiac cycle 2. Doppler demonstrates blood flow on both sides of flap
96
What does this image demonstrate?
Aortic dissection
97
What is Pseudoaneurysm (false)? 2
1. When blood escapes through a tear in wall 2. Blood contained by surrounding tissue
98
What are causes of pseudoaneurysms? 2
1. Failed graft 2. Trauma
99
What are sonographic descriptors of Pseudoaneurysms? 5
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
What is this an image of?
Pseudoaneurysm
101
What is a AV fistula?
Abnormal communication between an artery and vein
102
What is a AV fistula?
Abnormal communication between an artery and vein
103
How does blood move in a AV fistula?
From high pressure to low pressure
104
What is the causes AV fistulas? 2
1. Truama 2. Complication to aortic aneurysm
105
What is the signs and symptoms of AV fistulas? 3
1. Low back and abdominal pain 2. Altered hemodynamics 3. Swelling of lower extremities, dilated veins
106
What AV fistulas look like Sonographically 5
1. Markedly dilated IVC 2. Pulsation 3. Irregular wave form 4. High velocities 5. Reduced wave form
107
What causes vascular stenosis? 2
1. Varying degrees 2. Atherosclerotic plaque
108
What are common 2D and doppler findings of vascular stenosis? 4
1. Narrowed lumen 2. Post- stenotic dilation 3. At stenosis- increased velocities 4. Downstream changes
109
What is renal artery stenosis associated with? 2
1. Uncontrollable hypertension 2. Decreased glomerular filtration rate
110
What does renal artery stenosis cause? 2
1. Ischemic renal damage 2. Atherosclerotic plaque
111
Where is renal artery stenosis commonly seen?
Origin from aorta or within first 2 cm
112
When assessing the IVC, what do we look for? 4
1. Changes with respiration 2. Compressibility 3. Echo free lumen 4. **patency**
113
In terms of a dilated IVC, calibre increases where?
Below point of obstruction
114
What is a dilated IVC associated with? 8
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
What are s/s for dilated IVCs? 4 (think about what causes it and what it leads to)
1. Abdominal pain 2. Ascites 3. Hepatomegaly 4. Lower extremity edema
116
What are IVC tumors? 3 (what kinds)
1. Primary 2. Metastatic 3. Extension
117
What S/S does IVC tumor present with? 3
1. Leg edema 2. Ascites 3. Abdominal pain
118
How common are primary IVC tumors? What is an example?
1. Uncommon 2. Leiomyoma/ leiomyosarcoma
119
Where does metastatic IVC tumors most commonly present?
RCC
120
What is the U/S appearance of IVC tumours? 4
1. Intraluminal echogenic foci 2. Could be isoechoic 3. Calibre of IVC increased 4. Loss of respiratory changes
121
What is the prognosis of IVC thrombosis?
Life threatening
122
What is the most common abnormality of the IVC?
IVC thrombosis
123
IVC thrombosis can spread from where?
Another vein
124
What does IVC thrombosis look like on u/s? 3
1. Intraluminal filling defect, expanding the vessel 2. Echogenicity of thrombus depends on age 3. Respiratory changes decreased or absent
125
What are s/s of IVC thrombosis ? 5
1. Leg edema 2. Low back pain 3. GI complaints 4. Enlarged liver 5. Ascites
126
What does colour doppler show for IVC thrombosis? 2
1. No flow to the region of the thrombus 2. IVC filters may be used for treatment
127
Renal vein thrombosis presents how? 2 (Think about how it affects infants and adults)
1. As a serious complication in dehydrated or septic infants 2. In adults, a result of: shock, renal tumors, renal transplants or trauma
128
What is renal vein thrombosis associated with? 2 (conditions)
Diabetes and high blood pressure
129
What are renal vein thrombosis s/s? 3
1. Flank pain/mass 2. Hematuria 3. Proteinuria
130
How does renal vein thrombosis appear on u/s? 4 (Sonographically)
1. Enlarged kidney, hypoechoic 2. Dilated renal vein 3. Filling defect of variable echogenicity 4. Decreased or absent venou signal
131
Congenital abnormalities of the IVC most commonly occurs where?
At or below the level of the renal veins
132
What are the most common congenital abnormalities of the IVC?
Duplication and transposition
133
In terms of the congenital abnormality of the IVC, azygous or hemiazygous continuation occurs when what happens?
When the hepatic segment of the IVC fails to develop
134
What is hepatic congestion?
Passive edema of the liver secondary to vascular congestion
135
What is hepatic congestion related to?
heart failure
136
What causes hepatic congestion? (think blood flow)
Blood flow to the right side of the heart is impaired
137
What is the sonographic appearance of acute hepatic congestion? 4
1. Enlarged liver 2. IVC dilated/ no respiratory change 3. Hepatic veins - highly pulsatile/ flow reversal 4. Portal vein flow - pulsatile
138
What is the sonographic appearance of a chronic hepatic congestion? 2
1. Shrunken liver/ hepatic veins distended 2. LFTs- possible altered
139
What is portal hypertension due to?
Increase in portal venous pressures
140
What are two major types of portal hypertension?
1. Presinusoidal 2. Intrahepatic
141
What does extrahepatic preinusoidal PHT consist of? 2
1. Portal vein/ splenic vein thrombus 2. Ascites, splenomegaly, Varices
142
What are possible causes of presinusoidal? 6
1. Malignancy 2. Infection 3. Inflammation 4. Trauma 5. Splenectomy 6. Hypercoagulable states
143
What is intrahepatic portal hypertension caused by? 2
Diseases affecting the portal zones, such as 1. Schistosmiasis 2. Primary bilary cirrhosis
144
What is the most common cause of intrahepatic portal hypertension?
Cirrhosis
145
In terms of intrahepatic portal hypertension, when the normal parenchyma is replaced, what happens as a result in terms of flow?
Increased resistance to PV flow and obstruction to HV outflow
146
What are some things we see with intrahepatic portal hypertension? 3 (things that indicate)
1. Ascites 2. Splenomegaly 3. Collaterals
147
What is the sonographic appearance of portal hypertension? 6
1. Dilated PV in the early stages 2. Collateral flow 3. Patent umbilical vein/ coronary vein 4. Ascites 5. Splenomegaly 6. Monophasic >>> Biphasic >>>> Hepatofugal
148
What are examples of some collaterals? 5
1. Gastroesophageal 2. Paraumbilical 3. Splenorenal/ gastrorenal 4. Intestinal 5. Hemorrhoidal
149
What are some treatment options for portal hypertension? 3
1. Portosystemic shunts 2. Decompress the PV system 3. Shunts can be placed surgically or percutaneously
150
What does portosystemic shunts do?
Shunts venous blood flow from the congested venous system to a systemic vein
151
What does TIPS stand for?
Transjugular intrahepatic portosystemic shunt
152
How is TIPS inserted?
1. Inserted percutaneously via jugular vein 2. Inserted through HV to PV
153
How does blood flow with TIPS?
Blood then flows from portal venous system into the hepatic venous system
154
What is portal vein thrombosis?
Clot in the portal venous system
155
What are causes of portal vein thrombosis? 4
1. Malignancy 2. Infection/ inflammation 3. Trauma 4. Splenectomy
156
Why is colour doppler important for portal vein thrombosis? 2
1. Useful in distinguishing benign and malignant thrombi 2. Acute thrombus may be relatively anechoic - and can be overlooed
157
Portal vein thrombus can result in what?
Cavernous transformation
158
How common is Budd- Chiari syndrome?
Rare
159
What is Budd-Chiari syndrome?
Obstruction of the hepatic veins (varying degree)
160
In terms of Budd chari, besides the Hepatic veins, what else can be involved?
IVC
161
What are causes of Budd- Chiari syndrome?4
1. Coagulation/ congenital abnormalities 2. Trauma 3. **Oral congraceptives** 4. Tumor invasion (HCC)
162
What is the sonographic appearance of Budd-Chiari? 7
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
What are s/s of Bud-chiari? 3
1. RUQ pain 2. Hepatomegaly 3. Occasionally splenomegaly
164
What are infarctions?
1. Sudden interruption of blood supply 2. May lead to necrosis (tissue death)
165
Splenic infarct is a common cause of what?
Focal splenic lesion
166
What is splenic infarct caused by?
Occlusion of splenic artery
167
Splenic infarcts presents with sudden what?
Onset of LUQ pain
168
Splenic infarct comes with a variety of underlying causes such as what?
Sickle cell anemia
169
What does splenic infarcts look like sonographically? 2
1. Hypoechoic, wedge, shaped/ round area 2. Echogenicity changes with time (Becomes more hyperechoic)
170
What does renal infarctions look like?4
1. Segmental or diffuse 2. Time dependant 3. Early: hypoechoic 4. Resolving: echogenic
171
With renal infarctions how are renal infarctions?
Often remains normal
172
What does this image represent?
Dilated IVC
173
What does this image represent?
IVC thrombus
174
What does this image represent?
IVC thrombus in 2D
175
What does this demonstrate?
176
Label the image
177
What does this image describe?
TIPS
178
Label the image
1. Cavernous transformation 2. Thrombus dilated
179
What does this image represent?
Splenic infarct
180

DMST ABD 3 (11 decks)

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