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What ligament divides the liver into right and left?
falciform
Where does the aorta originate?
left ventricular outflow tract in the heart
Where does the aorta terminate?
fourth lumbar vertebra (near the umbilicus); where bifurcation occurs
Where does the IVC originate?
fifth lumbar vertebra (near the umbilicus); where bifurcation occurs
Where does the IVC terminate?
right atrium of the heart
What does the term “trunk” indicate?
branching into 2 or more
What type of structure is the aorta?
retroperitoneal
Where does the aorta bifurcate?
bifurcates into left and right common iliac arteries at the superior portion of the sacrum (or the 4th vertebra or near the umbilicus)
After bifurcation of the inferior abdominal aorta, the common iliac arteries further divide into what?
internal and external iliac arteries
How many branches does the celiac trunk have? What are they?
3; common hepatic, left gastric, splenic
Which artery could be web-like?
superior mesenteric artery
Where does the abdominal aorta supply blood to?
all structures below the diaphragm; abdominal organs, pelvic organs, lower extremeties
What are the major anterior branches of the aorta?
celiac axis/trunk (CA), superior mesenteric artery (SMA), inferior mesenteric artery (IMA)
What are the major lateral branches of the aorta?
left and right renal arteries (LRA & RRA), left and right common iliac arteries (LCIA & RCIA)
What artery of the aorta do you rarely see in ultrasound?
inferior mesenteric artery
What is the most superior branch of the abdominal aorta?
inferior phrenic artery
Where does the inferior phrenic artery supply blood to?
diaphragm
What is the most inferior branch of the abdominal aorta?
median sacral artery
Where does the median sacral artery supply blood to?
sacrum and rectum
What is the first abdominal branch?
celiac axis/trunk/artery
Where is the celiac artery usually on the aorta?
anterior
What does the celiac trunk give rise to?
splenic artery, common hepatic artery, left gastric artery
Where does the common hepatic artery supply blood to?
liver, right side of stomach, parts of the duodenum
What does the common hepatic artery branch into?
gastroduodenal artery and proper hepatic artery
Where does the splenic artery supply blood to?
spleen, pancreas, and left side of the stomach
What direction does the splenic artery come out of the celiac trunk at?
left at a 90-degree angle
What part of the liver does the left hepatic artery supply?
caudate and left lobe
Where does the right hepatic artery supply blood to?
gallbladder via the cystic artery and the liver
Where does the gastric artery supply blood to?
lower third of the esophagus and the upper right of the stomach
What is the largest branch of the celiac trunk?
splenic artery
What can be used as a landmark in locating the celiac trunk?
superior mesenteric artery
How can you differentiate the celiac trunk from the SMA?
“seagull sign”
Where is the distribution of blood of the celiac trunk vessels to?
liver, spleen, stomach, pancreas, and duodenum
How long is the celiac trunk?
approx. 1-2 cm
What is the second branch of the abdominal aorta?
superior mesenteric artery
Where is the SMA located?
1-2 cm inferior to the celiac axis
Where does the SMA supply blood to?
small intestine, ascending colon, and part of the transverse colon
What are the 5 main branches of the SMA?
inferior pancreatic artery, duodenal artery, colic artery, ileocolic artery, and intestinal artery
Where do the branches of the SMA supply blood to?
small bowel; proximal half of the colon (cecum, ascending, transverse) and the small intestine
What is the third branch of the abdominal aorta?
renal arteries
Where do the renal arteries originate?
lateral aspect of the aorta anterior at the level of the 1st lumbar vertebra, inferior to the SMA
How do the renal arteries course compared to the renal veins?
posteriorly
Which renal artery courses posterior to the IVC?
right renal artery
Which renal artery is longer?
right
Which artery courses from the aorta directly into the hilus of the left kidney?
left renal artery
T/F: both renal arteries are best seen in transverse sonograms
true
T/F: the left renal artery is lower than the right
false
Which kindey is more superior?
left
What branches of the abdominal aorta are not usually seen on scans?
gonadal arteries & inferior mesenteric artery
Where do the gonadal arteries originate?
inferior to the renal arteries on the anterior aorta
What are the respective terms of the gonadal artery dependent on gender?
testicular artery (male) & ovarian artery (female)
Where does the IMA originate?
superior to the umbilicus on the anterior aorta
Where does the IMA supply blood to?
transverse colon, descending colon, and rectum
What is the normal diameter of the proximal abdominal aorta?
approx. 2.0 cm
What is the normal diameter of the mid abdominal aorta?
approx. 1.5 cm
What is the normal diameter of the distal abdominal aorta?
approx. 0.8-1.0 cm
What is the normal diameter of the iliac arteries?
</=1.0 cm
What are three sonographic appearances of the abdominal aorta?
anechoic, tubular structure located slightly left of midline
bright, echogenic smooth wall margins
high-resistance arterial blood flow
What are the main reasons for imaging the abdominal aorta?
aneurysms, stenosis, & grafts
What are the types of aneurysms?
fusiform, saccular & dissecting
What can be identified using doppler sonography?
stenosis of the CA, SMA, renal artery, and common iliac; grafts can be evaluated for patency and complications
What does anastomosis mean?
a connection or opening between two things that are normally diverging or branching
How is the IVC formed?
anastomosis of the common iliac veins
How does the IVC course?
superiorly
Where is the IVC in respect to the aorta?
right side
Where is the IVC in respect to the spine?
anterior and to the right
After the IVC goes through the diaphragm, where does it go?
immediately empties into the right atrium
What does confluence mean?
two unequal vessels joining together
What are the IVC tributaries?
inferior phrenic veins, hepatic veins, renal veins, gonadal veins, and left & right common iliac veins
How many hepatic veins (HepV) are there?
usually 3, 2-4 sometimes; RHV, MHV, LHV
What are the renal veins of the IVC?
suprarenal; left & right renal
What is a large collapsible vein that returns blood from the abdomen, pelvis, and lower limbs through the system’s major tributaries into the right atrium of the heart?
IVC
What drains the head, neck, thoracic cavity and upper extremeties?
SVC
Why are the walls of the IVC thinner than aortic walls?
pressure of blood flow is lower
T/F: hepatic arteries and veins are seen in ultrasound?
false; only veins visible
What are sonographic appearances of the IVC?
anechoic tubular structure located to the right of midline
bright, echogenic smooth wall margins
What are 3 normal variants of the IVC?
Double IVC
Left-positioned IVC
Absence of a portion of the IVC (rare)
What is included in the portal venous system?
splenic vein, SMV, IMV, Main portal vein, LT portal vein, RT portal vein
What is the spleno-portal confluence?
union of the superior mesenteric vein and the splenic vein to form the portal vein
Which part of the portal venous system is difficult to recognize on ultrasound because of its anatomic location and small diameter?
inferior mesenteric vein
What are the components of the spleno-portal confluence?
main portal vein, left portal vein (lateral and medial branches), and right portal vein (anterior and posterior branches)
What is the purpose of the portal venous system?
collects blood and nutrients from the intestines and spleen
T/F: the portal venous system delivers deoxygenated blood to the liver
true
Where does the main portal vein enter the liver?
porta hepatis
What does it mean if the main portal vein is extrahepatic?
outside of the liver
How does the main portal vein course?
diagonally; left hip to right shoulder
What happens after the MPV enters the porta hepatis?
divides into right and left portal veins
What branches are on the left portal vein?
lateral and medial
What branches are on the right portal vein?
anterior and posterior
What can the liver be compared to in an airport?
customs; filters blood, collects blood from spleen for antibodies from the spleen
How are the portal vein walls in terms of color?
bright echogenic
T/F: portal veins have thick walls
false
Why is urine yellow?
it has bile in it
What vein drains the large intestine and varies widely as to where it actually joins the portal venous system?
inferior mesenteric vein
What is the region of anastomosis where the SMV and the splenic vein join?
spleno-portal confluence (portal confluence)
What vein courses along the posterior border of the pancreas?
splenic
Explain the course of the main portal vein.
Begins at portal confluence, courses for 5-6 cm (13mm diameter), ends at the porta hepatis of the liver where it bifurcates into LPV and RPV
Where does the right portal vein supply blood?
right lobe
Where does the left portal vein supply blood?
left lobe
What makes up the portal triad?
bile duct, hepatic artery, and portal vein
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