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