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MIDS 127 > Vessels > Flashcards

Vessels Flashcards

1
Q

Explain arteries

A

-Carry blood from heart
-Thicker walls
-Elastic and smooth
-Maintains shape

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2
Q

Explain veins

A

-Carry blood to heart
-Thinner walls and less smooth
-Collapsible
-Contains valves

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3
Q

What are the 3 layers of vessels?

A

-Tunica intima (inner)
-Tunica media (middle)
-Tunica adventitia (outer)

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4
Q

Describe location of aorta?

A

-Left ventricle
-Left side of midline
-More superficial distally towards bellybutton
-Tapers distally (towards bellybutton)

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5
Q

Measurement of AO?

A

Less than 3cm

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6
Q

What are the AO branches?

A
  1. CA/CT (includes LGA, HA, SA = LHS acronym)
  2. SMA
  3. L/R renal arteries
  4. IMA
  5. iliac arteries bifurcate
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7
Q

What do the CA branches supply?

A

LGA = stomach and esophagus (hard to see on U/S)
HA = liver, GB
SA = spleen

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8
Q

What does the HA branch into?

A

GDA and proper HA

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9
Q

What does the GDA supply?

A

Duodenum and parts of stomach with blood

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10
Q

What does the left HA supply?

A

-LLL
-Caudate
-Middle HA branches off left

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11
Q

What does the right HA supply?

A

-RLL
-GB via cystic artery

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12
Q

What is the variation of the HA?

A

2/3 people have the RHA sit posterior to the CBD rather than anterior
(normally CBD is on top with HA underneath)

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13
Q

What does the splenic artery supply?

A

-Spleen
-Stomach
-Pancreas
(courses posterior to pancreas)

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14
Q

What is the wings of seagull sign?

A

HA - wing
SA - wing
CA - body
(Image view: HA left side, SA right side, CA coming from AO in middle)

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15
Q

Location of SMA?

A

-2nd branch off AO
-Courses parallel to AO and anteriorly on U/S

(supplies sm and lg bowel)
(is surrounded by echogenic fat)

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16
Q

What is the nutcracker phenomenon?

A

LRV gets compressed between SMA and AO

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17
Q

Location of renal arteries?

A

-3rd branch off AO
-Lateral branches
-Best seen in TRV

(supplies L/R kidneys)

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18
Q

Location of IMA?

A

-4th branch off AO
-Anterior branch
-Looks like pumpkin stem above AO

(supplies distal colon)

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19
Q

Location of iliac arteries?

A

-Bifurcates at bellybutton area
-Can only view proximal part due to bowel
-Measurement is less than 1.5cm

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20
Q

Difference between ectatic and aneurysmal?

A

-Ectatic means diffusely dilated, the entire structure
-Aneurysmal means one spot of structure is dilated

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21
Q

Location of IVC?

A

-Right atrium
-Formed by junction of iliac veins
-Slightly to right of midline
-More oval shaped than AO

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22
Q

What happens to the IVC during respiratory changes?

A

-Collapses during first inhalation
-Expands when holding breathe, and during exhalation

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23
Q

Location of renal veins?

A

-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

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24
Q

What is the rabbit/playboy bunny sign?

A

-IVC as base
-RHV as low left branch
-MHV as middle branch
-LHV as top right branch

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25
Q

What do the HV’s do?

A

-Return deoxygenated blood from liver into IVC

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26
Q

What do the PV’s do?

A

-Drain blood from bowel and spleen
-Separate from IVC

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27
Q

How is the MPV formed?

A

-Junction of SV and SMV posterior to pancreas
(acronym SSM - super salty meal)

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28
Q

Measurement of MPV

A

Less than 13mm

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29
Q

Location of MPV branches?

A

-LPV into medial/lateral in liver
-RPV into anterior/posterior in liver

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30
Q

What is the course of the SV?

A

-Comes from splenic hilum
-Anterior to SMA
-Posterior to pancreas

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31
Q

What is the course of the SMV?

A

-Anterior to duodenum
-Posterior to neck of pancreas
-Joins SV to form MPV

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32
Q

What is the portal confluence?

A

-Junction of SMV and SV to make MPV
(is posterior to pancreas neck)

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33
Q

What is the portal triad?

A

-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)

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34
Q

What is an aneurysm?

A

Weakening of vessel wall

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35
Q

What type of flow do PV’s have?

A

Hepatopedal
(flow into liver, supplies caudate)

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36
Q

What type of flow do HV’s have?

A

Hepatofugal
(flow out of liver - think HEP is gross and fungus is gross)

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37
Q

What type of flow do HA’s have?

A

Hepatopedal
(blood flow into liver)

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38
Q

When does intrahepatic duct dilation occur?

A

Greater than 2cm

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39
Q

What are the liver functions?

A

-Bile formation and secretion
-Carb/fat/protein metabolism
-Blood reservoir
-Heat production
-Detoxification
-Lymph formation

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40
Q

What is bilirubin?

A

-Formed by destroyed RBC’s

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41
Q

What does increased direct/conjugated bilirubin suggest?

A

-Hepatitis
-Cirrhosis

42
Q

When is albumin decreased?

A

Only LFT that decreases with liver disease/damage

43
Q

What disease is associated with AFP?

A

-HCC/hepatitis

-Is a strong indicator that there is a liver mass b/c if normal there is no AFP in the blood

44
Q

SF of atherosclerosis?

A

-AO looks bumpy/wavy due to calcium deposits
-Wall has calcifications with shadowing underneath
-Common at AO BIF
-Associated with aneurysms

45
Q

What are the 3 types of AAA’s?

A

Fusiform (m/c) - complete dilation
Saccular - dilated on 1 side
Dissecting - tear in the wall

46
Q

Are most AAA’s infrarenal?

A

Yes! Means below the kidney

47
Q

Measurements of aneurysm + ectasia?

A

Aneurysm - focal dilation greater than 3cm
Ectasia - diffuse widening up to 3cm

48
Q

What is the m/c cause + r/f of AAA’s?

A

Cause: atherosclerosis
R/F: tobacco, hypertension + family history
CP: m/c in men over 65y/o

49
Q

When is surgery considered for a AAA?

A

When AO is greater than 4cm

50
Q

When will an AO/AAA rupture occur?

A

Increased risk if greater than 7cm (due to pressure on walls)

51
Q

What does a AAA SF look like?

A

-Hematoma in abdomen
-Abdominal fluid
-Hypoechoic areas near AAA

52
Q

What is a pseudoaneurysm?

A

False aneurysm b/c it does NOT include all 3 layers of the vessel wall like true ones

53
Q

M/c cause of a pseudoaneurysm?

A

Trauma

54
Q

Who is prone to getting an inflammatory aneurysm?

A

Younger people

55
Q

SF of an inflammatory aneurysm?

A

-AAA with hypoechoic mantle
-Thick wall
-Vascular

56
Q

What is involved with splanchnic aneurysms?

A

SA, HA + SMA (hard to see)

57
Q

What is the m/c type of splanchnic aneurysm?

A

Splenic aneurysms

58
Q

Lightbulb for splenic aneurysms?

A

-M/c in women
-M/c splanchnic aneurysm
-Very susceptible to rupturing
-R/f is portal hypertension + multigravidas (multiple pregnancies)

59
Q

Lightbulb for hepatic aneurysms?

A

-2nd m/c splanchnic aneurysm
-M/c in men
-M/c extrahepatic (outside liver)
-M/c cause is infection, arteriosclerosis + blunt abdominal trauma

60
Q

Lightbulb for SMA aneurysm?

A

-3rd m/c
-M/c cause is mycotic aneurysm (cystic medial necrosis)
-Sign is angina (reduced blood supply)

61
Q

What is the m/c type of RA aneurysm?

A

Extrarenal (outside the kidney)

62
Q

When is surgery required for a RA aneurysm?

A

If greater than 1.5cm

63
Q

M/c causes of RA aneurysm?

A

-Atherosclerosis
-Polyarteritis (multiple inflamed arteries)

64
Q

Lightbulb for iliac aneurysm?

A

-Associated with AAA
-M/c bilateral
-M/c cause arteriosclerosis
-Greater than 2cm

65
Q

What is an AO graft + what does it SF look like?

A

-Used to repair aneurysm by preventing flow into sac
-Looks like echogenic walls with echogenic dots/ribbing along it

66
Q

What is EVAR?

A

Endovascular repair of abdominal aortic aneurysms!
(used to decrease dilation)

67
Q

M/c complication of an AO graft?

A

Pseudoaneurysms

68
Q

M/c type of endoleak with AO grafts?

A

Type 2

69
Q

What is an AO dissection?

A

Separation of vessel walls from blood/hemorrhage

70
Q

M/c site Ao dissection occurs?

A

Proximal AO

71
Q

What is the cause + RF of AO dissection?

A

-Unknown cause
-RF is hypertension

72
Q

SF of AO dissection?

A

-Thin echogenic line/flap in lumen

73
Q

What is takayasu arteritis?

A

Disease causing inflammation to the large blood vessels

(m/c AO + branches)

74
Q

SF of takayasu arteritis?

A

-Concentrically thickened + homogeneous walls
-Macaroni sign!!

75
Q

Who is prone to getting takayasu arteritis?

A

Asian females

76
Q

What is arteriovenous fistulas (AVF)?

A

Abnormal connection b/w artery + vein

77
Q

Cause of AVF?

A

Trauma (can be AAA or RCC too)

78
Q

SF of an IVC thrombus?

A

-Echogenic/isoechoic foci in lumen
-Avascular

79
Q

M/c cause of IVC obstruction?

A

Right sided heart failure

80
Q

SF of IVC obstruction?

A

-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

81
Q

Are primary IVC tumours common?

A

No!

82
Q

M/c types of primary IVC tumours?

A

-Leiomyomas (benign)
-Leiomyosarcomas (malignant)

83
Q

M/c type of metastase of IVC tumours?

A

RCC

84
Q

SF of IVC tumours?

A

-Echogenic
-Normal or dilated
-Loss of respiratory changes

85
Q

What causes renal vein enlargement?

A

-Splenorenal/gastrorenal shunts
-RCC!
-AVM in kidneys

86
Q

SF of RV enlargement?

A

If both RV’s: IVC likely has suprarenal mass anteriorly
If 1 RV: mass is posterior (portal hypertension only affects LRV)

87
Q

SF of RV thrombosis?

A

-RV dilation prox to occlusion
-Isoechoic/echogenic lumen
-Kidney enlargement (b/c renal = kidney)
-Loss of renal shape

88
Q

M/c type of venous aneurysm?

A

Portal vein (is rare tho)

89
Q

M/c location of venous aneurysms?

A

Neck or lower extremities (not abdomen)

90
Q

What is Budd Chiari?

A

Occlusion of some/all HV’s and/or the IVC

91
Q

Lightbulb for Budd Chiari?

A

-Congenital or acquired (tumour)
-OCP + HCC are RF’s
-Classic triad: ascites, hepatomegaly + abdominal pain

92
Q

Cause of Budd Chiari?

A

25% idiopathic
75% hypercoagulable states

93
Q

SF of Budd Chiari?

A

Acute - hypoechoic
Chronic - hyperechoic
Also enlarged caudate

(HV’s may be NWS)

94
Q

M/c of portal venous thrombosis?

A

-Portal hypertension
-Cirrhosis
-Malignancies (liver/panc)

95
Q

Complications of portal venous thrombosis?

A

Bowel ischemia + perforation

96
Q

SF of PV thrombosis?

A

-Greater than 13mm if acute
-Less than 13mm if chronic
-Collaterals are present

97
Q

M/c causes of portal venous hypertension?

A

-Alcoholic hepatitis
-Cirrhosis
-Budd Chiari

98
Q

What is the caput medusa sign?

A

When paraumbilical veins dilate + are seen around bellybutton

99
Q

SF of PV hypertension?

A

-Comma shaped trunk
-Collaterals
-Dilated SMV + SV
-80-90% have esophageal varives + coronary vein enlargement!

100
Q

What is TIPS?

A

Transjugular intrahepatic portosystemic shunt

101
Q

What does a TIPS do + look like?

A

-Connects HV + PV with transcatheter through jugular vein to relieve pressure
-Is VERY echogenic

102
Q

What are the other shunts?

A

Portocaval - PV to IVC
Mesocaval - mesenteric vein to IVC
Splenorenal - SV to RV

MIDS 127 (14 decks)

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