Abdominal Vasculature

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What object is placed in the inferior vena cava to prevent the ascension of lower extremity thrombus into the lungs?

Inferior vena cava filters (Greenfield)

What is the most common cause of aneurysms?

atherosclerosis

The ascending lumbar veins are branches of the common iliac veins. What is the thoracic continuation of the right ascending lumbar vein?

azygos vein

The first main visceral branch of the abdominal aorta is the:

celiac artery

The _____ will most likely have a high-resistance flow pattern.

common iliac artery

What is nutcracker syndrome?

compression of the left renal vein between the superior mesenteric artery and the aorta

What are the sonographic signs of the nutcracker syndrome?

dilated left renal vein compared to the right renal vein

What is the definition of a pseudoaneurysm?

disruption of the arterial wall resulting in an adjacent communicating pocket

What is a dissecting aneurysm?

dissection of the intima away from the aortic wall

Abnormal serum laboratory results related to atherosclerosis include what?

elevated cholesterol

Which pathology is most likely seen in a nongravida 25-year-old?

fibromuscular dysplasia

Retrograde portal vein flow is termed?

hepatofugal

Where does the left gonadal vein drain?

inserts into the left renal vein which drains into the inferior vena cava

What vessel travels anterior to the left renal artery?

left renal vein

The hepatic artery should demonstrate:

low-resistance flow

An aneurysm associated with infection is termed:

mycotic

Define hepatofugal

portal vein flow away from the liver

Define hepatopetal

portal vein flow toward the liver

Prehepatic portal hypertension

portal vein thrombosis

What three vessels make up the portal triad?

portal vein, hepatic artery, bile duct

Name two clinical symptoms associated with mesenteric ischemia.

postprandial intestinal angina, weight loss

The IVC is located _____ of the abdominal aorta.

right

Out of the renal veins and renal arteries, which vessel is the shortest in length?

right renal vein

The gonadal arteries originate symmetrically from the aorta, and are below the origin of the renal arteries. Where does the right gonadal vein drain?

right side of the inferior vena cava, below the right renal vein

Enlargement of the IVC, with subsequent enlargement of the hepatic veins, is seen in cases of:

right sided heart failure

Which vascular structure may be confused for the main pancreatic duct?

splenic artery

What are the branches of the celiac axis?

splenic artery, common hepatic artery, left gastric artery

In which vessel is there an increase in diastolic blood flow after eating?

superior mesenteric artery

Which vessels are considered intersegmental within the liver?

thin-walled hepatic veins

The outer wall layer of a vessel is the:

tunica adventitia

The inner wall layer of a vessel, closest to the passing blood, is the:

tunica intima

The upper limit of normal diameter of the main portal vein in a 30-year-old is:

13mm

The diameter of the IVC should never exceed:

2.5cm

Sonographic diagnosis of mesenteric ischemia can be made if the IMA is turbulent and the superior mesenteric artery has a velocity greater than:

280cm/sec

An abdominal aortic aneurysm is present when the diameter of the abdominal aorta exceeds:

3cm

An infrarenal abdominal aortic aneurysm is diagnosed when the diameter is equal to or greater than?

3cm

Type A and Type B dissecting aneurysm

A: ascending thoracic aorta (more common) B: left subclavian artery

Occlusion of the hepatic veins describes what syndrome?

Budd-Chiari

Posthepatic portal hypertension

Budd-Chiari syndrome

True or false. Most aneurysms located within the abdominal aorta are false aneurysms.

False. Most are true.

What are two different types of true aneurysms?

Fusiform (spindle-shaped) or saccular (spherical outpouching)

In small bowel ischemia, the postprandial superior mesenteric artery will yield what flow pattern?

High resistance

A disorder of the connective tissue characterized by tall stature and aortic and mitral valve insufficiency is:

Marfan syndrome

What is the definition of a false aneurysm?

Pseudo, injury to the vessel wall where blood extravasates from the vessel and the blood surrounding the vessel is retained and walled off by the surrounding tissue

Why are the walls of the portal triad echogenic?

Surrounded by fibrofatty tissue

An outpatient with a history of back pain and hypertension presents to the ultrasound department for an abdominal aortic sonogram. You visualize a 6cm infrarenal aortic aneurysm with an echogenic linear structure noted gently swaying in the aortic lumen. What is the most likely diagnosis?

aortic dissection

What is the definition of a true aortic aneurysm?

dilatation of all three layers of the aorta, mainly in the distal portion

The most common shape of an abdominal aortic aneurysm is:

fusiform

Where are pseudoaneuryms (false) more commonly found?

groin from catheters introduced into the common femoral artery

What is the thoracic continuation of the left ascending lumbar vein?

hemiazygos

The gastroduodenal artery originates from the:

hepatic artery

The veins seen attaching to the IVC just below the diaphragm are the:

hepatic veins

What are the associated symptoms with the nutcracker syndrome?

left-sided hematuria, abdominal pain, varicocele formation, possible infertility

Where should the correct placement of the IVC filter be?

location inferior to the renal veins

What should the postprandial flow pattern by within the superior mesenteric artery?

low resistance

Waveform characteristics of the arterial side of an arteriovenous fistula

low resistive

Budd Chiari is considered a _______ cause of portal hypertension.

posthepatic

What are the 5 clinical findings of an abdominal aortic aneurysm?

pulsatile abdominal mass, abdominal bruit, back pan, abdominal pain, lower extremity pain

The IVC terminates at the:

right atrium

What are the sonographic findings of a dissecting aneurysm?

septation dividing the aorta into a true lumen and false lumen

The second main branch of the abdominal aorta is the:

superior mesenteric artery

Which vessel will show a different flow pattern after eating?

superior mesenteric artery

Where do the azygos and hemiazygos vein drain into?

superior vena cava

What is the flow pattern of the hepatic veins?

pulsatile, triphasic

The main portal vein is created by the union of the:

splenic vein and superior mesenteric vein join at the confluence adjacent to the head of the pancreas

A normal Doppler waveform of the aorta, from a suprarenal location, should appear:

biphasic

Intrahepatic portal hypertension

cirrhosis, schistosomiasis

Budd-Chiari syndrome is characterized by occlusion of the hepatic veins. What are the 5 sonographic findings associated with this syndrome?

hepatic vein thrombosis, ascites, hepatomegaly (acute), caudate lobe enlargement (chronic), portal hypertension

Waveform characteristics of the venous side of an arteriovenous fistula

increased velocity, pulsatility, spectral broadening due to turbulence

What is the last major branch to originate from the aorta prior to the aortic bifurcation?

inferior mesenteric artery

Portal vein thrombosis has been associated with hepatocellular carcinoma, metastatic liver disease, pancreatic carcinoma, and pancreatitis. What are the 3 sonographic findings of portal vein thrombosis?

intraluminal thrombus, increased vein diameter, cavernous transformatons

The aorta is located ______ of the midline.

left

Which vessel does not empty into the inferior vena cava?

left gonadal vein

What vessel travels posterior to the superior mesenteric artery and anterior to the abdominal aorta?

left renal vein

The aorta originates at the:

left ventricle

What three sonographic factors define mesenteric ischemia?

peak systolic velocity of the SMA >275 cm/sec peak systolic velocity of the celiac axis >200cm/sec two of the three arteries are occluded (SMA, IMA, celiac axis)

Which vessels are considered intrasegmental within the liver?

portal vein, hepatic artery, bile duct


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