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Abdominal Sonography > Vasculature > Flashcards

Vasculature Flashcards

1
Q

Explain Arteries Transport

A

Oxygenated blood from the heart (particularlly to tissue from the left ventricle of the heart) to the muscles and organs

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2
Q

Explain Veins Transport

A

Deoxygenated blood to the right atrium of the heart, then the blood passes to the right ventricle; blood from the muscles and organs back to the heart

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3
Q

Where does gas exhange occurs?

A

In the Lungs

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4
Q

Contrary to most of the arteries and veins, which vessel carries oxygenated blood from the lungs to the left atrium?

A

Pulmonary Veins

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5
Q

Contrary to most of the arteries and veins, which vessel return deoxygenated blood from the right ventricle to the lungs?

A

Pulmonary Artery

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6
Q

What are the layers of the blood vessel?

A
  1. TUNICA INTIMA - is the innermost section of a vessel wall; consists of endothelial lining and elastic tissue
  2. TUNICA MEDIA - are elastic fibers and smooth muscle
  3. TUNICA ADVENTITIA - is the outer portion of the vessel wall, it is composed of elastic and collagen fibers
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7
Q

What are the differences between Arteries and Veins?

A

ARTERIES VEINS

  • Intima Media thick - Intima Media thin
  • Maintains constant shape - Walls easy to collapse
  • Flow influenced by cardiac activity - Flow influenced by respiration,
  • Pulsatile muscle contraction and pressure
  • Diameter smaller than veins gradients
    - Phasic
    - Diameter larger than veins
    - Contain valves
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8
Q

What is Abdominal Aorta?

A
  1. It is the main artery of the chest and abdomen from which all other branch vessels are derived.
  2. It originates from the left ventricle of the heart
  3. Retroperitoneal
  4. Enters abdominal cavity at the aortic hiatus
  5. Anterior and left of spine
  6. Decreases in diameter, distally
  7. Parallel to IVC
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9
Q

Explain the Anatomical Relationships of the Aorta

A 
GE Junction - Anterolateral
Crura of Diaphragm -  Anterolateral
Left Lobe of Liver - Anterior
CA/ Celiac Axis - Anterior
SMA/Superior Mesenteric Artery - Anterior
Body of Pancreas - Anterior
Left Renal Vein - Anterior
IMA/Inferior Mesenteric Artery - Anterior
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10
Q

What is the normal size of the Aorta?

A

2cms and decreases in size of 1.5cm at its bifurcation into the CIA

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11
Q

What are the Branches of the Aorta?

A 
Celiac Artery (CA)
Superior Mesenteric Artery (SMA)
Renal Arteries (RA)
Gonadal Arteries 
Inferior Mesenteric Artery (IMA)
Common Iliac Arteries (CIA)
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12
Q

What is the Celiac Axis (CA)?

A
  • It is also referred to as the Celiac Trunk.
  • It is the first branch of the aorta; 1cm long
  • It originates from the anterior aspect of the aorta and is usually found within the first 2cm.
  • It is anterior to CA, SMA, IMA.
  • It is lateral to RA and gonadal arteries.
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13
Q

What are the 3 Branches of the Celiac Artery?

A
  1. CHA (Common Hepatic Artery)
  2. SA (Splenic Artery)
  3. LGA (Left Gastric Artery)
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14
Q

What is the Common Hepatic Artery or HA?

A
  • branches off the CA horizontally towards the right
  • superior to the pancreatic head
  • anterior to the MPV (Main Portal Vein)
  • moves anterior and enters the liver hilum (PORTA HEPATIS)
  • divides into right and left intrahepatically
  • supplies blood to the liver
  • it branches off to Cystic Artery, RGA/Right Gastric Artery and GDA/ Gastroduodenal Artery
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15
Q

What is the Cystic Artery?

A

It branches from the Right Hepatic Artery; supplies blood to the Gallbladder, CBD and hepatic ducts

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16
Q

What is the Right Gastric Artery?

A

It supplies the right side of the lesser curvature of the stomach.
RGA - branches off from Hepatic Artery
LGA - branches off from the Celiac Trunk

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17
Q

What is GDA or Gastroduodenal Artery?

A

It branches off from the Common Hepatic Artery; a landmark for the anterolateral Pancreatic Head; and supplies blood to the duodenum

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18
Q

What is Splenic Artery?

A
  • It is the largest of the three CA branches
  • It courses horizontally and to the left from the CA
  • It is posterior and superior to the Pancreatic Body
  • It supplies branches to the stomach and pancreas
  • It divides into at least 5 branches as it enters the splenic hilum
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19
Q

What is Left Gastric Artery?

A
  • It is anterior and superior course from the CA.
  • It supplies blood to the stomach and esophagus.
  • It travels to the left.
  • It is poorly visualized on ultrasound.
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20
Q

What is Superior Mesenteric Artery?

A
  • It is the second major aortic branch.
  • It is the anterior surface of the aorta.
  • 1 to 2.5 cm distal to the CA
  • Travels inferior
  • Posterior to the pancreatic body
  • Anterior to the Uncinate process and 3rd part of Duodenum
  • Supplies blood to the small and large bowel
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21
Q

Explain the Nutcracker Phenomenon.

A

It refers to the compression of the Left Renal Vein between the Aorta and the SMA/Superior Mesenteric Artery.

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22
Q

What are the Renal Arteries?

A
  • They are slightly inferior to SMA/Superior Mesenteric Artery.
  • They course posterolateral to the renal hilum.
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23
Q

What are the two lateral branches of the Renal Arteries?

A
  1. RRA/Right Renal Artery - is posterior to IVC; longer than the LRA because it has to pass behind the IVC and then through/between SMA and anterior Aorta to reach the kidney.
  2. LRA/ Left Renal Artery - goes straight to kidney.
24
Q

What is IMA / Inferior Mesenteric Artery?

A
  • It is the last mejor branch of the Aorta to arise from the abdominal aorta before it bifurcates.
  • It is the anterior aspect of the aorta and runs slightly inferior and to the left side of the abdomen.
  • It supplies blood to the distal colon. (large bowels)
  • It is difficult to visualize on ultrasound.
25
Q

What are the Gonadal Arteries?

A
  • They are anterior branch of the aorta.
  • They are inferior to renal arteries.
  • They are not typically visualized on ultrasound.
26
Q

What is the CIA / Common Iliac Artery?

A
  • This is where the bifurcation of aorta at the level of umbilicus (L4) occurs.
  • There are two branches of the CIA:
    1. RCIA - Right Common Iliac Artery
    2. LCIA - Left Common Iliac Artery
  • They travel at an oblique angle, inferior and posterior
  • CIA are anterior and lateral to common iliac veins
  • They are divided into:
    1. External Iliac Arteries (EIA)
    2. Internal Iliac Arteries (IIA)
27
Q

What is Inferior Vena Cava?

A
  • It is the largest vessel that returns blood to the right atrium from the lower limbs, pelvis and abdomen.
  • Retroperitoneal
  • To the right and anterior to spine
  • Travels superior and enters to right atrium of the heart
  • Size varies but should not exceed 3.7cm
28
Q

What are the Tributaries to the IVC?

A
  1. Common Iliac Veins
  2. Renal Veins
  3. Hepatic Veins - posterior to the liver
  4. Gonadal Veins

They all drain into the IVC

29
Q

What is Common Iliac Veins (CIV)

A
  • They join to form the Inferior Vena Cava (IVC)

- Posterior and medial to the common iliac arteries

30
Q

What are Renal Veins?

A
  • They are paired.
  • They insert on the lateral walls of the IVC.
  • RRV / Right Renal Vein is generally shorter than LRV because of the right kidney’s proximity to the IVC

LRV / Left Renal Vein traverses the abdomen, coursing anterior to the aorta and posterior to the SMA to finally entering the lateral aspect of IVC.

31
Q

What are the Hepatic Veins?

A
  • They drain directly into the IVC or right atrium.
  • They are posterior to the liver.
  • The Hepatic Vein confluence is best visualized in the transverse plane at xiphoid. “rabbit-ear” appearance
32
Q

What are the three Hepatic Veins?

A
  1. Left Hepatic Vein - medial and lateral
  2. Right Hepatic Vein - anterior and posterior
  3. Middle Hepatic Vein - right and left
  • All meet at one place, the IVC and drain to the IVC
33
Q

What is the Portal Venous System?

A
  • It is composed of the veins that drain blood from bowel and spleen.
  • It does not connect directly with the IVC.
  • It is formed by the union of the Splenic Vein and Superior Mesenteric Vein.
  • The Inferior Mesenteric Vein joins the Splenic Vein.
34
Q

What is the Portal Confluence?

A

It is the junction of the Superior Mesenteric Vein and the Splenic Vein and is immediately posterior to the neck of the Pancreas.

35
Q

Explain SV (Splenic Vein), IMV (Inferior Mesenteric Vein) and SMV (Superior Mesenteric Vein

A

Splenic Vein, Inferior Mesenteric Vein and Superior Mesenteric Vein are not part of the IVC but part of the Portal Venous System.

IMV (brings blood to the spleen from the bowel) &raquo_space; Splenic Vein (spleen)&raquo_space; SMV&raquo_space; Forms the MPV (Main Portal Vein)&raquo_space; Enters the Hilum of the Liver&raquo_space; Branches off to RHV (Right Hepatic Vein) Anterior and Posterior&raquo_space; LHV (Left Hepatic Vein) Medial and Lateral

36
Q

What is Splenic Vein?

A
  • Traverses from the splenic hilum
  • Courses medially and superiorly
  • Posterior and inferior to pancreas
  • Tortuos
  • Great landmark for pancreas
  • Joins the SMV to form the Portal Confluence which is posterior to Pancreatic Neck
37
Q

What is Superior Mesenteric Vein or SMV?

A
  • Starts at the root of Mesentery

- Travels superiorly and joins the Splenic Vein which is posterior to pancreatic neck

38
Q

What is Main Portal Vein or MPV?

A
  • Portal Confluence formed by the union of the SMV and SV
  • Moves superior and obliquely to enter the Porta Hepatis (liver entrance)
  • Divides into RPV (Right Portal Vein) and LPV (Left Portal Vein) at porta hepatis
  • supplies 50-60% of oxygen to liver (oxygenated blood to the liver)
39
Q

Differentiate Portal Veins with Hepatic Veins

A

Portal Veins

  • anechoic or hypoechoic lumen
  • hyperechoic walls; decreases in size as it enters the liver
  • going transverse ( ____ )

Hepatic Veins
- not hyperechoic walls (🌱 )

40
Q

Compare Right Portal Vein (RPV) with the Left Portal Vein (LPV)

A

Right Portal Vein/RPV

  • shorter and fatter than LPV
  • posterior and caudal path
  • divides into anterior and posterior

Left Portal Vein/LPV

  • borders the caudate lobe anteriorly
  • divides into medial and lateral branches “Steer’s Head” apperance
41
Q

Describe the Sonographic Apperance of the Portal Vein or PV

A
  • Anechoic or Hypoechoic Lumen
  • Hyperechoic Walls
  • Assessed in the sagittal and transverse planes
  • Decrease in size as it enters the liver
42
Q

Locate the Main Portal Vein or MPV

A
  • Find the long axis of splenic vein at pancreas
  • Follow to the point it widens (portal confluence)
  • Rotate the transducer clockwise at the portal confluence to elongate
  • Find the long axis of SMV at pancreatic neck
  • Rotate the transducer counterclockwise to elongate the MPV
43
Q

Decribe the Sonographic Characteristics between Arteries and Veins

A

Arteries

  • Anechoic Lumen
  • Hyperechoic Walls
  • Pulsatile

Veins

  • Anechoic Lumen
  • Echogenic Walls
  • Responds to respiratory variations
44
Q

Describe Sagittal Aorta

A
  • Tubular shape
  • Anechoic/hypoechoic lumen
  • Hyperechoic walls
  • Tapers inferiorly
  • Pulsatile
  • Measures: 2 cm proximally and 1.5cm distally
  • Measure Aorta: AP measurement and outer wall to outer wall
45
Q

Describe the Transverse Aorta

A
  • Round shape
  • Oval shape distally
  • Spine posterior
  • CIA : 2 anechoic circles; Men 1.4-1.5cm; Women 1.2cm
46
Q

What are the common artifacts to Aorta?

A
  1. Duplicated Aorta - due to the refraction of the sound wave from the curved surface of the rectus abdominis muscle
47
Q

What is the Relational Anatomy of Aorta?

A
  • Anterior to the spine
  • Left of IVC
  • More posterior proximally than distally
48
Q

What is the Relational Anatomy of IVC or Inferior Vena Cava?

A
  • Anterior to the spine
  • Right of Aorta
  • Courses anteriorly to enter right atrium
49
Q

What is the Relational Anatomy of Hepatic Artery

A
  • Anterior to the Portal Vein
  • Left of the Common Bile Duct
  • Superior to the Head of the Pancreas
50
Q

What is the Relational Anatomy of Splenic Artery?

A
  • Superior to the body and tail of the pancreas
51
Q

What is the Relational Anatomy of SMA or Superior Mesenteric Artery?

A
  • Posterior to the body of the pancreas and the Splenic Vein

- Anterior to the Aorta

52
Q

What is the Relational Anatomy of the Right Renal Artery?

A
  • Posterior to the IVC
53
Q

What is the Relational Anatomy of Splenic Vein?

A
  • Posterior to the body and tail of the pancreas
54
Q

What is the Relational Anatomy of SMV or Superior Mesenteric Vein?

A
  • Right and parallel to the SMA Superior Mesenteric Artery
55
Q

What is the Relational Anatomy of the Left Renal Vein?

A
  • Anterior to the Aorta
  • Posterior to the SMA
  • Anterior to the Right Renal Artery
56
Q

What is the Relational Anatomy of the Portal Vein?

A
  • Anterior to the IVC
57
Q

What is the Relational Anatomy of Common Bile Duct?

A
  • Anterior to the Portal Vein

- Right of the Hepatic Artery

Abdominal Sonography (4 decks)

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