Penny Abdomen Chapter 9: Abdominal Vasculature

SONOGRAPHIC FINDINGS OF AN AORTIC RUPTURE

1. abdominal aneurysm with an adjacent hematoma

CLINICAL FINDINGS OF AN AORTIC RUPTURE

1. decreased hematocrit 2. hypotension 3. pulsatile abdominal mass 4. abdominal bruit 5. back pain 6. abdominal pain 7. lower extremity pain

CLINICAL FINDINGS OF AN AORTIC DISSECTION

1. intense back pain 2. hypertension 3. abdominal pain 4. lower back pain 5. neurologic symptoms 6. marfan syndrome

SONOGRAPHIC FINDINGS OF A PSEUDOANEURYSM

1. perivascular hematoma containing swirling blood and has a neck connecting it to the vessel 2. color doppler demonstration of turbulent flow within the mass

SONOGRAPHIC FINDINGS OF AN AORTIC DISSECTION

1. possible AAA 2. intimal flap may be noted within the aortic lumen

An AAA is present when the diameter of the abdominal aorta exceeds ___ cm.

3 cm

Specifically, aneurysms that measure greater than __ cm in diameter are more prone to rupture

7

_____ has been cited as the most common cause of aneurysms in the United States

Atherosclerosis

_______ should be noted within the normal splenic artery.

Low-resistance flow

REVIEW QUESTIONS

REVIEW QUESTIONS

embolism

a blockage caused by an abnormal mass (embolus) within the bloodstream that hinders circulation downstream, leading to tissue damage

small bowel ischemia

a condition resulting in interruption or reduction of the blood supply to the small intestines

false aneurysm

a contained rupture of a blood vessel that is most likely secondary to the disruption of one or more layers of that vessel's walls

atherosclerosis

a disease of the arteries characterized by the deposition of plaques on the walls.

Marfan syndrome

a disorder of the connective tissue characterized by tall stature and aortic and mitral valve insufficiency

transitional cell carcinoma

a malignant tumor of the urinary tract that is often found within the urinary bladder or within the renal pelvis

Budd-Chiari syndrome

a syndrome described as the occlusion of the hepatic veins, with possible coexisting occlusion of the inferior vena cava

What flow pattern would the postprandial SMA yield in small bowel ischemia? a. High resistance b. Low resistance

a. High resistance

All of the following are branches of the celiac axis except: a. Right gastric artery b. Hepatic artery c. Splenic artery d. Left gastric artery

a. Right gastric artery

The main portal vein is created by the union of the: a. Splenic vein and superior mesenteric vein b. Superior mesenteric vein and inferior mesenteric vein c. Splenic vein and inferior mesenteric vein d. Splenic vein and gastroduodenal vein

a. Splenic vein and superior mesenteric vein

postprandial

after a meal

aneurysm

any dilation of a blood vessel, whether focal or diffuse

The _______, the largest artery in the body, originates at the left ventricle of the heart

aorta

Once the aorta passes through the _____ of the diaphragm, it is referred to as the abdominal aorta

aortic hiatus

The abnormal connection between arteries and veins is referred to as _____.

arteriovenous fistulas

The first main visceral branch of the abdominal aorta is the: a. SMA b. Celiac artery c. Renal arteries d. Hepatic artery

b. Celiac artery

What should the postprandial flow pattern be within the SMA? a. High resistance b. Low resistance

b. Low resistance

The IVC terminates at the: a. Common iliac veins b. Right atrium c. Left atrium d. Left ventricle

b. Right atrium

Which of the following is not true about the abdominal aorta? a. The abdominal bifurcates into the common iliac arteries. b. The proximal aorta is situated more anterior than the distal aorta. c. The aorta has a thicker tunica media than the IVC. d. The third major branches of the abdominal aorta are the renal arteries.

b. The proximal aorta is situated more anterior than the distal aorta.

The inner wall layer of a vessel, closest to the passing blood, is the: a. Tunica media b. Tunica intima c. Tunica rugae d. Tunica adventitia

b. Tunica intima

The primary function of the IVC is to:

bring deoxygenated blood from the lower extremities, pelvis, and abdominal organs back to the heart.

An AAA is present when the diameter of the abdominal aorta exceeds: a. 10 mm b. 2.5 mm c. 3 cm d. 2 mm

c. 3 cm

What branch and its tributaries of the abdominal aorta appears as a "seagull" in the transverse plane? a. SMA b. Hepatic artery c. Celiac artery d. Common iliac artery

c. Celiac artery

The veins seen attaching to the IVC just below the diaphragm are the: a. Renal veins b. Superior mesenteric vein c. Hepatic veins d. Celiac axis

c. Hepatic veins

A disorder of the connective tissue characterized by tall stature and aortic and mitral valve insufficiency is: a. Wilms syndrome b. Meckel-Gruber syndrome c. Marfan syndrome d. Kleinman syndrome

c. Marfan syndrome

In the sagittal plane, you recognize a circular, anechoic vascular structure posterior to the IVC. Which of the following would this structure be most likely? a. Abdominal aorta b. Left renal vein c. Right renal artery d. SMA

c. Right renal artery

The SMA typically originates along the anterior aspect of the abdominal aorta, just distal to the origin of the __________.

celiac trunk

The IVC is created by the union of the _____.

common iliac veins

The celiac trunk arises from the anterior aspect of the abdominal aorta, between the _______.

crura of the diaphragm

One significant branch of the right hepatic artery is the ______ artery, which supplies blood to the gallbladder

cystic artery

Occlusion of the hepatic veins describes: a. Marfan syndrome b. Klinefelter syndrome c. Morrison syndrome d. Budd-Chiari syndrome

d. Budd-Chiari syndrome

Which of the following vessels would most likely yield a high-resistance flow pattern? a. Celiac artery b. Common hepatic artery c. Renal artery d. Fasting SMA

d. Fasting SMA

An aneurysm associated with infection is termed: a. Recanalized b. Saccular c. Fusiform d. Mycotic

d. Mycotic

Which of the following vessels show a different flow pattern after eating? a. Celiac artery b. Splenic artery c. Renal artery d. SMA

d. SMA

A patient presents with unexplained abdominal pain for a vascular assessment of the SMA. Sonographically, you note that the patient's SMA yields a persistent high-resistive flow pattern. This is indicative of: a. Crohn disease b. Intussusception c. Bowel obstruction d. Small bowel ischemia

d. Small bowel ischemia

Which vascular structure may be confused for the main pancreatic duct? a. Hepatic artery b. Left gastric artery c. SMA d. Splenic artery

d. Splenic artery

The outer wall layer of a vessel is the: a. Tunica media b. Tunica intima c. Tunica rugae d. Tunica adventitia

d. Tunica adventitia

The sonographic visualization of an intimal flap is indicative of aortic ____.

dissection.

Complications of an AAA include:

distal embolism, infection, dissection, and rupture.

abdominal aortic aneurysm

enlargement of the diameter of the abdominal aorta to greater than 3 cm

The most common shape of an AAA is ____.

fusiform

The common hepatic artery branches into the ______ at the level of the pancreatic head. After this point, the common hepatic artery becomes the proper hepatic artery.

gastroduodenal artery

The _____ veins are referred to as testicular veins in the male and ovarian veins in the female.

gonadal

The fourth branches, the _____ arteries, arise from the anterior surface of the abdominal aorta, just below the renal artery level.

gonadal

A common site for pseudoaneurysm development is:

groin at the level of the femoral artery (following a heart catheterization)

Normal flow within the portal veins should be ________ and ______

hepatopetal monophasic

The SMA will exhibit _____-resistance flow in the fasting patient. However, 30 to 90 minutes postprandial, the SMA will yield a ______- resistance waveform.

high resistance low resistance

The most common location of an AAA is ____.

infrarenal

False aneurysms typically result from:

injury to an artery (procedures, surgery, trauma)

The left gonadal vein drains into the ______, whereas right renal vein drains ______.

left renal vein directly into the IVC

Normally, the spectral waveform of the proximal aorta superior to the abdominal visceral branches is considered ____ resistance, whereas the distal abdominal aorta is typically ______ resistance.

low high

The hepatic artery should yield _______ and _____ flow.

low- resistance hepatopetal

The ____ is created by the union of the superior mesenteric vein and splenic vein.

main portal vein

An aneurysms caused by infection is referred to as a _________.

mycotic aneurysm

endovascular aortic stent graft repair

nonsurgical method for treating abdominal aortic aneurysms

intimal flap

observation of the intimal layer of a vessel as a result of a dissection

Treatment for an AAA includes:

open surgery and endovascular aortic stent graft repair (EVAR).

The next main venous connections to the IVC, just below the hepatic veins, are the _____.

paired renal veins

A junction referred to as the portal splenic confluence or portal confluence is located posterior to the _____.

pancreatic neck

he main portal vein travels right lateral to the liver and enters the liver at the _____.

porta hepatis

A false aneurysm may also be called a _____.

pseudoaneurysm

Tumor invasion of the IVC is often associated with _______.

renal cell carcinoma

The IVC travels through the vena caval foramen of the diaphragm and ultimately terminates in the ______.

right atrium of the heart

________ is the most common cause of IVC obstruction that leads to enlargement.

right-sided heart failure

Enlargement of the hepatic veins and IVC is often seen with:

right-sided heart failure.

fusiform

shaped like a spindle; wider in the middle and tapering toward the ends

The SMA supplies blood to parts of the:

small intestines, some of the colon, and the pancreas

the IVC has a smaller amount of _____ within its tunica media compared with the abdominal aorta.

smooth muscle

Celiac branches into three arteries:

splenic artery common hepatic artery left gastric artery

SMA is located posterior to the ___ and _______ ; left lateral to the _______.

splenic vein and pancreas superior mesenteric vein

The second main branch of the abdominal aorta is the ____________.

superior mesenteric artery (SMA)

true aneurysm

the enlargement of a vessel that involves all three layers of the wall

Wilms tumor

the most common solid malignant pediatric abdominal mass; a malignant pediatric renal mass that may also be referred to as nephroblastoma

false lumen

the residual channel of a vessel created by the accumulation of a clot within that vessel

The subdivision of the aorta within the chest is referred to as the _________.

thoracic aorta

The inferior mesenteric artery (IMA) arises from the anterior surface of the abdominal aorta. It supplies blood to the:

transverse colon, descending colon, and rectum.

The wall of the aorta consists of three layers:

tunica intima (inner), tunica media (middle), tunica adventitia (outer)

The aorta bifurcates at or near the level of the ______.

umbilicus

SONOGRAPHIC FINDINGS OF AN ABDOMINAL AORTIC ANEURYSM

1. Diameter of the abdominal aorta measures greater than 3 cm 2. Thrombus within the lumen of the aorta 3. Calcifications, along with the thrombus, may produce acoustic shadowing

CLINICAL FINDINGS OF AN ABDOMINAL AORTIC ANEURYSM

1. pulsatile abdominal mass 2. abdominal bruit 3. back pain 4. abdominal pain 5. lower extremity pain

CLINICAL FINDINGS OF A PSEUDOANEURYSM

1. recent catheterization, surgery or trauma 2. pulsatile mass in area of puncture location

The diameter of the portal vein can vary with respiration, although typically it is less than ___ mm

13

The diameter of the IVC should not exceed ____ cm.

2.5

saccular aneurysm

a sac-like bulge on one side of an artery

What vessel can be often noted coursing between the SMA and the abdominal aorta in the transverse scan plane? a. Left renal vein b. Left renal artery c. Right renal vein d. Right renal artery

a. Left renal vein

The second main branch of the abdominal aorta is the: a. SMA b. Celiac artery c. Renal arteries d. Hepatic artery

a. SMA

A true aneurysm involves what?

all three layers of the vessel wall

mycotic aneurysm

an aneurysm caused by infection

What is the first main visceral branch of the abdominal aorta?

celiac trunk

The most common shape of an AAA is: a. Saccular b. Bulbous c. True d. Fusiform

d. Fusiform