Abdominal Vascular System

tunica intima

innermost layer of vessel wall

tunica media

middle layer of vessel wall

tunica adventitia (externa)

outer layer of vessel wall

arteries

thicker walls are a characteristic of _____________

arteries

________________ have internal & external elastic membranes

arteries

the tunica media is thicker in _______________

arteries

the lumen is smaller in _________________

arteries

________________ are pulsatile and not collapsible

arteries

______________ have no valves

veins

thinner walls are a characteristic of ______________

veins

_____________ have no internal or external elastic membranes

veins

the tunica media is very thin in _________________

veins

the lumen is larger in ______________

veins

_____________ are collapsible and not usually pulsatile

veins

_____________ have valves

aorta

• largest artery in the body

• arises from LVOT

aortic ectasia

absence of aorta tapering

celiac axis/trunk

first anterior aortic branch

common hepatic artery, splenic artery, and left gastric artery

the 3 branches of the celiac axis are:

common hepatic artery

right branch of celiac trunk

splenic artery

• largest branch of celiac axis

• runs left

left gastric artery

• smallest branch of celiac axis

• runs left & superiorly

superior mesenteric artery (SMA)

second anterior aortic branch

superior mesenteric artery (SMA)

the ______________ feeds the colon and the small intestine

renal arteries

arise from the aorta inferiorly to SMA at about level of 1st lumbar vertebrae

right renal artery

• longer than left renal artery

• usually runs post. to IVC and ant. to vertebral column into hilum of right kidney

left renal artery

runs from aorta directly into hilum of left kidney

inferior mesenteric artery (IMA)

one of the main branches of the aorta inferior to the aorta and the renal artery branches

tributaries

• branches that empty into IVC

• hepatic veins, Rt adrenal vein, Rt and Lt renal veins, Rt gonadal vein, inf phrenic vein, lumbar veins, Rt & Lt common iliac veins, median sacral veins

hepatic veins

• largest visceral tributary

• originate in liver & drain into IVC

• 3 branches: right, left, and middle

renal veins

5-6 branches join to form main renal vein on each side

right renal vein

• flows directly from right kidney to posterolateral IVC

• usually no tributaries into it outside kidney

left renal vein

• exits hilum of left kidney on medial side

• flows from left kidney to IVC

• longer than the right one and accepts tributaries from left adrenal, left gonadal, & lumbar veins

splenic vein, superior mesenteric vein, and inferior mesenteric vein

the 3 tributaries of the portal venous system are:

Doppler shift

the amount of the perceived frequency change

time

on a spectral Doppler display, the x axis is:

Doppler shift frequency (velocity)

on a spectral Doppler display, the y axis is:

quantity of blood flowing at a given velocity

on a spectral Doppler display, the z axis is:

laminar flow (parabolic flow)

• flow travels in layers

• normal arterial flow down a straight vessel

• fastest flow in center of vessel, slowest near vessel wall due to friction

• place cursor in center of vessel to get accurate peak velocity

• see in vessels with lower resistance/slower velocities

plug flow

• most of blood is traveling at the same velocity

• seen in vessels with higher resistance & higher velocities

resistance

• opposition to blood flow

• mainly due to friction between blood & vessel wall

blood viscosity, blood vessel radius, and blood vessel length

the three factors of resistance are:

blood viscosity

thickness of blood

blood vessel radius

how big the radius is around the lumen

increases

when blood viscosity increases, resistance _____________

decreases

when blood vessel radius increases, resistance __________

increases

when blood vessel length increases, resistance ______________

high resistance

describes flow that has little or no diastolic flow

low resistance

describes flow that has forward flow throughout diastole

spectral window

the area within a laminar or plug flow spectral profile when there are no echoes

spectral broadening

filling in of the spectral window because blood cells are flowing at many velocities

perpendicular

when the receiver is absolutely _______________ to the transmitter, there is no Doppler shift, and therefore no Doppler information is generated

parallel

the largest Doppler shift, and therefore the best Doppler information occurs when the flow is ____________ to the sound beam (Doppler angle 0)

Nyquist limit

aliasing occurs when the ____________ is exceeded

Nyquist limit

maximum frequency shift that can be displayed in PW Doppler without aliasing

PRF

aliasing can be corrected by increasing the ____________ or adjusting to a window where vessel is closer to the transducer

pulsed wave Doppler

aliasing only occurs with ______________

presence/absence, direction, and disturbance

Doppler is commonly used to detect the ________________ of flow

does not change

the flow in the celiac axis _______________ after meals

hepatic artery

always check the _____________ in heart and liver transplant patients

splenic artery

• most turbulent celiac branch

• prone to aneurysm

pancreatic pseudocysts

always do a Doppler exam (color and PW) of ______________ as they could be an aneurysm instead

non-resistive

after a meal, the SMA becomes _____________

renal arteries

have a low resistance pattern

renal veins and hepatic veins

variable flow like IVC

IVC

• variable 2-step forward/1 step back waveform

• always look for tumor or clot

athersclerosis

form of arteriosclerosis in which intimal lining of arteries is altered by the accumulation of lipids, carbs, blood, fibrous tissue, and calcium deposits

abdominal aortic aneurysm (AAA)

risk factors include over age of 60, hypertension, smoking, vascular disease, and being male

infrarenal

• most common location of aneurysm

• below the origin of the renal arteries

perirenal

• location of aneurysm that involves the level or origin of the renal arteries

• hard to repair

suprarenal

• location of aneurysm that is located above renal artery origins

• may extend above diaphragm

3

normal aortic lumen diameter is less than __________ cm

pseudoaneurysm

• a collection of blood in tissue caused by a leaking hole in an artery

• most commonly seen after catheterization via femoral artery puncture

aortic dissection

• separation of aortic wall layers with blood coursing through false lumen

• frequently fatal

Stanford and DeBakey

the two main classifications of aortic dissection are:

vascular stenosis

vessel lumen narrowed by plaque or arteriosclerotic changes

mesenteric artery stenosis/ischemia

• results from lack of adequate blood supply (ischemia) to the GI tract either due to occlusion (embolic event) or atherosclerosis

• aka mesenteric (intestinal) insufficiency

origin/proximal

majority of stenotic lesions are found in the ___________ segment of vessels

plaque

renal artery stenosis is most commonly caused by _______________

renovascular hypertension (RVHT)

the term used to describe elevated blood pressure that is primarily caused by renal artery stenosis

good perfusion

RI of .7 or less

possible rejection

RI of .7 to .9

probable rejection

RI >.9

azygous & hemiazygous veins

if the IVC is obstructed, the ______________ takes over

venous thrombosis of the lower extremities

the most common origin of pulmonary embolus (PE) is:

renal cell carcinoma

the most common malignancy to invade the IVC

normal portal vein flow

• hepatopetal flow

• decreased forward flow on inhalation

• increased forward flow on exhalation

• forward flow continuous

mild portal hypertension

• respiratory phasicity seen in normal PV flow is lost

• continuous forward flow still seen

• increased pressure in liver stops effects of respiration but does not reverse it

moderate portal hypertension

• hepatopetal PV flow only seen upon exhalation

• no flow seen on inhalation

• pressure in liver high enough to eliminate forward flow into liver with inhalation

early severe portal hypertension

• PV flow becomes back and forth with hepatopetal flow upon exhalation and hepatofugal flow on inhalation

• pressure in liver & with inhalation so high that flow reversed in PV

severe portal hypertension

• flow becomes completely hepatofugal

• pressure in the liver becomes so high that blood cannot enter it

normal portal vein flow

mild portal hypertension

moderate portal hypertension

early severe portal hypertension

severe portal hypertension