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abd > Vessels > Flashcards

Vessels Flashcards

1
Q

Ao enters the abdominal cavity in a ____ location and progressively becomes more ______ as it travels caudally.

A

posterior

anterior

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2
Q

The IVC mainatins a ______ course throughout the retroperitoneum.

A

horizontal

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3
Q

First major branch of Ao

A

celiac axis

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4
Q

The celiac axis is __-___cm long, located superior to the ____ and branches into what 3 arteris?

A 
2-3cm
sup to panc
CHA (common hepatic artery)
LT gastric artery
Splenic Artery
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5
Q

Describe the termintaion of the celiac axis

A

terminates with the bifurcation of the CHA and SA, which is seen as the “seagull” or “dove sign”

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6
Q

What is the largest branch of the celiac axis?

A

SA

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7
Q

The left gastric artery is usually not visible but can be seen extending ____ from the celiac axis.

A

cranially

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8
Q

As the CHA course towards the _____ it dives into what two arteries?

A

LIV

bifurcates into the PHA (proper hepatic artery) and the GDA (gastroduodenal artery)

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9
Q

The SMA branches off the Ao ____cm inferior to the ____ ____. It ______ the Ao and is seen ____/_____ to the body of the pancreas.

A

1cm
celiac axis
parallels
post/inf to body of panc

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10
Q

SMA Doppler waveform in a fasting state?

A

high resistance, low diastolic

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11
Q

SMA Doppler waveform in a postprandial state?

A

low resistance, increased velocity

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12
Q

Renal arteriesarise from where?

A

from the lateral walls of Ao, just below the origin of teh SMA

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13
Q

Which renal artery is longer?

A

right

left is shorter as the Ao lies to the left of ML

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14
Q

Course of the right renal artery?

A

passes posterior to the IVC

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15
Q

The right and left gonadal arteries arise ____from the ___ Ao and are rarely imaged.

A

directly

distal Ao - LT is slightly superior

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16
Q

The inferior mesenteric artery arises from the ___ aspect of the ____ Ao. It is typically small although easy to image

A

anterior

distal

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17
Q

In the presence of SMA and CA stenosis/occlusion, what will happen to the IMA?

A

becomes enlarged

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18
Q

IVC lies to the _____ of the Ao and posterior to the _____ and _____ _____.

A

right

liver and panc head

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19
Q

Why might the IVC dilate?

A

cardiac failure

fluid overload

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20
Q

Most common tumor to involve the IVC?

A

RCC

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21
Q

Reasons for IVC displacement (6)

A 
liver mass
RT renal artery aneurysm
lymphadenopathy
tortuous Ao
Right renal mass
Right adrenal mass
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22
Q

Retrocaval lymphadenopathy will displace the IVC _____ in a ______ formation.

A

anteriorly

arcing

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23
Q

Purpose of the Greenfield filter

A

to prevent the ascent of lower extremity vein thrombosis

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24
Q

What is the proper location for an IVC filter?

A

inferior to the renal veins

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25
Q

Hepatics veins

A

RT, middle, left

-drain into the iVC

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26
Q

What is shorter, the left renal vein or right renal vein?

A
  • right RV, drains directly into the iVC

- left RV is longer, passes b/w SMA and Ao as it travels from LT Kid to the iVC

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27
Q

Nutcracker syndrome

A

engoregment of the left RV due to its compression by the SMA and Ao

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28
Q

retroaortic left renal vein

A

anatominal variant, left RV located between the Ao and the vertebra, drains into the IVC

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29
Q

What does the right gonadal vein drain into?

A

IVC

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30
Q

What does the left gonadal vein drain into?

A

left renal vein

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31
Q

A right liver mass will displace the IVC ________

A

posteriorly

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32
Q

A right renal artery aneurysm will displace the IVC ______

A

anteriorly

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33
Q

A tortuous Ao will displace the IVC _______

A

right

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34
Q

A right adrenal mass will displace the IVC _____/_______

A

medial/anterior

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35
Q

A right renal mass will displace the IVC ______/______.

A

medial/left

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36
Q

Although lyphandenopathy typically surrounds longitudinal vessels in the abdomen, it commonly displaces the IVC and SMA _______

A

anteriorly

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37
Q

A left adrenal mass will displace the splenic vein _______

A

anterior

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38
Q

A hematoma in the pouch of Douglass will displace the bladder _______

A

anterior

39
Q

With a gastric outlet obstruction and dilatation of the stomach, the pancreatic tail will be displaced ________

A

posteriorly

40
Q

A mass in the uncinate process will displace the SMV _________

A

anteriorly

41
Q

A neuroblastoma will displace the ipsilateral kidney ______

A

inferiorly

42
Q

A mass in the left lobe of the liver will displace the GE junction __________

A

posteriorly

43
Q

Three general types of aneurysms

A

true
false/pseudo
dissecting

44
Q

Specific types of aneurysms (5)

A 
berry
mycotic
athersclerotic
fusiform
saccular
45
Q

Berry A

A

small saccular A

commonly located in the cerebrum

46
Q

Mycotic A

A

infected aneurysm

47
Q

Athersclerotic A

A

results from weakening of the media in severe althersclerosis

48
Q

Fusiform A

A

spindle-shaped dilatation, the stretching process affects the entire circumference of the artery

49
Q

Saccular A

A

localized spherical outpouching of the vessel wall

50
Q

Arterial layers

A

adeventita
media
intima

51
Q

Which layers of the artery are involved in a true aneurysm?

A

all three

52
Q

MC cause of AAA (true A)?

A

arteriosclerotic disease

53
Q

AAA are typically what kind of A?

A

fusiform, rarely saccular

54
Q

How are A measured?

A

A/P and TRV from outer wall to outer wall

55
Q

Aortic A have a ______ association.

A

genetic

56
Q

Where are most Aortic A?

A 
distal Ao (infrarenal)
-prox Ao is infrequently involved
57
Q

Aneurysms by definition are a _____ dilatation with at least ____% increase over normal aortic diameter

A

focal

50%

58
Q

What other aneurysms are associated with aortic A?

A

iliac and popliteal artery aneurysms

59
Q

What do false/pseudo A reults from?

A

injury to the vessel wall and then extravasated blood is walled off by the surrouding tissues

60
Q

Can false/pseudo A mimic true aortic A?

A

Yes

It is important to deterime the true aortic wall

61
Q

The term “pseudoaneurysm” is typically used when dealing with ________ arteries. They are commonly associated with _______ _______ or ______ ______.

A

peripheral arteries
angiographic punctures
surgical anastomoses

62
Q

Correction of a pseudoaneurysm may be accomplsihed by

A

surgical repair
compression repair
thrombin injection

63
Q

Sonographically, psedo A are seen as a vascular compartment connected to the native artery. What kind of waveform is see and where should you place your caliper?

A

caliper should be placed at the stalk

biphasic/bidirectional

64
Q

Where do dissecting A usally originate?

A

at the aortic arch in the thorax

65
Q

What is a dissection?

A

separation of the intima from the media of the Aortic wall, floating intima

66
Q

Where can an Ao dissection extend into?

A

carotid arteries or down to the femoral arteries

67
Q

Etiologies of dissecting aneurysms (8)

A 
Marfan syndrome
chornic HTN
Ao aneurysms
Ao athersclerosis (cystic medial necrosis)
Iatrogenic cardiac intervention
Congenital Ao valve anomalies
Coarctation of the Ao
Chest trauma
68
Q

Most frequent cause of premature death?

A

dissecting aneurysms

69
Q

For patients with an AAA, what alternative treatment exists for repair?

A

Endovascular stent graft inserted into the groin and deplored within the Ao

70
Q

Who qualifies for an endovascular stent graft?

A

Patient with AAA that os infrarenal

71
Q

Post graft placement eval includes

A

monitoring for leaks
the A should be measured and compared to the pre graft size
-over time the A should contract down around the grafting material

72
Q

What is MAy-Thurner Syndrome?

A

chronic left common Iliac vein compression against the lumbar vertebrae by overlapping right right common iliiac artery

73
Q

What are patients with May-Thurner’s syndrome at risk for?

A

developing DVTs in the LLE

74
Q

Mesenteric (intestional) Ischemia

A

rare chronic intestional ischemia that presents as recurring postprandial ABD pain and weight loss

75
Q

What else has symptoms similar to chronic mesenteric ischemia?

A

abdominal malignancy
ulcerative disease
cholelithiasis

76
Q

What vessels should be evaluated is chornic mesenteris ischemia is suspected?

A

CA
SMA
IMA

77
Q

When do symptoms of chronic mesenteris ischemia usually present pathologically?

A

Not until at least 2 of the major mesenteric arteries are occluded or highly stenosed…. this typically results in silatation of the IMA

78
Q

Can symptoms result from a single mesenteric vessel occlusion?

A

Yes
typically the SMA is occluded
can occur in patient who have had previous abdomina surgery that interrupted important mesenteric collaterals

79
Q

Criteria for mesenteric artery stenosis (mesenteric ischemia)?

A

SMA velocity >275cm/sec
CA velocity >200cm/sec
*suggests a 70% stenosis

80
Q

MALS (median arcuate ligament compression syndrome) or celiac axis compression syndrome

A

compression of the proximal celiac axis by the median arcuate ligament of the diaphragm

81
Q

What should a sonorgapher do if they discover an elevated celiac axis velocity

A

compare insp/exp velocities

82
Q

MALS may present with an abdominal _____ with expiration and disappears with ispiration.

A

bruit

83
Q

If a case of MALS, what happens with expiration?

A

the median arcuate ligament compressions the ventral aspect of the celiac axis
-makes a “S” shaped axis in TRV and produces a significant stenosis

84
Q

If a case of MALS, what happens with inspiration?

A

the celiac axis should straighten out and any stenosis should disappear
-elevated velocities decrease to normal <200cm/sec

85
Q

Anterior/Posterior Nutcracker Syndrome

A

when the left renal vein is compressed between the SMA and Ao if anterior or between the Ao and vertebra if LRV is retroaortic

86
Q

What can Nutcracker syndrome cause?

A

venous HTN that results in venous collateralsand retrograde flow in the adrenal and gonadal veins….. this can then cause pelvic congestion syndrome in females and varicoceles in males

87
Q

What is a common symptom in patients with Nutcracker syndrome?

A

heamturia and left flank pain

88
Q

What is an arteriovensou shunt or fistual?

A

connection between an atery and vein

ex: cca and jug

89
Q

AV shunts are commonly associated with angiographic punctures/biopsies of the _____ ______ artery just inferior to the _____.

A

common femoral

groin

90
Q

What are AV shunts assoc with (6)

A 
trauma
surgery
biopsy
inflammation
neoplasm
congenital formation
91
Q

How might an AV shunt present in patient?

A

bruit or thrill depending on lcoation
HTN
cardiomegaly
heart failure

92
Q

Sonorgaphic characteristic of an AV shunt?

A

color flow bruit tissue vibration….. bc it’s a jet
pulsatile venous flow…..doesn’t have to go through cap bed
low resistive arterial flow

93
Q

intrarenal AV shunts result from what

A

renal biopsy
percutaneous renal biopsy is the most common known acquired renal AV fistual
-est 15 to 50% of biopsies result in some degree of fistual formation

94
Q

intrarenal shunts will produce what kind of waveform?

A

high velocity, low resistance

abd (20 decks)

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