Vascular system Flashcards
arteries divide into smaller branches, the smallest of which are the ______
arterioles
the arterioles lead into the ______, which are minute vessels that branch and form a network where the exchange of materials between blood fluid takes place
capillaries; then it is collected in the small veins or venules that unites with large vessels to return blood to the heart
the artery consists of what 3 layers?
tunica intima (inner), tunica media (middle), and tunica adventitia (external layer)
the ______ comprises the tiny arteries and veins that supply the walls of blood vessels
vasa vasorum
what are the 5 sections of the aorta?
root of the aorta, ascending aorta and arch, descending aorta, abdominal aorta and abdominal aortic branches, and bifurcation of the aorta into iliac arteries
the systemic circulation leaves the ____ ventricle of the heart by way of the aorta (where the root of the aorta is)
left
after the aorta arises from the left ventricle, it ascends posterior to the main ______ artery to form the ascending aorta
pulmonary
the ascending aorta arises a short distance from the ventricle and arches superiorly to form the aortic arch at the level of the ______ junction
sternoclavicular
what 3 branches arise from the superior border of the aortic arch to supply the head, neck, and upper extremities?
brachiocephalic, left common carotid, and left subclavian arteries
from the aortic arch, the aorta descends posteriorly along the back wall of the heart, where it pierces the diaphragm to become the ______
abdominal aorta
the ______ aorta enters the abdomen through the aortic opening of the diaphragm anterior to the 12th thoracic vertebra in the retroperitoneal space
descending
the aorta lies ______ to the left lobe of the liver, the body of the pancreas, the gastroesophageal junction, the pylorus, and the splenic vein
posterior
at the level of ______ the aorta bifurcates into the right and left common iliac arteries
fourth lumbar vertebra
the diameter of the abdominal aorta measures less than ______ in men and ______ in women, with a gradual tapering to ______ after it proceeds inferiorly to the bifurcation
2.3cm; 2cm; 10 to 15mm
normal is less than 3cm
the small ______ arteries arise from the lateral walls of the aorta to supply the undersurface of the diaphragm
phrenic (surgical intervention or trama to these arteries may cause limited movement of the diaphragm)
the ______ is the first anterior branch of the aorta, arising 1 to 2 cm inferior to the diaphragm
celiac trunk
the celiac trunk gives rise to what 3 vessels?
splenic, hepatic, and left gastric arteries
the ______ is the second anterior branch of the aorta, arising approximately 2 cm from the celiac trunk
superior mesenteric artery; just inferior to that is the left and right renal arteries
the small ______ artery arises anteriorly near the bifurcation
inferior mesenteric
if bowel or gas is overlaying the aorta, roll the patient into a ______ and scan along the left lateral flank with the transducer directed toward the spine
right lateral decubitus
if the abdomen is very concave, the patient may be instructed to ______ his abdomen (push muscle out)
extend
how do you measure the aorta?
perpendicular to the vessel from outer layer to outer layer
the iliac arteries should measure less than ______ in transverse AP diameter
1.2 cm; if measured greater than 3 cm surgical repair is needed
most aneurysms develop inferior to the ______ vessels near the bifurcation of the aorta
renal
the size of the aorta increases up to ______ in the 7th and 8th decades
25%
______ occurs when the aorta increases in both long and trans (diffuse dilation), causes the distal aorta to “kink” usually anterior and to the left
ectasia
______ or atheroma, is a vascular wall disorder characterized by the presence of lipid deposits in the intima, over time the plaque causes narrowing
arteriosclerosis (can create embolus or local thrombus; most commonly associated with the development of an aneurysm) can make walls echogenic and calcified
an ______ is defined as a permanent localized dilation of an artery with an increase in diameter greater than 1.5 times its normal diameter
aneurysm; surgery should be considered when greater than 5cm
what are the risk factors of an aneurysm?
tobacco use, hypertension, and vascular disease
30% to 60% of patients with an abdominal aortic aneurysm are ______
asymptomatic
______ for treatment are a less invasive approach to the repair of an aneurysm
endovascular stent grafts; its placed through two small incisions in the abdomen
the ______ extent of the aneurysm as it relates to the origin of the renal vessels, should be measured
longitudinal
aneurysms may be classified as a _____ aneurysm (lined by all three layers of the aorta) or as a _____ aneurysm (pseudoaneurysm/not lined by all three layers)
true (forms when the tensile strength of the wall decreases); false (pulsatile hematoma that results from leakage of blood into the soft tissue abutting the punctured artery)
the most common presentation of an atherosclerotic aneurysm is a _____ aneurysm of the distal aorta at the aortic bifurcation
fusiform; represents a gradual transition between normal and abnormal (football-like)
a _____ aneurysm shows a sudden transition between normal and abnormal and is somewhat spherical and larger (5 to 10cm) than fusiform
saccular
the term _____ applies to the figure-eight appearance of the aneurysm, where one may see more than one protrusion of the vessel
dumbbell
what are the classic symptoms of a ruptured aortic aneurysm?
abdominal pain, shock, and an expanding abdominal mass; the most common site is the lateral wall inferior to the renal vessels; compression of the renal artery can cause hypertension and renal ischemia
location of an aneurysm in relation to the renal arteries is important and evaluation of both ______
kidneys
a defect in the vessel intimal wall must exist along with internal weakness for a _____ to occur
dissection; may occur secondary to cystic medial necrosis (weakening of the arterial wall), to hypertension, or to the inherited disease Marfan’s syndrome. color flow doppler could detect flow into the false channel
the most dangerous type of dissection ______ because it can block the coronary arteries (blocking blood to the heard)
type 1 and 2
the sonographer should look for a dissection _____ or recent channel
flap (demonstrated in M-mode as a fluttering within the lumen) with dissection hemorrhage occurs between the middle and outer thirds of the media
during evaluation of a graft look for _____ at the ends of the graft, aneurysm formation, or pseudoaneurysm development; fluid collection may develop at the graft site
stenosis
clinical signs of ______ are explained on the basis of altered hemodynamics produced by a high-velocity shunt leading to increased blood volume, venous pressure, and cardiac output with cardiac failure and cardiomegaly
arteriovenous fistulas; if lower trunk and leg edema is present, along with a dilated inferior vena cava this should be suspected
what does the common hepatic artery branch into?
proper hepatic artery (goes into the liver through the porta hepatis) and the gastroduodenal artery (courses along the upper border of the head of pancreas)
the duodenum and part of the stomach are supplied by the ______ and ______
grastoduodental and right gastric artery
the ______ is a small branch supplying the caudate lobe and left lobe of the liver
left hepatic artery
the ______ supplies the gallbladder via the cystic artery and the liver
right hepatic artery
the ______ artery is a small branch of the celiac trunk, goes to the esophagus and then descends along the lesser curvature of the stomach
left gastric artery; supplies the lower third of the esophagus and the upper right of the stomach
the _____ artery is the largest of the three branches of the celiac trunk; forms the superior border of the pancreas, divides into the left gastroepiploic artery and the short gastric artery (supplies the fundus of the stomach)
splenic
the ______ runs posterior to the neck of the pancreas and anterior uncinate process; then branches into the mesentery and colon
Superior mesenteric artery; 5 main branches, inferior pancreatic artery, duodenal artery, colic artery, ilecolic artery, and intestinal artery(all supplying the small bowel)
____ artery distributes arterial blood to the descending colon, sigmoid colon, and rectum; it has 3 main branches the left colic, sigmoid, and superior rectal arteries
inferior mesenteric artery
a ______ aneurysm occurs in the SMA, hepatic and splenic arteries, gastroduodenal arteries, or inferior mesenteric artery
splanchnic
______ arteries are paired small vessels that arise from the lateral wall of the aorta to supply the undersurface of the diaphragm
phrenic
the ______ artery courses posterior to the IVC and anterior to the vertebral column to enter the hilus of the kidney
right renal; longer than the left
the ______ courses from the aorta directly into the hilus of the kidney
left renal artery
renal artery stenosis may present clinically as _____, its due to athersclerotic disease or fibromuscular hyperplasia
hypertension
the ______ artery arises inferior to the renal arteries and courses long the psoas muscle to the respective gonadal area
gonadal
____ lumbar arteries are usually present on each side of the aorta; supplies the muscle, skin, bone, and spinal cord
four
the _____ is formed by the union of the common iliac veins posterior to the right common iliac artery at the level of the 5th lumbar vertebra
inferior vena cava; it enters the diaphragm at the level of the 8th thoracic vertebra to enter the right atrium of the heart
the patient should be instructed to hold their breath when scanning the IVC, this causes the patient to perform a slight _____ maneuver toward the end of inspiration. which dilates it
valsalva; may expand IVC to 2 to 3 cm
in the adult patient, the normal IVC usually measures _____ and shows respiratory variations
less than 2 cm
______ of the IVC is noted in several pathologies, including right ventricular heart failure, congenital heart disease, constrictive pericarditis, tricuspid disease, and right heart obstructive tumors
dilation; tumors or thrombus maybe found in the IVC and cause obstruction
what 3 pairs of cardinal veins form the IVC?
posterior cardinal (6weeks), subcardinal-prerenal segment (7weeks), and supracardinal-postrenal segment (8weeks)
the most common type of double inferior vena cava is the left IVC joins the _____, which crosses the midline at this normal level to join the right IVC
left renal vein; less than 3% incidence
_____ condition results from the failure of union of the hepatic veins and the right subcardinal vein; can include azygos
infrahepatic interruption of the IVC; interruption of the IVC connection to the heart is associated with acyanotic or cyanotic congenital heart disease, abnormalities of cardiac position, and abdominal situs with asplenia and ploysplenia
in patients with right ventricular failure, the IVC does not _____ with expiration
collapse
with enlargement of the liver, the IVC is _____ rather than displaced
compressed; masses in the caudate lobe or right lobe may elevate the IVC; same with the pancreatic portion and lower segment
the ultrasound appearance of an IVC tumor is a single or multiple _____ nodules along the wall; it may be distended and filled with the tumor
echogenic; most common tumor is renal cell carcinoma usually from the rt kidney
______ within the IVC appears as a homogeneous mass, presents with leg edema, low back pain, pelvic pain, gastrointestinal complaints, and renal and liver abnormalities
thrombosis; use color doppler to see if it is occluded
surgical and angiographic placement of transvenous filters into the IVC has been used to prevent recurrent _____ in patients who cannot tolerate anticoagulants
embolization; most common origin of pulmonary emboli is venous thrombosis from the lower extremities; preferred location of the filer is in the iliac bifurcation
______ within the IVC appears as a homogeneous mass, presents with leg edema, low back pain, pelvic pain, gastrointestinal complaints, and renal and liver abnormalities
thrombosis; use color doppler to see if it is occluded
surgical and angiographic placement of transvenous filters into the IVC has been used to prevent recurrent _____ in patients who cannot tolerate anticoagulants
embolization; most common origin of pulmonary emboli is venous thrombosis from the lower extremities; preferred location of the filer is in the iliac bifurcation
______ flows from the kidney posterior to the superior mesenteric artery and anterior to the aorta to enter the lateral wall of the IVC
left renal vein; larger than the right renal vein; visualized as a circular structure coursing between the SMA and the aorta on long image
renal vain ______ is seen in the dehydrated or septic infant; may also be seen in adults with multiple renal abnormalities
obstruction
with ______ the patient presents with flank pain, hematuria, flank mass, and proteinuria, this condition may be associated with maternal diabetes and transient high blood pressure
renal vein obstruction; may seen clumps of echoes in kidney, with surrounding echo-free space, decrease in renal size
the _____ are the largest visceral tributaries of the IVC; shows pulsatile flow
hepatic veins; the right vein drains into the right lobe, the middle vein into the caudate lobe, the left into the left lobe
the _____ vein enters the left renal vein; the _____ vein enters into the IVC
left gonadal; right gonadal (same with the suprarenal veins)
the _____ are the largest visceral tributaries of the IVC; shows pulsatile flow
hepatic veins; the right vein drains into the right lobe, the middle vein into the caudate lobe, the left into the left lobe
the _____ is formed posterior to the pancreas by the union of the superior mesenteric vein and splenic veins at the level of L2
portal vein; its trunk is 5 to 7 cm in length; drains into the IVC via the hepatic veins
the portal vein carries blood from the _____ to the liver by means of its 2 main breaches; the right and left portal veins
intestinal tract; it has an anastomosis with the esophageal veins, rectal venous plexus, and superficial abdominal veins
what is the portal triad?
branches of the portal vein, hepatic artery, and bile duct contained within a connective tissue sheath
_____ begins at the hilum of the spleen, where it is formed by the union of several veins, then joint by the short gastric and left gastroepiploic veins
splenic vein; runs along the posterioromedial border of the pancreas; joins the SMV posterior to the neck of the pancreas to form the portal vein; drains from the stomach, spleen, and pancreas
_____ begins at the ileocolic junction, within the root of the mesentery of the small intestine to the right of the superior mesenteric artery
superior mesenteric vein; passes anterior to the 3rd part of the duodenum and posterior to the neck of the pancreas and anterior border of the uncinate process
the _____ drains the left third of the colon and upper colon and ascends retroperitoneally along the left psoas muscle; it begins midway down the anal canal as the superior rectal vein
IMV
