Ch 10 : Abdominal Aorta
proximal 2.0 cm akaanteroposterior aorta mid 1.5 cm distal 0.8 - 1.0 cm (approx L4)
**normal abd aorta measurements proximal (thoracic) aka mid distal
anterior aspect branches into: left gastric artery splenic artery common hepatic artery
CELIAC ARTERY branches off from the ______ aspect of the aorta branches into the ....
Stystole
Contraction of the heart
1. left hepatic artery 2. common hepatic artery 3. celiac trunk 4. inferior phrenic artery 5. left gastric artery 6. splenic artery 7. left renal artery 8. left gastroepiploic artery 9. superior mesenteric artery 10. inferior anterior and posterior pancreatic duodenal artery 11. left gonadal artery 12. inferior mesenteric artery 13. left common iliac artery 14. median sacral artery 15. superior anterior and posterior pancreatic duodenal artery 16. right gastroepiploic artery 17. right renal artery 18. right gastric artery 19. gastroduodenal artery 20. proper hepatic artery 21. cystic artery 22. right hepatic artery 23. middle hepatic artery
GO OVER AND CHECK ONE TIME figure 10-3 Correctly ID each structure
during diastole: ventricles contract, blood quickly sent into AO, forcing expansion potential energy is stored in vessel wall aortic valve closes, arterial wall recoils blood to continue forward movement BP is maintained
How does the AO participate in blood pressure without valves?
RRA courses posteriorly to the IVC anterior to the spine on its long course to the right kidney.
RRA courses ________ to the IVC _____ to the spine
diastole
Relaxation of the heart
branches anterior aspect of the AO within cm of the CELIAC AXIS / TRUNK continues on a ANTERIOR-INFERIOR course divides into branches that feed the ... largest portion of the small intestine (gut)
SMA branches ___________ of the AO within centimeters of the _______ continues ________ course divides into branches that supply the _____
retroperitoneal structure coursing superior-to-inferior direction along the left side of the spine multiple branches bifurcates into the left and right common iliac arteries
The aorta is a ___________ structure coursing in a _________ direction along the _____ side of the ____ has __________ branches bifurcates at the ___________
left lobe of liver body of pancreas pylorus of stomach splenic artery left renal vein
What are anterior to the aorta?
psoas major muscles of the back spine
What is posterior to the aorta?
saccular aneurysm
a sac-like bulge on one side
stomach and duodenum
celiac axis (CA) supplies blood to the (2)
fusiform aneurysm
circumferential enlargement of a vessel with tapering at both ends
gastroduodenal artery GDA proper hepatic artery PHA
common hepatic artery branches into the
horizontal course to the right branches into the gastroduodenal artery and proper hepatic artery
common hepatic artery is a ______ course to the _____ branches into ____ ____
pelvis lower extremities
common iliac artery supply the (2)
Anastomosis
connecting two tubular structures
gallbladder
cystic artery feeds the
left ventricle of the heart ascending aorta aortic arch descending aorta thoracic aorta abdominal aorta L4 as it bifurcates to the common iliac arteries (at the umbilibus)
describe the path of the aorta originates and at the _______ ascends the _____ and ---> _____ descends ____ ____ ____ bifurcates at____
common iliac arteries 0.8 - 1.0 cm
distal aorta, bifurcates into the
systolic and diastolic flow
doppler assessment pf the abdominal AO and branches is useful to understand ___________ and _________
primary = channel blood to organs / tissues to ensure --oxygen --metabolism
functions of the aorta and its branches primary functions ______ to ensure _____ and ______
evaluated for patency and complications using Doppler sono
grafts for
longitudinal tubular highly pulsatile structure *slightly anterior and the the left of the spine*
in a sagittal plane the aorta is seen as a ________ ________ highly _________ structure _______ and _____ of the spine.
anterior aspect of the aorta supplies blood to the transverse colon descending colon rectum
inferior mesenteric artery branch from the _________ supplies blood to the ______ , _______, and ______-
courses superiorly supplies the lesser curvature of the stomach eventually anastomoses with (R) gastric artery
left gastric artery courses .... supplies the...
epigastric region
midline of the AO
aorta (can be) left gastric artery (very tortuous) splenic artery (tortuous)
name 3 arteries that are tortuous
-stenosis SMA celiac axis common iliac
narrowing of a blood vessel what can this happen to? (3)
branch laterally off of the aorta course Posterior to the renal veins
renal arteries branch ______ off of the aorta course _____ to the renal veins
TRANSVERSE plane seen as small-diameter curvilinear longitudinal structures branching right and left laterally and then to their kidneys
renal arteries are the most easily seen in _____ plane as _________, _____, ____ structures branching ________ laterally from the AO and then running to their kidneys
lateral aspect of the AO course horizontally supply the kidneys
renal arteries branch from the _________ of the AO course _______ supply the _______
right side of lesser curvature of the stomach
right gastric artery supplies the
tunica intima tunica media tunica adventitia thicker tunica media for greater elasticity
three layers of the aorta (3) which is the thickest and why?
a single photo you should not be able to see L4 umbilicus common iliac arteries
transverse distal AO needs to be a ________ photo. you should not be able to see lumbar# ____ / _______ or common ______
fibrous outermost section of the vessel appears as a moderately bright line
tunica adventitia is the _____________ section of the vessel and appears
bright echogenic line on the innermost portion of the vessel wall
tunica intima on a sonogram appears
anechoic / echo free
tunica media on a sonogram appears
distal aorta sag plane
view of the in what plane
IMAGING •Duplex Doppler sonography •Color Doppler imaging •Computed axial tomography (CT scan) •Spiral computed axial tomography (spiral CT) •Magnetic resonance imaging (MRI) ***NOT FORMS OF IMAGING .... *** •Plethysmography and segmental blood pressure •Arteriography
Associated imaging exams
the SEAGULL SHAPE in a TRANSVERSE SCANNING PLANE longitudinal sections of the splenic artery (SPA) = l wing common hepatic artery (CHA) = r wing CA = body
celiac axis and it's branches are easy to ID by
left gastric artery
celiac trunk which main branch is not visible in US?
Fresnal
anterior view =
proximal diameter thoracic 2cm
anteroposterior diammeter aka
homeostasis
aorta and its branches play a critical role in
1) celiac trunk / axis : anteriorly 2) superior mesenteric artery : anteriorly 3) renal arteries (bilateral) : Laterally 4) gonadal arteries (bilateral) : anteriorly 5) inferior mesenteric artery : anteriorly 6) common iliac arteries (bilateral and bifurcate at approx L4) : laterally
aorta branches in order and orientation relative to the aorta
great vessels of the body of 2
aorta is one of the bodies
dissecting aneurysm
blood accumulates between the tunics of the artery and separates them, usually because of degeneration of the tunica media
common hepatic artery -->proper hepatic artery --> left and right hepatic arteries -->cystic artery off of RHA gastroduodenal artery --> right gastroepiploic artery
celiac trunk branches off to the RIGHT into the
courses inferiorly supplying the stomach pancreatic duodenal area
gastroduodenal artery courses _____ supplying the _____ and _____
anterior aspect of the AO course inferiorly the LEFT artery often originates superiorly than right artery.
gonadal arteries originate from the _________ aspect of the AO course ________ to their respective organs the ____ artery originates slight higher than the other.
anterior aspect of the aorta (testicular artery or ovarian artery)
gonadal artery branch form the ________ of the aorta
anterior aspect of the AO anteroinferior course supplying the *transverse colon *descending colon *rectum
inferior mesenteric artery originates ______ aspect of the AO ________ course supply the (3)
Fraunhofer
posterior view =
PHA branch of the common hepatic artery courses Right Lateral and Superiorly, supplying the LIVER via the right and left HEPATIC arteries
proper hepatic artery branch of the ______________ artery courses right _____ and ______ supplying the ____________ via the ______, _______, and _____ _____ arteries
courses right lateral and superiorly supplying the liver via the right, middle, and left hepatic arteries
proper hepatic artery courses ___ and _____ supplying the...
proximal (anteroposterior) / thoracic) AO appears CURVILINEAR as it runs ANTERIORLY until it bifurcates
proximal AO appears ________ as it continues to run __________ until it bifurcates
CA SMA renal artery common iliac can be IDed with Doppler sonography
sono for stenosis of the _________ structures (4) Identified with?
sagittal proximal aorta aka anteroposterior (thoracic area) in sagittal plane
sono view of the ___________- in _____ plane
anechoic tubular structure located slightly to the left of midline bright, echogenic, smooth wall margins high-resistance arterial blood flow
sonographic appearance of the abdominal aorta _______ tubular structure located slightly.... ________ wall margins __________ blood flow
aortic aneurysms (primarily) stenosis grafts
sonographic applications for the aorta: (3)
branches to the left Supplies the: spleen, pancreas, left side of the greater curvature of the stomach as it courses horizontally to left
splenic artery branches to the _____ supplies the: ______ _____ _____ as it courses _______ to the _____
spleen pancreas left side of the greater curvature of the stomach courses horizontally to the left with slight inferior- t0- superior angulation
splenic artery supplies the courses _________ to the left with slight____________ angulation
anterioposterior (proximal) thoracic area measurement in longitudinal section
suggested to measure the aorta ... to take the _____________ measurement in a _____ section
branches anteriorly from the aorta small intestine ascending colon transverse colon
superior mesenteric artery branches from the _________ aspect of the aorta supplies the largest portion of the ____________ , _________, and part of the _________
aka adrenal arteries originate BILATERALLY from the LATERAL aspect of the AO course HORIZONTALLY to the ADRENAL GLANDS originate between the CELIAC AXIS and the SMA
suprarenal arteries aka originate _____ from the _____ aspect of the aorta course _______ to the adrenal glands originate between the ______ and the level of the ____
slightly inferior to the celiac axis courses inferior-anterior pancreatic duodenal artery
suprarenal artery _____ to the celiac axis courses ___________ and ______
adrenal artery lateral aspect of the aorta course horizontally to the adrenal glands
suprarenal artery AKA ______ aspect of the aorta course ______ to the _______
lateral aspect of the aorta supplies the adrenal glands
suprarenal artery branches from the __________ aspect of the aorta supplies the
graft
surgery that can create new routes around narrowed and blocked arteries, permitting increased blood flow to deliver oxygen and nutrients to the heart muscle.
can be difficult
the AO is often tortuous so ID of a significant longitudinal portion in scanning is
14 cm long begins at the AORTIC HIATIS (approx at the 12th thoracic vertebra) inferiorly to the 4th lumbar vertebra
the abdominal portion of the aorta is approximately _____ cm long begins at the _________ (approx at the ____ thoracic vertebra) inferiorly to the ____ lumbar vertebra
tortuous
the aorta can be twisted or _______-
common hepatic artery branches into the PROPER HEPATIC ARTERY the proper hepatic artery branches into LEFT HEPATIC ARTERY MIDDLE HEPATIC ARTERY RIGHT HEPATIC ARTERY the right hepatic artery branches into the CYSTIC ARTERY
the common hepatic artery branches into the ________ hepatic artery the proper hepatic artery branches into _____ ____ ____ the right hepatic artery branches into the ____
should not exceed 3cm or it's considered aneurysmal
the diameter of the aorta should not exceed ______ or its _________
right gastroepiploic artery
the gastroduodenal artery branches medially off into the _______
transverse bifurcation of the iliac arteries
view of the in what plane
mid aorta sag plane
view of the in the ____ plane
mid aorta transverse
view of the in what plane
transverse distal aorta
view of the in what plane
cystic artery
what branches off of the right hepatic artery?
spine
what is posterior to the common iliac arteries
renin which acts on angiotensin II which initiates vasoconstriction BP is then maintained through vasoconstriction
what is released from the kidney in the event of bleeding?
approx L4
where do the common iliac arteries bifurcate?
located a few centimeters inferior to the CA
where is the SMA relative to the CA
right renal artery because the AO sits on the left side of the spine, forces RRA to travel a greater distance to the R kidney
which renal artery has a longer course? why?
distal portion of the AO narrows slightly demonstrated in the TRANSVERSE plane
AO bifurcates at the common iliac arteries just before they bifurcate, the distal portion of the AO .... most easily demonstrated in the _____ plane