Quiz #3 (Exam #1)

What should a patient do to prepare for an Aorta ultrasound?

What should a patient do to prepare for an Aorta ultrasound?

Be NPO

What should the Aorta lumen look like?

Anechoic

How/when does the diameter of the Aorta taper?

Distally

What does the absence of tapering suggest?

Aortic ectasia

What size is abnormal for the common iliacs?

Above 1 cm

What size is abnormal for the Aorta?

Above 3 cm

Where is the Aorta located relative to the spine?

Anterior

Where is the Aorta located relative to the midline?

Left of midline

What are the three layers of the aortic wall?

1. Tunica intima

2. Tunica media

3. Tunica externa

What is the first aortic branch distal to the diaphragm?

Celiac Axis

What does the Celiac Axis branch to form?

1. Right = common hepatic artery

2. Left = splenic artery

What is the second aortic branch?

Superior Mesenteric Artery

Does the SMA run perpendicular or parallel to the Aorta?

Parallel

What are the lateral branches of the Aorta that arise just inferior to the origin of the SMA?

Renal Arteries

What anterior branch of the Aorta is rarely seen on an ultrasound and arises at the L1 level?

Inferior Mesenteric Artery

What does the distal Aorta bifurcate into? What do these vessels bifurcate into shortly after?

1. Common iliac arteries

   1. External iliac arteries

   2. Internal iliac arteries

What does AAA stand for?

Abdominal Aortic Aneurysm

What is an aneurysm? What characterizes one on an ultrasound?

1. Permanent localized dilation of an artery

2. AP diameter = greater than 3 cm

Where is the most common aortic aneurysm location?

Infrarenal (below origin of renal arteries)

Who should have an AAA screening?

1. Men aged 65-75 who have ever smoked

2. Men age 60 or older who have a sibling or parent with an AAA

What are the risk factors associated with AAA?

1. Male

2. Over 50

3. Smoker

4. Hypertension

5. Diabetic

6. History of coronary artery disease

Is heavy drinking associated with AAA?

NO

What gender is not recommended to get a general screening for AAA? Who is at risk in this category?

1. Women

2. At risk

   1. Smokers

   2. Family history of AAA

When may we see blood coursing through a “false lumen”?

Aortic dissection

What are the risk factors of aortic dissection?

1. Male

2. Over 60

3. Smoker

4. Hypertension

5. Atherosclerotic Disease

6. Marfan’s Syndrome

7. Pregnancy

8. Chest Trauma

What are some of the signs and symptoms of aortic dissection?

1. Known aneurysm

2. Sudden onset chest pain radiating to back, may also be asymptomatic

3. Pulsatile abdominal mass

4. Hemorrhaging between tunica intima and tunica media

5. Rupture into body cavity

6. Fatality

What is the most common reason for an aortic ultrasound?

Looking for abdominal aortic aneurysm (AAA)

What should the Aorta look like in long?

Extended across the screen from superior to inferior

What should the Aorta look like in transverse?

Round, not ovoid

When is the best time to measure the Aorta?

Largest pulsing diameter

In relation to the vessel walls, how should the Aorta be measured?

Perpendicular

How should the Aorta be measured in long?

A-P diameter

How should the Aorta be measured in trans?

Right-left (Rt-Lt) diameter

What is the main reason for an IVC ultrasound?

1. Thrombus

2. Tumor invasion

What vessels form the IVC?

Right and Left Common Iliac Veins

Where is the IVC relative to the spine?

Anterior

Where is the IVC relative to the Aorta?

Right of Aorta

Where does the IVC enter the heart?

Right atrium

How should a patient prepare for an IVC ultrasound?

Be NPO

How many branches join to form the main renal vein (MRV) on each side?

5-6 branches

What is the path of blood flow for the right renal vein? Does it have any tributaries?

1. Right kidney to posterolateral IVC

2. No tributaries outside of kidney

What is the path of blood flow for the left renal vein? Does is have any tributaries?

1. Left kidney to IVC

2. Tributaries

   1. Left adrenal vein

   2. Left gonadal vein

   3. Lumbar veins

Where do the right adrenal and gonadal veins drain directly into?

IVC

Is the right or left renal vein larger?

Left is larger

What is the largest visceral tributaries?

Hepatic Veins

Where do the hepatic veins originate and drain into?

1. Originate in liver

2. Drain into IVC at diaphragm

What are the three branches of the hepatic veins? What do these structures drain?

1. Right Hepatic Vein: drains right lobe

2. Middle Hepatic Vein: drains caudate lobe and right lobe

3. Left Hepatic Vein: drains left lobe

What is the most common reason for an ultrasound of the anterior abdominal wall?

Hernia

What are the reasons for an ultrasound of the anterior abdominal wall?

1. Hernia

2. Masses

3. Trauma

4. Nerve blocks

What can happen to the Linea Alba in post-partum women?

Can become very wide

Why do we use ultrasound to evaluate the peritoneal cavity?

1. Distinguish cystic from solid lesions

2. No radiation

3. Easily guide aspirations or biopsies

Peritoneum

1. Double-layered, serous membrane

2. Lines abdominal cavity

3. Covers abdominal organs

Peritoneal Cavity

1. Space between parietal peritoneum and visceral peritoneum

2. Contains small amount of serous fluid

Mesentery

1. Double-layered fold of peritoneal membrane

2. Attaches part of intestine to posterior abdominal wall

Omentum

1. Double-layered fold of peritoneal membrane

2. Attaches stomach to another organ

Potential Space

1. Area within body cavity that is normally collapsed

2. Can be a collection place for

   1. Fluid

   2. Blood

   3. Infectious material

Subphrenic Spaces

Small spaces between diaphragm and liver, on each side of Falciform Ligament

Left Posterior Suprahepatic Space

Extension of lesser sac between diaphragm and posterior superior margin of left lobe

Subhepatic Spaces

1. Small slit-like spaces within peritoneum

2. Under liver on each side of porta hepatis

Morison Pouch

1. Part of right subhepatic space

2. Between liver and right kidney

What is a common collection point for ascites?

Morison Pouch

Paracolic Gutters

1. Spaces along ascending and descending colon

2. Allow fluid/blood/pus/cancer cells to flow from one area of abdomen to another

Colic Compartments

Division of peritoneal cavity into superior and inferior sections by transverse colon and its mesentery

What is aortic ectasia?

Failure of the aorta to taper distally, without an aneurysm

The proximal measurement of a patients aorta is 1.75 cm, the mid aorta measures 1.6 cm, and the distal aorta measures 3.7 cm. What is happening to the patient?

AAA

What is the order of the abdominal muscles from superficial to deep?

1. External oblique

2. Internal oblique

3. Transversus abdominis