Vascular Test 1 Flashcards
0
Q
what are the three parts of the vessel walls?
A
tunica intima
tunica media
tunica externa/adventitia
1
Q
what is the function of the heart?
A
the circulatory system transports gases and nutrients to the tissue and transports waste products away from the tissue
2
Q
What is the tunica intima?
A
endothelial cells-lumen
delicate connective tissue
elastic tissue
inner layer
3
Q
What is the tunica media?
A
smooth elastic muscle
middle layer of a blood vessel
helps regulate flow by controlling diameter
4
Q
What is the tunica externa/adventitia?
A
loose connective tissue
smooth muscles and elastic tissue
outer layer
5
Q
What are the vasa vasorum?
A
the small blood vessels that supply the walls of the aorta and vena cava
6
Q
What are capillaries?
A
small vessels connecting the arterial and venous systems
nutrients pass through capillaries into the body
7
Q
What are the major arteries of the systemic circulation?
A
aorta celiac axis sma renal ima common iliac
8
Q
Describe the aorta Root - LVOT (left ventricle outflow tract)
A
leaves the left ventricle
three cusps on the aortic valve
coronary arteries arise from the cusps
9
Q
Describe the aorta - ascending aorta portion
A
arches to form the aortic arch
to the right:
brachiocephalic -> right subclavian, right common carotid
to the left right off of the arch:
left common carotid
left subclavian
10
Q
aorta - descending
A
enters the abdomen through the opening of the diaphragm
11
Q
Describe the aorta - abdominal
A
largest artery in the body
slightly left of the vertebral column
transverse = circular structure
gradual tapering
becomes more anterior distally
12
Q
What is the diaphragmatic crura?
A
tendinous structures that extend inferiorly from the diaphragm to attach to the vertebral column.
forms a tether for muscular contraction
13
Q
What is the abdominal aortas measurement?
A
normal diameter 2-3 cm no more than 3cm
can be less than normal but not bigger (for adults)
14
Q
What are some scanning techniques for the Aorta?
A
best anatomic landmark
patient in the supine position
longitudinal- hollow tube anterior to spine but in the retroperitneum
may need to apply pressure and angle the transducer due to gas or air if recent endoscopic evaluation
use breathing techniques
extend abd technique
roll patient rld
15
Q
What are some indications that the aorta needs to be scanned?
A
abd pain
pulsatile mass (felt by touch)
AAA on plain film (abd aortic aneurysm on x-ray)
F/U AAA (Follow Up AAA)
trauma
Abd bruit (brewy…can hear with stethoscope abnormal sound)
hemodynamic compromise in the lower legs (aorta US to see if there is a problem above the legs even though leg pain…cannot scan legs only aorta)
16
Q
aorta measurements (prox –> iliacs)
A
prox 2.0-2.6cm
mid 1.6-2.4cm
distal 1.1-2.0cm
iliacs 0.6-1.4cm
17
Q
What are the phrenic arteries?
A
arise from the lateral walls of the aorta to supply the diaphragm
18
Q
Where does the celiac trunk/axis live?
A
first ANTERIOR BRANCH in the abdomen
Celiac “trunk” or “axis”
19
Q
What is the SMA (superior mesenteric artery)?
A
second ANTERIOR BRANCH off of the aorta in the abdomen
just posterior to the celiac trunk
runs parallel to the aorta, posterior to the neck/body of the pancreas
supplies the small intestine and proximal colon
20
Q
Right and Left Renal arteries
A
lateral branches off of aorta below SMA
21
Q
IMA
A
inferior mesenteric artery
anterior near bifurcation
22
Q
Paired branches of the aorta ( on both sides)
A
Suprarenal artieris *RENAL ARTERIES* gonadal arteries lumbar arteries common iliac arteries
23
Q
What arteries do we see?
A
Celiac Axis (trunk) SMA
24
cystic artery
branch of the right hepatic artery
feeds the gallbladder
25
What sign will you see on US when doing the Celiac Trunk?
Seagull sign... because the trunk is short it splits into the hepatic and splenic arteries quickly.
26
Gastroduodenal Artery (GDA)
transverse-circular structure in ANTERIOR head of pancreas (one of the "eyes of the worm")
CBD circular structure in posterior head of pancreas
GDA is not IN the pancreas but behind it (appears in the pancreas on US)
27
Other than the Gastroduodenal artery, what other branches come off of the common hepatic artery?
the Left Hepatic artery
the Right Hepatic artery
28
What is the largest branch off of the Celiac Axis/Trunk?
the Splenic Artery (SA)
29
What is the smallest branch of the Celiac Axis?
Left Gastric Artery
30
what are the unpaired branches of the aorta?
celiac axis
SMA
IMA
31
What are the anterior branches of the aorta?
celiac axis
SMA
IMA
32
What are the lateral branches of the aorta?
renal arteries
| common iliac arteries
33
when scanning a vessel how do you determine it's name?
find it's origin and it's endpoint = name
34
Where is the portal confluence?
large anechoic area under the pancreas
35
What makes up the portal confluence?
The area where the superior mesenteric vein and the splenic vein meet
They run posterior to the pancreas and form the portal vein
36
How does the SMA look on US?
Longitudinal: tublular structure coursing parallel to anterior aorta
Transverse: circular structure anterior to aorta and posterior to pancreas body
halo- surrounded by highly reflective echoes
37
What is SMA/IMA intestinal angina?
medical condition in which lack of blood causes severe chest pains
38
Right renal artery vs left renal artery
Right:
Longer
Posterior to IVC
posterior to the vein before entering the hilum
Left:
Shorter
courses directly into the hilum
39
How do you scan the Renal Arteries?
Best Seen in transverse
RRA courses posterior to IVC
Use color Doppler to aid visualization
low resistance flow
40
What causes Renal Artery Stenosis?
Hypertension
determined on US with color and Doppler - looking for a stenosis or narrowing of the renal artery (hard to do because you can't see the artery from the Ao all the way to the kidney)
41
What are Renal Arteriovenous Fistulas?
They can be congenital or aquired
Appear as a cluster of tubular structures
They create a connection between artery and vein
42
What is a fistula?
a connection between and artery and a vein
43
Arteries we can possibly see and need to look for...
```
Aorta
celiac
common hepatic
gastroduodenal
splenic
SMA
Renal
Common iliac
```
44
what are the major veins of the systemic circulation?
IVC
hepatic veins
renal veins
common iliac veins
45
What are some reasons to scan the IVC?
abdominal pain
palpable mass
F/U filter placement....history of DVT
Hx renal tumor - every time you see a significant mass on the kidney, you would check the IVC to check to see if the tumor has spread. check the renal vein as well
46
Why does the IVC dilate?
Heart problems cause the IVC to dilate
right ventricular heart failure
congestive heart failure
constrictive pericarditis
tricuspid disease
right heart obstructive tumor
when the right side of the heart has problems it pushes the blood back into the IVC
47
What can cause obstruction in the IVC?
Distended vessel
renal cell carcinoma
wilm's tumor
complete thrombosis = life threatening can lead to a pulmonary emboli, or venous thrombosis (fix with a surgically placed filter)
48
Why is the IVC Dilated that is not from the heart?
hepatomegaly
increased pressure
cirrhosis (liver is course, fluid around it, irregular borders, causes pressure = dilated vein)
49
What causes the IVC to be compressed?
Later stage of pregnancy - edema of the feet and ankles
malignant retroperitoneal tumors
hepatic or pancreatic masses
50
What are some abnormalities of the IVC?
Congenital:
double IVC
interruption of the IVC
51
What does the IVC look like on ultrasound?
looks like a hammock for the liver
anechoic
52
What are the Renal Veins?
Drains the kidneys, urters and adrenals
RRV courses anterior off of the IVC
LRV courses between the aorta and SMA
LRV comes anterior to the Ao but posterior to the SMA (under it)
53
How to you scan the Renal Veins?
RRV best seen in transverse, anterior to the renal artery
LVR best seen in transverse anterior to the aorta and posterior to the SMA
"Nutcracker" sign
54
What are the Hepatic Veins?
largest tributaries
RHV
LHV
middle hv
55
How do the Hepatic Veins look on US?
Makes the bunny sign in the liver
See drawing from lecture
fat near IVC and thin out as they go into liver
56
What are the major veins of the hepatic - portal system?
SMV
IMV
Splenic vein
Portal Vein
57
What is the portal vein?
It the the union of the superior mesenteric vein and the splenic vein
(SMV and SV)
58
Where is the main portal vein formed?
posterior to the pancreas
59
How do we scan the Main portal vein?
Best seen in transverse as a tubular structure from pancreas head to liver
diameter changes with resiration and valsalva
normal diameter < 13mm
60
What is the Portal triad?
Portal vein
hepatic ARTERY!!
common bile duct
transverse view on US make Mickey Mouse sign (look for IVC to get this picture, IVC will be large and long-ish)
61
WHAT IS the difference between the hepatic veins and the portal veins?
Portal Veins:
Thick reflective walls (radicals - edges of the portal veins - they are echogenic)
constant diameter
flow toward liver
Hepatic:
thin walls
triphasic (blood flow has a scalloped look to it)
increase in diameter as they near IVC
flow away from liver
drain cephalad toward the diaphragm
62
What are some reasons to scan hepatic veins and portal veins?
Hepatic veins: Congestive Heart Failure (CHF), liver disease
Portal Veins: liver disease, portal HTN (hypertension)
63
Where does the splenic vein originate?
originates at the splenic hilum
courses posterior to the pancreas
64
How do we US the splenic vein?
seen in transverse as a tubular structure posterior to the body and tail of the pancreas
65
How do we see the superior mesenteric vein on US?
best seen in longitudinal as a tubular structure to the right of the SMA
transverse seen as a circular structure
66
What vessels take blood away from the heart?
Arteries
67
Which vessels are smaller in diameter? larger?
smaller: arteries
larger: veins
68
Which vessels have the faster moving blood, arteries or veins?
arteries
69
Which vessels have greater elasticity, arteries or veins?
arteries
70
Which vessels have no change with respiration? arteries or veins?
arteries
71
Which vessels are collapsible?
veins
72
Which vessels take blood to the heart?
veins
73
Which vessels have slower moving blood, arteries or veins?
veins
74
Which vessels have slower moving blood and valves, arteries or veins?
veins
75
which vessels have little elasticity?
veins
76
which vessels have a larger diameter, arteries or veins?
veins
77
Which artery is the trunk artery?
the aorta
78
where does the aorta sit in the body?
slightly left of the vertebral column
79
When scanning the aorta, how does it appear in the transverse plane?
circular anechoic structure
80
What happens to the size and location of the aorta as it moves down the body?
size: gradual tapering
location: becomes more anterior distally
81
What three branches come off of the celiac trunk?
Common Hepatic artery
Left Gastric artery
Splenic artery
82
Is blood flow high or low resistance into the celiac axis/trunk?
Low resistance blood flow
83
What surrounds the celiac trunk?
Surrounded by liver, spleen, IVC, and pancreas
84
In relation to the celiac trunk what happens to the PSV (peak systolic velocity) after eating?
Nothing...it remains unchanged.
85
Which artery travels along hte superior border of the head of the pancreas?
The common hepatic artery
86
Which branch of the common hepatic artery (CHA) enters into the liver?
Proper Hepatic artery
87
Which artery supplies the pancreas and the duodenum?
the Gastroduodenal artery...which is a branch of the common hepatic artery.
88
What does the left hepatic artery supply?
the caudate and left lobe
89
what does the right hepatic artery supply?
supplies the right lobe of the liver
supplies the gallbladder via the cystic artery
90
Where does the splenic artery's tortuous course take it?
superior and posterior to the body and proximal tail of the pancreas
91
What organs does the splenic artery supply?
the spleen
pancreas
fundus of the stomach
92
What is the blood flow resistance in the splenic artery?
low resistance
93
How does the Left Gastric Artery travel in the body?
anterior and cephalad
94
What does the Left Gastric Artery supply?
the stomach
the pylorus
95
Where in the body do you find the Superior Mesenteric Artery?
anterior branch of the aorta
1-2 cm below the Celiac Axis
96
How does the SMA run in the body?
parallel to the aorta
posterior to the neck/body of the pancreas
97
What does the SMA supply?
small intestine
proximal colon
98
What is the blood flow resistance in the SMA?
Preprandial: high resistance flow
Postprandial: low resistance flow
99
When scanning the SMA how does it appear in transverse plane?
circular structure
anterior to the aorta
posterior to the pancreas body
surrounded by highly reflective echoes
100
Where in the body do you find the renal arteries?
1-3 cm inferior to the SMA off of the lateral sides of the aorta
101
What artery courses posterior to the IVC?
The RRA (right renal artery)
102
Which artery courses anterior to the psoas muscle
Left Renal Artery (LRA)
LRA also runs anterior to the Ao and Posterior to the SMA
103
What do the renal arteries supply?
Kidneys
adrenals
ureters
104
What pathology do we look for when we scan renal arteries and find a problem?
renal tumor
HTN (hypertension) due to renal artery stenosis
105
Where do we find the common iliac arteries?
at the bifurcation of the aorta
106
What do the common iliac arteries supply?
legs
pelvis
107
What size do the common iliac arteries measure?
<1.2cm
108
What do the common iliac arteries branch into?
internal iliac
external iliac
109
What does the internal iliac artery supply?
the pelvis
buttocks
110
What does the external iliac artery supply?
the legs
111
Which vein is the trunk vein?
The IVC
112
What part of the heart does the IVC empty into?
the right atrium
113
Where do you find the IVC in the body?
courses to the right of the aorta
Anterior to the duodenum and pancreas
114
From where does the IVC return blood?
abdomen
pelvis
lower limbs
115
Which has lower pressure the aorta or IVC?
IVC
116
Can you collapse the IVC?
yes...veins are collapsible
117
What are the pairs of veins that come off of the IVC?
aka Retroperitoneum tributaries
common iliac veins
lumbar veins
gonadal veins
renal veins
suprarenal veins
hepatic veins
118
Who has thinner walls...aorta or IVC?
IVC
119
What happens to the IVC's diameter if you inhale?
the diameter of the IVC increases
120
What happens to the IVC's diameter if you exhale?
the diameter decreases
121
What is the Valsalva maneuver?
patient is asked to bear down as if having a bowel movement...this causes dilation
122
What is the normal size of the IVC?
< 2.0cm
123
what kind of thrombosis is found in the IVC?
pulmonary emboli
venous thrombosis
124
What does the Right Hepatic Vein do?
drains right lobe
divides right lobe into anterior and posterior segments
125
What does the Left Hepatic Vein do?
drains left lobe
divides left lobe into medial and lateral segments
126
What does the middle hepatic vein do?
drains caudate lobe
divides liver into right and left lobes
127
What happens to the hepatic veins when you breathe?
diameter and flow vary with respiration
128
What happens to the hepatic veins as they approach the IVC?
they increase in size
129
What do the veins of the hepatic - portal system drain?
GI tract
spleen
pancreas
gallbladder
Delivers blood to the liver to clean it
130
What does the main portal vein branch into?
right and left portal veins
131
What happens to the blood from the portal vein after it traverses the liver?
it drains into the IVC via the hepatic veins
132
Where does the main portal vein enter the liver?
at the PORTA HEPATIS (then splits into rhv and lhv branches)
133
Which vein supplies up to one half of the oxygen to the hepatocytes?
main portal vein
134
Where is the main portal vein in relation to the IVC?
anterior to the IVC
135
Why would you measure the main portal vein?
measured with suspected portal hypertension
cannot be larger than 13mm or 1.3cm
136
What does the splenic vein join to form the MPV (main portal vein)?
the SMV (superior mesenteric vein)
137
What does the splenic vein drain?
stomach
spleen
pancreas
138
Where does the superior mesenteric vein originate?
at the mesentery
139
Where does the superior mesenteric vein join the splenic vein and what do they form?
joins SV: posterior to the neck of the pancreas
forms: main portal vein
140
What does the superior mesenteric vein drain?
the small intestine and proximal colon
141
Where do we find the inferior mesenteric vein in the body?
arises from colon
ascends to the left of the IMA
joins splenic vein posterior to the body of the pancreas
142
What does the IMV drain?
distal colon
not usually seen
143
Which artery is the largest principal artery?
the aorta
144
which vessel arises from the left ventricle?
the aorta
145
Which vessel distributes blood to the organs and limbs?
the aorta
146
True or False
in most cases the branch of the vessel is named after the organ it is feeding?
true
147
What are the five sections of the aorta?
Root - LVOT
ascending
arch
descending thoracic
descending abdominal - retroperitoneum
148
What is the position of the arteries to veins above the umbilicus?
arteries are posterior to veins
149
What is the position of the arteries to veins below the umbilicus?
the arteries are anterior to the veins
150
What are the gonadal veins?
testicular and ovarian
**left - empties into LRV**
right - empties into the IVC
not usually seen
151
What surrounds the aorta through the diaphragm?
the diaphragmatic crura
152
What is the normal diameter of the abdominal aorta?
2-3 cm
