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100 Cards in this Set
- Front
- Back
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From innermost to outermost, what are the three layers of blood vessels (both veins and arteries)?
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1. Tunica intima
2. Tunica media 3. Tunica adventitia |
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Of what is tunica intima composed?
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Endothelial cells
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Of what is tunica media composed?
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Smooth muscle and collagen
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Of what is tunica adventitia composed?
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A thin fibrous layer
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Which layer is markedly different between arteries and veins, and in what way?
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The tunica media layer is much thicker in arteries than in veins.
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What are the two portions of the descending aorta?
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1. The thoracic aorta
2. The abdominal aorta |
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What are three names for the first branch off the abdominal aorta?
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1. Celiac axis
2. Celiac trunk 3. Celiac artery |
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In what direction, and how far from the diaphragm, does the celiac artery branch from the aorta?
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It branches anteriorly, about 2 cm below the diagphragm
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What does the common hepatic artery supply?
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The liver
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What does the left gastric artery supply?
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The stomach and esophagus
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What does the splenic artery supply?
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The stomach, pancreas, and spleen
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What is the 2nd major branch off of the aorta?
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Superior mesenteric artery = SMA
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In what direction does the SMA branch, and where with respect to the celiac artery?
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It branches anteriorly, about 1 cm below the celiac artery
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In what directions do the common hepatic, left gastric, and splenic arteries branch from the celiac trunk?
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1. common hepatic: right
2. left gastric: superior 3. splenic: left |
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Which of the 3 branches of the celiac truck is least often observed in a sonographic transverse view?
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The left gastric artery - since it branches superiorly, it comes right into the sonographic "slice", instead of extending to the left or right
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What is the 2nd major branch of the aorta, and in what direction does it branch?
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The Superior Mesenteric Artery (SMA). It branches anteriorly.
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In which direction does the SMA travel, and where is it with respect to the pancreas?
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It travels inferiorly, posterior to the body of the pancreas
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What structures does the SMA supply with blood?
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The small and large intestines
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What is the first paired arterial branch off the abdominal aorta?
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The renal arteries
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In what direction do the renal arteries branch, and where do the branches occur with respect to the SMA and the vertebrae?
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They branch laterally, just inferior to the SMA, near the 1st lumbar vertebrae.
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How is right renal artery positioned with respect to the vena cava?
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Posteriorly
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Can the renal arteries be seen in a sagittal view?
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Usually not, but sometimes, they can.
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What is the 3rd unpaired arterial branch off the aorta? In what direction does it branch, and where does the branch occur?
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The Inferior Mesenteric Artery (IMA) branches anteriorly, about 3-4 cm superior to the aortal bifurcation.
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How does the diameter of the IMA compare to the SMA, and how does this affect its sonographic appearance?
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The IMA is smaller, and thus more difficult to see on a sonogram.
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What structure does the IMA supply with blood?
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The distal colon.
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What is the 2nd paired branch of arteries off of the aorta?
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The gonadal arteries
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In what direction do the gonadal arteries branch off the aorta, and where does the branch occur with respect to the renal arteries and the IMA?
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They branch anteriorly and laterally off the aorta, inferior to the renal arteries, superior to the IMA.
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What structures do the gonadal arteries supply in males and females, and how do they course with respect to those organs?
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They supply the testicles in males and the ovaries in females, and course inferiorly with respect to those organs.
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What is the more specific name for the gonadal arteries in males? In females?
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Males: testicular arteries
Females: ovarian arteries |
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What is the sonographic appearance of the gonadal arteries?
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They are too small to usually be seen branching off of the aorta, but you will see them when you image their respective organs.
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Where does aortal bifurcation occur?
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Near the 4th lumbar vertebrae (L4)
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What does the SMV always "point to"?
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The head of the pancreas
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Where does the left renal vein lie with respect to the aorta and SMA?
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It lies anterior to the aorta, and posterior to the SMA.
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What are the 3 types of Doppler available to the sonographer?
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1. Spectral pulse wave analysis Doppler
2. Color Doppler 3. Power Doppler |
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What information is conveyed by spectral analysis Doppler?
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The velocity of the flow, but not the direction.
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What information is conveyed by color Doppler?
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1. The mean velocity of the flow
2. The direction of the flow (with respect to the transducer) |
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What information is conveyed by power Doppler?
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The presence of a flow, but not the direction or the velocity
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What is the diameter of the renal arteries with respect to the celiac artery and the SMA, and how does this affect their sonographic appearance?
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They are smaller, and thus more difficult to see.
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Why do we try to locate the renal arteries, even though they are so small?
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Because we want to determine whether an aortic aneurysm lies close to them, because if it does, it might affect the kidneys, and the kidneys regulate blood pressure. The closer the aneurysm is to the bifurcation, the better it is for the patient.
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What technique do we sometimes use to help locate the renal arteries?
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Power doppler
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What level of gain should be used when scanning the aorta? Why?
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Low to medium gain, to demonstrate the walls without noise in the vessel
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What planes do we always want to use when scanning the aorta?
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Sagittal and transverse
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What vertebrae exist inferior to the xiphiod process?
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Usually, T11 and T12, and then the lumbar vertebrae
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Where do aortal aneurysms typically occur?
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Inferior to the renal arteries, superior to the bifurcation.
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What is arteriosclerosis?
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A thickening and loss of elasticity in arterial walls
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What is the proper medical term for "hardening of the arteries?"
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arteriosclorosis
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What is the proper medical term for "high cholesterol?"
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hyperlipidemia
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What 4 conditions can lead to arteriosclorosis?
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1. hyperlipidiemia
2. hypertension 3. cigarette smoking 4. diabetes mellitus |
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What is atherosclerosis?
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Narrowing of the lumen due to deposits of cholesterol and lipoid materials
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In atherosclorosis, where do the deposits of cholesterol and lipoid materials form?
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Within the intima and inner media of larger arteries
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What are the symptoms of atherosclorosis?
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It is normally asymptomatic, unless a significant stenosis develops
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What does "stenosis" mean?"
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Narrowing of a vessel
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What % of aneurysims are caused by atherosclorosis?
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97%
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What is the ratio at which atherosclorosis occurs in men vs. women?
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5:1
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After what age does atherosclorosis most commonly occur?
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After age 50
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What evidence of atherosclorosis might be sonographically visible?
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1. Luminal irregularities
2. Tortuosity 3. Aortic wall calcification |
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What is the nature of the ""luminal irregularities" which occur with atherosclorosis?"
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Low-level echoing along the internal walls of the aorta, especially at bifurcations
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How will the 'aortic wall calcification" which occurs with atherosclorosis manifest itself?"
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Calcium plaque produces an echogenic focus in the arterial wall, which may produce shadowing behind it, similar to what we see when we view the spine.
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What is an aneurysim?
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A localized dilation of a vessel
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What are the 3 main types of aneurysims?
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1. Berry
2. Fusiform 3. Saccular |
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What is the size and shape of a berry aneurysim?
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spherical, 1 - 1.5 cm in diameter
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Where does a berry aneurysim most commonly occur?
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Within the Circle of Willis in the brain
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What is the most common type of aneurysim in the abdominal area?
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Fusiform
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Is the shape of a fusiform dilation irregular or uniform?
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Uniform - it will balloon out equally around the vessel (it will appear on both vessel walls in a 2D view).
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How is the shape of a saccular aneurysim different from that of a fusiform?
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A saccular aneurysim ballons out only on one side of the vessel.
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What are the 3 symptoms of an aneurysm?
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They are usually asymptomatic, but may sometimes be detected as
1. A pulsatile abdominal mass 2. Lower back/abdominal pain 3. After rupture, a decreased hematocrit |
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What does "hematocrit" mean?"
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An indication of the volume of red blood cells present in the blood
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What is the normal diameter of the aorta in the abdomen?
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Less than or equal to 3 cm. in the proximal aorta, and tapering down as it travels toward the bifurcation
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What should the diameters of the common iliacs be?
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Less than 2 cm.
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Do the common iliacs need to be identical in diameter?
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No
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Can aneurysms occur in any artery, or only the aorta?
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Any artery
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Are aneurysms in smaller arteries less threatening that aneurysms in the aorta?
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Not necessarily - even small ones can be life threatening
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What diameter can aneurysms be?
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From 3 cm to 10 cm in Debra's experience, and up to 20 cm according to the literature
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Other than the dilation of the artery, what another visible sonographic symptom of an aneurysm?
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Thrombus will often form, appearing as low-level echoes along the vessel walls
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What 3 questions does the sonographer try to answer about an aneurysm?
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1. What is its size?
2. Where is it located (specifically, does it involve the renal arteries)? 3. Do we have clear flow, or is there thrombus, resulting in diminished flow? |
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Is aortic dissection a type of aneurysm?
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No, it is different, but some books do classify it as a type of aneurysm.
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What is the name that some books give to an aortic dissection?
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A "dissecting aneurysm".
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What is an aortic dissection?
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A separation in the layers of the arterial wall, which becomes filled by blood
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In an aortic dissection, what layer(s) of the vessel lining is torn?
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The intimal layer lining tears first, and sometimes the media layer then tears afterward
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How does an aortic dissection manifest itself sonographically?
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A little flap hangs out into the vessel, and pulsates with the blood flow
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What usually causes an aortic dissection?
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Hypertension
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What is the mortality rate for an untreated aortic rupture?
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100%
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At what diameter of an aneurysm can we say the risk of aortic rupture is increased?
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Greater than 7 cm
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What are the 3 non-sonographic symptoms of aortic rupture?
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1. Low or central back pain
2. Hypotension (low blood pressure) 3. Low hematocrit |
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What is the visible sonographic symptom of aortic rupture?
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Hematoma (a collection of blood) in the abdomen
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What is the standard treatment for a patient with a suspected aortic rupture?
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A very fast ultrasound scan. If blood is found in the abdomen, they are immediately sent to surgery, even if the exact site of the rupture has not been identified.
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What would be the best way to identify the site of a rupture?
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A CT or MRI scan.
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Why is ultrasound used to detect an aortic rupture, since CT or MRI scans can better identify the rupture site?
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Because ultrasound is faster.
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What word means "a collection of blood"?
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Hematoma
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Is a "leaking aneurysm" treated the same as an aortic rupture?
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No, if the leakage is slow, it is not treated as an immediate emergency.
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What is ultrasound used for with regard to grafts?
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It is used to assess whether a graft has any problems
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What are grafts usually made of?
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1. Another vessel
2. A synthetic material, usually Teflon or Dacron |
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Is the aneurysm always removed and replaced with the graft?
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Not always, the aneurysm is sometimes just bypassed
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What are the 2 sonographically visible characteristics of a graft?
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1. If synthetic material, wall brightness
2. Straighter than rest of vessel |
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What are 4 possible complications that can occur with a graft?
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1. Graft aneurysm, caused by degeneration of graft material
2. Hematoma (some of which is normal after surgery) 3. Abscess (infection) (appears echogenic) 4. Occlusion (blockage by thrombus) |
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Which complication of grafts is ultrasound most commonly requested to check for?
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Occlusion, which is also the most serious
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In which direction is it considered most important to measure the diameter of the aorta?
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The AP (anterior-posterior) diameter. This is the measurement used to make the diagnosis of an aneurysm.
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What measurements should a sonographer take of any structure of interest?
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1. Length
2. Width 3. Height |
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If you can't see the renal arteries on your long view, how can you say whether or not an aortal aneurysm involves the renals?
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If you can see 2 cm inferior to the SMA without any dilation, you can say that the renals are not involved.
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How far apart are the dots on the side of the sonographer's screen?
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1 cm
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