aorta and ivc

abdoment test 2

typically blood vessels are composed of __ distinct layers

\`3

__ - the inner most layer of a vessel wall

tunica intima

tunica intima is composed of a lining of __ cells, elastic, and connective tissue

endothelial

__ - the middle lining

tunica media

tunica media is composed of elastic fibers and __

smooth muscle

__ - the outer layer

tunica adventita

tunica adventita is composed of elastic and __ fibers

collagen

what makes arteries different from veins?

arteries have a thicker tunica media

tunica media is largely responsible for the elasticity and __

contractility

__ from tunica media helps maintain the vessel shape so that they do not collapse

thickness

__ - a network of small arterioles, capillaries and venules that supply the outer tissues of large blood vessels like the aorta

vasa vasorum

veins have less __ muscle and __ tissue composition than do arteries

smooth and elastic

veins lack contractility to force blood through their __

lumen

venous return to the heart is accomplished by:


1. __, the difference between the arterial and venous systems

pressure gradient

venous returns to the heart is therefore accomplished by:


2. __ __

respiratory motion

venous return to the heart is therefore accomplished by:


3. contractions of __

skeletal muscles (calf muscles)

venous return to the heart is therefore accomplished by:


4. network of __ within the lumen of veins which prevents __

valves

back-flow

__ - originates at the left ventricle of the heart and is the main artery of the chest and abdomen

aorta

the aorta originates at the __ ventricle of the heart

left

the aorta is the main artery of the __ and __

chest and abdomen

__ - formed as the aorta leaves the heart and travels superior (ascending aorta) and to the right then curves posteriorly and to the left (descending aorta)

aortic arch

__ - portion of the aorta between the arch and the diaphragm

thoracic aorta

__ - once the aorta pierces the diaphragm It is termed

abdominal aorta

__ - into the common iliac arteries about the level of the umbilicus

bifurcaation

__ - first branch of the abdominal aorta

celiac axis (CA) or celiac trunk

the celiac axis originates from the __ aspect of the aorta

anterior

the celiac axis is usually located within the first __ cm of the abdominal aorta after It penetrates the diaphragm

2

how many branches is the celiac axis divided into

3

once inside the liver, after the gastroduodenal artery (GDU?) branches off, the common hepatic artery is termed the __

proper hepatic artery

what are the three branches of the celiac axis?

1. common hepatic artery
2. left gastric artery
3. splenic artery

__ - the second major branch originating from the abdominal aorta

superior mesenteric artery (SMA)

the SMA originates approximately __ cm below the celiac axis

1-2

the SMA runs __ to the pancreas

posterior

__ - just inferior to the SMA

renal arteries

both the left and right renal arteries course __ to enter the kidneys at the renal hilum

posterolaterally

both the left and right renal arteries course posterolaterally to enter the kidneys at the __

renal hilum

__ - the last major branch arising from the abdominal aorta prior to aortic bifurcation

inferior mesenteric artery (IMA)

the IMA originates from the __ aspect of the abdominal aorta

anterior

the IMA courses slightly to the __ and __ into the abdomen

left and inferior

__ artery is not easily visualized on ultrasound, unless there is pathology

IMA

__ - divides into the left and right common iliac arteries at approximately the umbilicus

aortic bifurcation

aortic bifurcation divides into left and right __ at approximately the umbilicus

common iliac arteries

the aortic bifurcation courses __ and __ into the lower extremities

inferior and posterior

sonographically, the __ of all vascular structures should appear anechoic

lumen

the aorta can be seen as an anechoic, tubular, structure immediately anterior to the __

spine

the aorta sits just left of __

midline

the aorta travels __ and more __ from origin

inferior and anterior

as the aorta courses caudally, it __ and becomes smaller in caliber

tapers

__ - closest to heart. contains both the celiac axis and the superior mesenteric artery

proximal aorta

__ - will demonstrate the proximity between the CA and the SMA to the best advantage

longitude plane

__ plane - first branch is the celiac axis

transverse

in the transverse plane the celiac axis resembles __

wings of a seagull

__ - below SMA

mid aorta

the mid aorta includes __

renal arteries

__ - just above bifurcation

distal aorta

__ - in transverse, It appears round and is surrounded by an echogenic “tent”, consisting of fat

SMA

SMA can be seen in __

sag or trans

__ - immediately inferior to the origin of the SMA

renal arteries

the renal arteries are well demonstrated in the __ plane

transverse

__ - at approximately the level of the umbilicus, as a splitting of the aorta

right and left common iliac arteries

__ - large vessel that returns blood to the heart from the lower portions of the body

IVC

the IVC courses __ to enter the right atrium of the heart

anteriorly

the IVC courses anteriorly to enter the __ atrium of the heart

right

the sonographic appearance of the IVC resembles a __ in long axis

hockey stick

the IVC is a __ or __ shape in the transverse plane

oval or tear-drop

the IVC responds to __ variations

respiratory

during __ the IVC may collapse

inspiration

during __ the IVC may expand

expiration

suspended respiration causes the IVC to __, due to increased __ pressure and decreases blood flow to the heart

expand, thoracic

what is another term for the valsalva maneuver

bear down

the valsalva maneuver causes the IVC to __ due to increaased abdominal pressure

collapse

the __ and __ veins are those most consistently demonstrated entering the IVC

renal and hepatic

__ - empty directly into the IVC and located most superior

hepatic veins

what are the three hepatic veins

left middle right

hepatic veins are demonstrated in the __ plane with the transducer placed just inferior to the xiphoid and angled towards the patients RT shoulder

transverse

partial imaging of the RHV with the elongated MHV and LHV is known as the __ or __ sign

playboy bunny or rabbit ear

the __ renal vein is shorter, due to the close proximity to the IVC

right

the __ vein traverses the abdomen anterior to the aorta and posterior to the SMA to enter the lateral aspect of the IVC

left renal

the left renal vein traverses the abdomen __ to the aorta and __ to the SMA to enter the lateral aspect of the IVC

anterior, posterior

what system is SEPARATE from the IVC

portal venous system

__ - formed at the junction of the splenic vein and the superior mesenteric vein

main portal vein

the main portal vein does not return blood to the heart but brings blood to the __ from the __

liver, bowel

the main portal vein travels __ and __ before entering the liver

obliquely, anteriorly

the main portal vein is divided into the __ and __ branches

right, left

__ - emerges from the splenic hilum and courses medially

splenic vein

the splenic vein emerges from the splenic __ and courses medially

hilum

__ - merges with the splenic vein at the confluence to form MPV

superior mesenteric vein

__ - where the SMV and splenic vein merge

portosplenic confluence (PSC)

normal measurement for the aorta at the level of the diaphragm is __

2\.5 cm

normal range of measurement for the aorta at the level of bifurcation is about __

1\.5-2.0 cm

__ - > or = 3.0 cm

aneurysmal aorta

__ - is slightly widened, up to 3.0 cm luminal diameter

ectatic aorta

__ - focal dialation (widening) of an artery caused by a structural weakness in the wall

true aneurysm

these are signs and symptoms of what?

* pulsatile mass
* abdominal pain
* back pain

s/s true aneurysm

__ - uniform dilation of aorta

fusiform

__ - saclike protrusion on one side of the aorta

saccular

__ - weakening of the wall due to infection

mycotic

__ - small spherical aneurysm 1-1.5 cm in diameter in a cerebral artery

berry

abdominal aortic aneurysms of any size can rupture, however most likely, larger than __

7 cm

these signs and symptoms refer to __:

* central back pain
* sudden hypotension

aneurysm rupture