Chapter 9: Abdominal Vasculature (Penny)

10. In small bowel ischemia, the postprandial SMA will yield what flow pattern? a. high resistance b. low resistance

a. high resistance

16. the main portal vein is created by the union of the a. splenic vein and SMV b. SMV and IMV c. splenic vein and IMV d. splenic vein and gastroduodenal vein

a. splenic vein and SMV

one of the most common causes of aneurysms in the US

atherosclerosis

13. the most common shape of an AAA is: a. saccular b. bulbous c. true d. fusiform

d. fusiform

complications of an AAA include:

distal embolism infection dissection rupture

Fourth branch of the AA just below the renals

gonadal arteries

Referred to as the testicular veins in the male and ovarian veins in the female

gonadal veins

the most common location of an AAA is

infrarenal

Vessels that have high resistance flow include:

infrarenal aorta common iliac artery fasting SMA

the left renal vein is (longer/shorter) than the right and is anterior to the aorta and _________ and is posterior to the ________

longer, LRA, SMA

The the portal/splenic confluence is located _______ to the pancreas neck

posterior

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

pseudo

A false aneurysm is termed ____________

pseudoaneurysm

the IVC is retroperitoneal and to the (right/left) of the aorta and ends at the (right/left) atrium of the heart.

right, right

the three branhes of the celiac trunk are

splenic, common hepatic, and left gastric arteries.

second main branch of the AA

superior mesenteric artery (SMA) .

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

transitional cell carcinoma

denotes the actual lumen of the aorta including thrombus

true lumen

24. what vessel travels anterior to the left renal artery? a. LRV b. hepatic artery c. RRV d. SMV

a. LRV

25. From the list below, which one is the shortest in length? a. RRV b. RRA c. LRV d. LRA

a. RRV

8. the second main branch of the abdominal aorta is the: a. SMA b. celiac artery c. renal arteries d. hepatic artery

a. SMA

dilation of the blood vessel that can be focal or diffuse

abdominal aortic aneurysm

a disease characterized by the accumulation of plaque within the walls of arteries

atherosclerosis

19. the hepatic artery should demonstrate: a. high resistance flow b. low resistance flow

b. low resistance flow

20. clinical findings of an AAA include all of the following except: a. lower extremity pain b. back pain c. abdominal bruit d. neck pain

d. neck pain

26. Enlargement of the IVC with subsequent enlargement of the hepatic veins, is seen is cases of: a. Budd-chiari syndrome b. marfan syndrome c. left sided heart failure d. right sided heart failure

d. right sided heart failure

14. 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

sonographic findings of aneurysm

diameter greater than 3cm mural thrombus within lumen calcifications

the hepatic artery should have ______ flow

low-resistant, hepatopetal flow

normal flow within the portal veins should be

monophasic and hepatopetal

the right renal artery travels ___________ to the IVC on its way to the right renal hilum

posterior

the splenic vein is located (anterior/posterior) to the pancreatic body and tail

posterior

Where is the SMA located?

posterior to the splenic vein and pancreas/ Left lateral to the SMV

the right and left portal veins supply blood to the ______ and ______ portal veins

right and left

the aorta bifurcates into the

right and left common iliac arteries

the proper hepatic enters the liver and then splits into

right and left hepatic arteries

The IVC travels (superior/inferior) through the abdomen

superior

Just like the Abdominal Aorta, the IVC contains 3 layers (intimal, media, adventitia), but the __________ layer has a smaller amount of smooth muscle compared to the aorta

tunica media

the aorta bifurcates at the level of the

umbilicus

Sonographic findings of pseudo's include:

- perivascular hematoma containing swirling blood and has a neck connecting it to the vessel - color doppler demonstrates turbulent flow within the mass (to and fro)

The function of the abdominal aorta is to supply blood to the:

-abdominal organs -pelvis -lower extremities

portal vein should not exceed

13mm

the diameter of the IVC should not exceeed

2.5 cm

common iliac arteries should not exceed

2cm

an aneurysm is present when the diameter exceeds

3 cm

direct communication between arteries and veins

AVF

Aneurysms that measure greater than 7cm are prone to this?

Aortic rupture

Syndrome described as the occlusion of the hepatic veins with possible co-existing occlusion of the IVC

Budd-chiari syndrome

True or false. Pediatric Wilm's tumor and renal transitional cell carcinoma do not also attack the IVC.

False, they may also attack the IVC

the common hepatic artery branches into the ______ and turns in the the proper hepatic artery

GDA

largest vein in the body created by the union of the common iliac veins

IVC

thrombus within the IVC

IVC thrombosis

The left gonadal vein drains into the ______ and is much longer that the right gonadal vein

LRV

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

Marfan syndrome

Clinical findings of pseudo's include:

Recent cath, trauma, or surgical intervention pulsatile mass at the puncture site

supplies blood to the pancreas, colon and intestines

SMA

the most common solid malignant pediatric abdominal mass aka nephroblastoma

Wilm's tumor

22. what vessel travels posterior to the SMA and ANTERIOR to the aorta? a. LRV b. LRA c. RRV d. splenic vein

a. LRV

30. Which of the following statements about the AA is not true? a. most aneurysms located within the AA are false aneurysms b. the AA is located just left of the midline c. the most common location of an AAA is infrarenal d. the AA is considered to be retroperitoneal in location

a. most aneurysms located within the AA are false aneurysms

5. 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

Sonographic findings of an aortic rupture?

abdominal aneurysm with an adjacent hematoma

celiac trunk arises from the ___________ aspect of the AA between the crura of the diaphragm

anterior

The aorta is located _____ to the spine and just ____ of the midline

anterior, left

the aorta is the largest artery in the body that originates

at the left ventricle of the heart

28. the diameter of the IVC should never exceed: a. 1.5cm b. 2.5cm c. 3.5 cm d. 8mm

b. 2.5cm

23. Which of the following would most likely have a high resistance flow pattern? a. celiac artery b. CIA c. splenic artery d. RRA

b. CIA

3. The first main visceral branch of the aorta: a. SMA b. celiac artery c. renal arteries d. hepatic artery

b. celiac artery

27. which of the following would have a pulsatile, triphasic flow pattern? a. renal veins b. hepatic veins c. gonadal veins d. CIV's

b. hepatic veins

7. What should the postprandial flow pattern be within the SMA? a. high resistance b. low resistance

b. low resistance

11. an AAA is present when the diameter of the AA exceeds: a. 10mm b. 2.5mm c. 3cm d. 2mm

c. 3cm

1. 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

18. the aorta originates at the: a. left atrium b. right atrium c. left ventricle d. right ventricle

c. left ventricle

first main branch of the abdominal aorta

celiac trunk

clinical findings of an AAA dissection

chest pain HTN abdominal pain lower back pain neurologic symptoms

SEAGULL SIGN

common hepatic and splenic artery branching off of the celiac trunk

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

d. tunica adventitia

Clinical findings of an aortic rupture?

decreased hematocrit hypotension pulsatile abdominal mass abdominal bruit back pain abdominal pain lower extremity pain

right sided heart failure is the most common cause of IVC obstruction that leads to __________

enlargement

the opening available after the narrowing from the thrombus has occurred

false lumen

the most common shape of an aneurysm is

fusiform; a gradual enlargement

Primary function of the IVC is to bring deoxygenated blood from the lower extremities, pelvis, and abdominal organs back to the _______

heart

most superior portion of the IVC, segment below the diaphragm, courses posterior to the caudate lobe of the liver and through the bare area

hepatic veins

supplies blood to the transverse colon, descending color, and rectum

inferior mesenteric artery (IMA)

the right renal artery is ____ than the left.

longer

most abdominal arteries have ____ ____ flow

low resistance

Common anomaly of the renal arteries:

multiple renal arteries

aneurysms caused by infection are termed

mycotic aneurysms

What is the 3rd main visceral branch of the AA?

paired renal arteries

below the hepatic veins are the

paired renal veins

Sonographic findings of an aortic dissection

possible AAA intimal flap may be noted within the aortic lumen

the left renal vein is __________ to the SMA and ________ to the aorta

posterior; anterior

aorta measurements

proximal; 2.5cm. mid; 2cm. distal; 1.8cm.

With PW doppler, the hepatic veins have what type of flow?

pulsatile, triphasic due to proximity to right atrium

tumor invasion of the IVC is usually associated with

renal cell carcinoma. pediatric wilm's tumor, transitional cell carcinoma.

Aorta is a __________ organ

retroperitoneal

the MPV travels (right/left) lateral to the liver and entered the liver at the porta hepatis

right

sudden dilation of a vessel, a sac like dilation of a vessel

saccular aneurysm

what type of aneurysm is often spherical and can be fairly large?

saccular aneurysm

the splenic artery can be found along the _________ margin of the pancreas traveling toward the left side of the patient toward the spleen

superior

the main portal vein is made through the union of the

superior mesenteric vein and splenic vein.

aorta infrarenal flow should be (biphasic or triphasic) with (high or low) resistant flow with (reversal or no reversal) of flow in diastole

triphasic, high-resistant flow, reversal

True or False. most AAA's are true aneurysms.

true

what type of aneurysm has all layers of the vessel dilated?

true aneurysm

Common site for pseudo's

within the groin at the level of the CFA following cath lab

the abnormal connection between arteries and veins

AVM

clinical findings of an aneurysm

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

a separation of the layers of the wall, predominantly the intima

Aortic Dissection

What complication of an AAA has a high mortality rate and morbidity rate?

Aortic rupture sono: aneurysm with adjacenthematoma

the renal arteries arise just below the ________

SMA

15. the IVC terminated at the: a. CIA b. right atrium c. left atrium d. left ventricle

b. right atrium

2. 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

21. an outpatient with a hx of back pain and HTN presents to the ultrasound dept. for an abdominal aortic sonogram. Sonographically, you visualize a 6cm infrarenal AAA with an echogenic linear structure noted gently swayed in the aortic lumen. What is the most likely diagnosis? a. aortic rupture b. chronic aortic aneurysm c. aortic dissection d. aortic rupture

c. aortic dissection

17. the veins seen attaching to the IVC just below the diaphragm are: a. renal veins b. SMV c. hepatic veins d. celiac axis

c. hepatic veins

29. Which of the following statements about the IVC is not true? a. the diameter of the IVC is variable b. respiration can affect the size of the IVC c. the IVC is located to the left of the AA d. the IVC is considered retroperitoneal in location

c. the IVC is located to the left of the AA

the right hepatic artery branches into the ________ artery, which feeds the gallbladder

cystic

9. Of the following, which vessel will show a different flow pattern after eating? a. celiac artery b. splenic artery c. renal artery d. SMA

d. SMA

12. Occlusion of the hepatic veins describes: a. marfan syndrome b. Klinefelter syndrome c. morrison syndrome d. budd-chiari syndrome

d. budd-chiari syndrome

4. an aneurysm associated with infection is termed: a. recanalized b. saccular c. fusiform d. mycotic

d. mycotic

the left renal artery travels ___________ to the LRV on its way to the leftt renal hilum

posterior

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

small bowel ischemia