CH 8 - THE VASCULAR SYSTEM

What is the function of the vascular system?

Transport gases, nutrient materials, and other essential substances to the tissues, waste products from the cells to the appropriate sites for excretion

___________ are hollow elastic tubes that carry blood away from the heart.

arteries

Arteries divide into progressively smaller branches, the smallest of which are the _____________.

arterioles

Arterioles lead into the ______________.

capillaries

Which definition best describes capillaries?

microscopic vessels just wide enough to let one red blood cell squeeze through and connect the arterial and venous systems (materials are exchanged between blood and tissue fluid).

Arteries are enclosed within a _______________________________.

sheath that includes a vein and nerve

Smaller arteries contain less elastic tissue and more smooth muscles than the ____________________.

larger arteries

Elasticity of the _______________ arteries is important for maintaining steady blood flow.

larger

The ____________ abdominal aorta will not change in diameter with changes in respiration.

pulsatile

_____________ carry blood to the heart and back from the tissues.

Veins

Where is blood collected after the blood passes through the capillaries?

in the small veins or venules

What unites to form larger vessels that eventually return the blood to the heart for recirculation?

Venules

How many layers does arteries have?

3

Name the 3 artery layers:

tunica intima, tunica media, tunica adventitia

A ____________ is a hollow collapsible tubes with diminished tunica media that carry blood toward the heart.

vein

What will most likely appear collapsed due to little elastic tissue or

muscle within their walls?

vein

Which of the following have a larger total diameter?

vein

A ____________ move blood more slowly.

vein

A ____________ contain special valves that prevent backflow and permit blood to flow only in one direction—toward the heart.

vein

____________ should dilate slightly with suspended respiration.

IVC

How many layers are within the tunica intima?

3

Which of the following best describes the 3 layers within the tunica intima (inner layer)?

A layer of endothelial cells lining the arterial passage (lumen)

A layer of delicate connective tissue

An elastic layer made up of a network of elastic fibers

Which of the following best describes tunica media (middle layer)?

Smooth muscle fibers with elastic and collagenous tissue

Which of the following best describes tunica adventitia (external layer)?

Loose connective tissue with bundles of smooth muscle fibers

and elastic tissue

Vasa vasorum tiny arteries and veins that supply the

walls of blood vessels.

What are the components of the abdominal vasculature?

(What major blood vessel systems exist in the abdomen?)

aorta, IVC, Portal Venous System, Abdominal Doppler (renal, abdominal veins, portal venous hypertension)

Which of the following best describes aorta?

largest principal artery in the body

How many sections is the aorta divided into?

5

Describe the 5 sections of the aorta:

root of the aorta

ascending aorta and arch

descending aorta

abdominal aorta and abdominal aortic branches

bifurcation of the aorta into iliac arteries

What 4 things the aorta assess?

diameter, calcification, thrombus, or direction

Aorta measurements on MEN:

Diameter (cm)

AO Supraceliac 2.5-2.7

AO Infrarenal 2.0-2.4

AO Distal 1.1-1.5

CIA 1.3 +/-2.0

CFA 1.1 +/-1.5

Aorta measurements on WOMEN:

Diameter (cm)

AO Supraceliac 2.1-2.3

AO Infrarenal 1.7-2.2

AO Distal 1.1-1.3

CIA 1.2 +/-1.3

CFA 1.0 +/-1.0

_______________ arise from the lateral walls of the aorta to supply the undersurface of the diaphragm.

Phrenic arteries

_______________ is the first anterior branch of the aorta, arising 1 to 2 cm inferior to the diaphragm.

Celiac trunk

________________________ is the second anterior branch, arising approximately 2 cm from the celiac trunk.

Superior mesenteric artery

___________________ are lateral branches arising just inferior to the superior mesenteric artery.

Renal arteries

The small _____________________ arises anteriorly near the bifurcation.

inferior mesenteric artery

The arteries whose distribution is to the visceral organs and the mesentery are which branches?

SMA & IMA

What arise at the bifurcation of the abdominal aorta at the fourth

lumbar vertebra (near the superior sacrum)?

common iliac arteries

Common iliac arteries divide into the _____________________.

internal and external iliac arteries

Which artery divides into anterior and posterior branches to supply the pelvic viscera, peritoneum, buttocks, and sacral canal?

internal iliac artery

Which 2 branches branch off before they pass under the inguinal ligament to become the femoral artery?

inferior epigastric and deep circumflex iliac branches

The portion of the femoral artery posterior to the knee is the

___________________.

popliteal artery

The ____________ artery further divides into the anterior and

posterior tibial arteries.

popliteal

___________ and ___________ are ALWAYS posterior to Portal.

duct and artery

Name the five main branches of the SMA that supply the small bowel/right side of the abdomen.

Inferior pancreatic artery, Duodenal artery, Colic artery, Ileocolic artery, Intestinal artery

Name the three main branches of the IMA:

Left colic, Sigmoid, Superior rectal arteries

The SMA distribution is to:

proximal half of the colon & small intestine

The IMA distribution is to:

the left transverse colon, descending colon, sigmoid colon, and rectum

Clinical reasons for sonographic evaluation:

Pulsatile abdominal mass, Abdominal pain radiating to the back, Abdominal bruit, Hemodynamic compromise in the lower legs

Pathology of the Aorta:

Atheroma, Aneurysm, Connective tissue disorder, Rupture, Thrombosis, Infection

Sonographic Findings of the Aorta:

normal, ectasia, tortuous aorta & aneurysm

_____________ occurs when the arterial vascular system becomes thick and stiff, leading to blood flow restriction to the organs and tissues in the body (general term).

Arteriosclerosis

Normal healthy arteries are flexible and elastic. With the development of arteriosclerosis, the walls in the arteries can:

harden and stiffen, resulting in higher blood pressure.

________________ is a buildup of fats, cholesterol, and other substances (aka plaque) and restricts flow.

Atherosclerosis

Clinical symptoms for both Arteriosclerosis and Atherosclerosis

Heart—chest pain or pressure (angina)

Brain—sudden numbness or weakness in arms or legs, difficulty speaking or slurred speech, or drooping muscles in the face

Arms and legs—leg pain when walking or exercising (intermittent claudication)

Kidneys—high blood pressure or kidney failure

What does AAA stands for?

Abdominal Aorta Aneurysm

An ____________ is defined as a permanent localized dilation of an artery, with an increase in diameter of greater than 1.5 times its normal diameter.

aneurysm

Descriptive terms for an aneurysm:

bulbous, saccular, and dumbbell

Most patients with an AAA are asymptomatic. If the patient does have symptoms, they may include:

throbbing or deep pain in the abdomen, back, or flank area

Most AAA are ______ aneurysms and all involve all three layers.

true

What is the percentage of infrarenal?

95%

_________________ is common with a larger aneurysm.

Mural thrombus

In AAA, ________________ (with tortuosity, folding) is present.

Atherosclerosis

What is the name for a false aneurysm, resulting from trauma.

Aortic pseudoaneurysm

___________________ is the result of infection.

Mycotic aneurysm

Surgery is considered when an aneurysm is _________.

>5 cm

Risk factors for AAA:

Tobacco, Hypertension, Vascular disease (Marfan syndrome), Chronic obstructive pulmonary disease (COPD), Family history for abdominal aortic aneurysm

Causes for AAA

Atherosclerosis, Trauma (after transection), Congenital defects, Syphilis (involving the ascending aorta and arch), Mycosis (fungal dissection), Cystic medial necrosis, Inflammation of media and adventitia, Increased pressure, Abnormal volume load

Aneurysms <4 cm in diameter are followed how often?

every 6 months with intervention if the patient becomes symptomatic

For aneurysms 4 to 5 cm in diameter, what is recommended?

surgical intervention may be suggested if the patient is in good health.

Aneurysms >5 to 6 cm may benefit from

surgical repair, especially if patient has other factors for rupture

Highest risk patients:

Aneurysms >6 to 7 cm in diameter pose the greatest risk; risk increases with age and other medical problems.

true aneurysm

Forms when the tensile strength of the wall decreases (bulge in wall)

false aneurysm or pseudoaneurysm

A pulsatile hematoma that results from the leakage of blood into the soft tissue abutting the punctured artery, with subsequent fibrous encapsulation and failure of the vessel wall to heal

False aneurysm is NOT lined by how many layers?

by all 3

False can or cannot rupture?

Can rupture

1 multiple choice option

Mortality rate for an aortic aneurysm rupture

50-80%

Aneurysms >5 cm have a _____ cumulative incidence of rupture over 8 years.

25%

2 multiple choice options

Symptoms of a rupture of aortic aneurysm

Excruciating abdominal pain, Shock, Expanding abdominal mass

An abdominal aortic aneurysm may be surgically repaired with a ___________________ material attached to the end of the remaining aorta.

flexible graft

The synthetic material used for a graft produces ____________________ reflections compared with those from typical aortic walls.

bright textured echo

What is formed by the union of the common iliac veins posterior to the right common iliac artery at the level of the fifth lumbar vertebra?

IVC

Superior to the renal vein entrance, the ____________ shows posterior "hammocking" through the bare area of the liver.

inferior vena cava (IVC)

1 multiple choice option

The __________ serves as a landmark for many other abdominal structures and should be routinely visualized on all examinations.

IVC

What portion of the IVC is seen by using the liver as an acoustic window?

Intrahepatic

How many anterior hepatic veins are associated with the IVC?

3

How many lateral tributaries are associated with the IVC?

3

Name the lateral tributaries of the IVC

Renal veins, Suprarenal veins, Gonadal veins

How many lateral abdominal wall tributaries are associated with the IVC?

5

Name the five lateral abdominal wall tributaries of the IVC:

the inferior phrenic vein and the four lumbar veins

Veins of origin:

two common iliac veins

Abnormalities of the IVC

Congenital abnormalities (Double IVC & Infrahepatic interruption of the IVC), IVC dilation (IVC will not collapse), IVC tumor, IVC thrombosis

IVC dilation

1.2-1.7

Spontaneous Breathing

IVC tends to collapse during inspiration

Mechanical Positive Pressure Ventilation

IVC tends to distend during inspiratory phase

Duplication of the inferior vena cava (IVC) is a congenital anomaly with an incidence of ______________.

0.1% to 3.5%

1 multiple choice option

The correct diagnosis for double IVC is important for ________________ and _____________________. Most patients have no clinical symptoms.

retroperitoneal surgery and venous interventions

Most common origin of pulmonary emboli is ________________ from the lower extremities.

venous thrombosis

Surgical and angiographic placement of transvenous filters into the IVC have been used to prevent recurrent ____________ in patients who cannot tolerate anticoagulants.

embolization

The _________ veins are the largest visceral tributaries of the IVC.

hepatic