Vessels Flashcards
Explain arteries
-Carry blood from heart
-Thicker walls
-Elastic and smooth
-Maintains shape
Explain veins
-Carry blood to heart
-Thinner walls and less smooth
-Collapsible
-Contains valves
What are the 3 layers of vessels?
-Tunica intima (inner)
-Tunica media (middle)
-Tunica adventitia (outer)
Describe location of aorta?
-Left ventricle
-Left side of midline
-More superficial distally towards bellybutton
-Tapers distally (towards bellybutton)
Measurement of AO?
Less than 3cm
What are the AO branches?
- CA/CT (includes LGA, HA, SA = LHS acronym)
- SMA
- L/R renal arteries
- IMA
- iliac arteries bifurcate
What do the CA branches supply?
LGA = stomach and esophagus (hard to see on U/S)
HA = liver, GB
SA = spleen
What does the HA branch into?
GDA and proper HA
What does the GDA supply?
Duodenum and parts of stomach with blood
What does the left HA supply?
-LLL
-Caudate
-Middle HA branches off left
What does the right HA supply?
-RLL
-GB via cystic artery
What is the variation of the HA?
2/3 people have the RHA sit posterior to the CBD rather than anterior
(normally CBD is on top with HA underneath)
What does the splenic artery supply?
-Spleen
-Stomach
-Pancreas
(courses posterior to pancreas)
What is the wings of seagull sign?
HA - wing
SA - wing
CA - body
(Image view: HA left side, SA right side, CA coming from AO in middle)
Location of SMA?
-2nd branch off AO
-Courses parallel to AO and anteriorly on U/S
(supplies sm and lg bowel)
(is surrounded by echogenic fat)
What is the nutcracker phenomenon?
LRV gets compressed between SMA and AO
Location of renal arteries?
-3rd branch off AO
-Lateral branches
-Best seen in TRV
(supplies L/R kidneys)
Location of IMA?
-4th branch off AO
-Anterior branch
-Looks like pumpkin stem above AO
(supplies distal colon)
Location of iliac arteries?
-Bifurcates at bellybutton area
-Can only view proximal part due to bowel
-Measurement is less than 1.5cm
Difference between ectatic and aneurysmal?
-Ectatic means diffusely dilated, the entire structure
-Aneurysmal means one spot of structure is dilated
Location of IVC?
-Right atrium
-Formed by junction of iliac veins
-Slightly to right of midline
-More oval shaped than AO
What happens to the IVC during respiratory changes?
-Collapses during first inhalation
-Expands when holding breathe, and during exhalation
Location of renal veins?
-Right is shorter than left b/c it is closer to the IVC
-Right veins insert into RRV and IVC directly
-Left courses anterior to AO and posterior to SMA
-Left veins connect to LRV and then into IVC
What is the rabbit/playboy bunny sign?
-IVC as base
-RHV as low left branch
-MHV as middle branch
-LHV as top right branch
What do the HV’s do?
-Return deoxygenated blood from liver into IVC
What do the PV’s do?
-Drain blood from bowel and spleen
-Separate from IVC
How is the MPV formed?
-Junction of SV and SMV posterior to pancreas
(acronym SSM - super salty meal)
Measurement of MPV
Less than 13mm
Location of MPV branches?
-LPV into medial/lateral in liver
-RPV into anterior/posterior in liver
What is the course of the SV?
-Comes from splenic hilum
-Anterior to SMA
-Posterior to pancreas
What is the course of the SMV?
-Anterior to duodenum
-Posterior to neck of pancreas
-Joins SV to form MPV
What is the portal confluence?
-Junction of SMV and SV to make MPV
(is posterior to pancreas neck)
What is the portal triad?
-Formed by the PV, HA, and CBD
(mickey mouse sign = PV is main circle, HA is left ear, CBD is right ear)
(acronym HPD = happy peanut butter)
What is an aneurysm?
Weakening of vessel wall
What type of flow do PV’s have?
Hepatopedal
(flow into liver, supplies caudate)
What type of flow do HV’s have?
Hepatofugal
(flow out of liver - think HEP is gross and fungus is gross)
What type of flow do HA’s have?
Hepatopedal
(blood flow into liver)
When does intrahepatic duct dilation occur?
Greater than 2cm
What are the liver functions?
-Bile formation and secretion
-Carb/fat/protein metabolism
-Blood reservoir
-Heat production
-Detoxification
-Lymph formation
What is bilirubin?
-Formed by destroyed RBC’s
What does increased direct/conjugated bilirubin suggest?
-Hepatitis
-Cirrhosis
When is albumin decreased?
Only LFT that decreases with liver disease/damage
What disease is associated with AFP?
-HCC/hepatitis
-Is a strong indicator that there is a liver mass b/c if normal there is no AFP in the blood
SF of atherosclerosis?
-AO looks bumpy/wavy due to calcium deposits
-Wall has calcifications with shadowing underneath
-Common at AO BIF
-Associated with aneurysms
What are the 3 types of AAA’s?
Fusiform (m/c) - complete dilation
Saccular - dilated on 1 side
Dissecting - tear in the wall
Are most AAA’s infrarenal?
Yes! Means below the kidney
Measurements of aneurysm + ectasia?
Aneurysm - focal dilation greater than 3cm
Ectasia - diffuse widening up to 3cm
What is the m/c cause + r/f of AAA’s?
Cause: atherosclerosis
R/F: tobacco, hypertension + family history
CP: m/c in men over 65y/o
When is surgery considered for a AAA?
When AO is greater than 4cm
When will an AO/AAA rupture occur?
Increased risk if greater than 7cm (due to pressure on walls)
What does a AAA SF look like?
-Hematoma in abdomen
-Abdominal fluid
-Hypoechoic areas near AAA
What is a pseudoaneurysm?
False aneurysm b/c it does NOT include all 3 layers of the vessel wall like true ones
M/c cause of a pseudoaneurysm?
Trauma
Who is prone to getting an inflammatory aneurysm?
Younger people
SF of an inflammatory aneurysm?
-AAA with hypoechoic mantle
-Thick wall
-Vascular
What is involved with splanchnic aneurysms?
SA, HA + SMA (hard to see)
What is the m/c type of splanchnic aneurysm?
Splenic aneurysms
Lightbulb for splenic aneurysms?
-M/c in women
-M/c splanchnic aneurysm
-Very susceptible to rupturing
-R/f is portal hypertension + multigravidas (multiple pregnancies)
Lightbulb for hepatic aneurysms?
-2nd m/c splanchnic aneurysm
-M/c in men
-M/c extrahepatic (outside liver)
-M/c cause is infection, arteriosclerosis + blunt abdominal trauma
Lightbulb for SMA aneurysm?
-3rd m/c
-M/c cause is mycotic aneurysm (cystic medial necrosis)
-Sign is angina (reduced blood supply)
What is the m/c type of RA aneurysm?
Extrarenal (outside the kidney)
When is surgery required for a RA aneurysm?
If greater than 1.5cm
M/c causes of RA aneurysm?
-Atherosclerosis
-Polyarteritis (multiple inflamed arteries)
Lightbulb for iliac aneurysm?
-Associated with AAA
-M/c bilateral
-M/c cause arteriosclerosis
-Greater than 2cm
What is an AO graft + what does it SF look like?
-Used to repair aneurysm by preventing flow into sac
-Looks like echogenic walls with echogenic dots/ribbing along it
What is EVAR?
Endovascular repair of abdominal aortic aneurysms!
(used to decrease dilation)
M/c complication of an AO graft?
Pseudoaneurysms
M/c type of endoleak with AO grafts?
Type 2
What is an AO dissection?
Separation of vessel walls from blood/hemorrhage
M/c site Ao dissection occurs?
Proximal AO
What is the cause + RF of AO dissection?
-Unknown cause
-RF is hypertension
SF of AO dissection?
-Thin echogenic line/flap in lumen
What is takayasu arteritis?
Disease causing inflammation to the large blood vessels
(m/c AO + branches)
SF of takayasu arteritis?
-Concentrically thickened + homogeneous walls
-Macaroni sign!!
Who is prone to getting takayasu arteritis?
Asian females
What is arteriovenous fistulas (AVF)?
Abnormal connection b/w artery + vein
Cause of AVF?
Trauma (can be AAA or RCC too)
SF of an IVC thrombus?
-Echogenic/isoechoic foci in lumen
-Avascular
M/c cause of IVC obstruction?
Right sided heart failure
SF of IVC obstruction?
-IVC dilates below obstruction
-RSHF: dilated prox to IVC + HV’s
-Decreased/absent respiratory variations
-Body creates collaterals to go around mass/obstruction or existing veins reroute blood
Are primary IVC tumours common?
No!
M/c types of primary IVC tumours?
-Leiomyomas (benign)
-Leiomyosarcomas (malignant)
M/c type of metastase of IVC tumours?
RCC
SF of IVC tumours?
-Echogenic
-Normal or dilated
-Loss of respiratory changes
What causes renal vein enlargement?
-Splenorenal/gastrorenal shunts
-RCC!
-AVM in kidneys
SF of RV enlargement?
If both RV’s: IVC likely has suprarenal mass anteriorly
If 1 RV: mass is posterior (portal hypertension only affects LRV)
SF of RV thrombosis?
-RV dilation prox to occlusion
-Isoechoic/echogenic lumen
-Kidney enlargement (b/c renal = kidney)
-Loss of renal shape
M/c type of venous aneurysm?
Portal vein (is rare tho)
M/c location of venous aneurysms?
Neck or lower extremities (not abdomen)
What is Budd Chiari?
Occlusion of some/all HV’s and/or the IVC
Lightbulb for Budd Chiari?
-Congenital or acquired (tumour)
-OCP + HCC are RF’s
-Classic triad: ascites, hepatomegaly + abdominal pain
Cause of Budd Chiari?
25% idiopathic
75% hypercoagulable states
SF of Budd Chiari?
Acute - hypoechoic
Chronic - hyperechoic
Also enlarged caudate
(HV’s may be NWS)
M/c of portal venous thrombosis?
-Portal hypertension
-Cirrhosis
-Malignancies (liver/panc)
Complications of portal venous thrombosis?
Bowel ischemia + perforation
SF of PV thrombosis?
-Greater than 13mm if acute
-Less than 13mm if chronic
-Collaterals are present
M/c causes of portal venous hypertension?
-Alcoholic hepatitis
-Cirrhosis
-Budd Chiari
What is the caput medusa sign?
When paraumbilical veins dilate + are seen around bellybutton
SF of PV hypertension?
-Comma shaped trunk
-Collaterals
-Dilated SMV + SV
-80-90% have esophageal varives + coronary vein enlargement!
What is TIPS?
Transjugular intrahepatic portosystemic shunt
What does a TIPS do + look like?
-Connects HV + PV with transcatheter through jugular vein to relieve pressure
-Is VERY echogenic
What are the other shunts?
Portocaval - PV to IVC
Mesocaval - mesenteric vein to IVC
Splenorenal - SV to RV
