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76 Cards in this Set
- Front
- Back
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What is the echogenicity ladder of the liver, kidneys, pancreas, and spleen? |
Renal Sinus (hyperechoic), pancreas, spleen, liver, Renal Cortex (hypoechoic) |
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What is the purpose of the echogenicity ladder? |
Used as a reference of normal echogenicity patterns of an organ in comparison to organs in close proximity to it. |
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What are all the types of blood vessels? |
Arteries, veins, arterioles, venules, and capplilaries. |
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What are the three layers of the arteries and veins? |
Tunica adventitia (fibrous outer layer), tunica media (muscular/elastic middle layer), and tunica intima (endothelial inner layer |
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What is the main anatomical difference between arteries and veins? |
Arteries often have a thicker tunica media to allow for greater elasticity than veins. This also allows the arteries to resist pressure and become pulsatile. The veins respond to changes in respiration meaning that they are collapsible due to thinner walls and decreased pressure in their system. |
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What is referred pulsation? |
Pulses that occur in veins due to their close proximity to a closed artery. |
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What is present in veins but not in arteries? |
Valves, they allow maintenance of blood pressure. |
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What is the function of the aorta? |
The aorta channels blood to organs and its tissues to ensure oxygenation and metabolism. |
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What does the abdominal aorta supply with blood? |
The lower extremities, abdominopelvic viscera, and walls. |
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Where does the aorta originate? |
The left ventricle |
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What are the segments of the aorta? |
Ascending, arch, descending, thoracic, and abdominal. |
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What are the tributaries of the abdominal aorta? |
The celiac axis (CHA [HAP - R {CyA}, L, and M], GDA, SA, and LGA - RGA), the SMA, the renals (left and right), the gonadals (left and right), the IMV, and the common iliacs (left and right). |
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Where is the aorta located? |
Retroperitoneal, anterior and to the left of the spine. Right lateral to kidneys, spleen, ureters, and psoas muscle. |
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What is the gastroesophageal junction? |
The GE junction is the area on the diaphragm where the esophagus passes through it. Just below this landmark is the right crus. |
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How can you determine if a vessel is an artery or a vein sonographically? |
Assess pulsatility (only in arteries), collapsibility (veins), response to respiration (veins open), and doppler characteristics (direction of flow). Also, artery walls are more reflective than vein walls. |
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Is it normal to see some blood flow in the IVC? |
Yes! This is from the clumping of red blood cells. |
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What are some indications that someone might need a sonogram of their aorta? |
Pulsatile abdominal mass, hemodynamic compromise in the lower limb arterial system, abdominal pain, or abdominal bruit (the sound blood makes as it rushes past an obstruction). |
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Explain a routine scan of the aorta. |
Scanned from the diaphragm to the bifurcation and proximal common iliac arteries in longitudinal and transverse. You will asses the smooth, homogenous width of the vessel, the anechoic lumen, pulsatility, size of the aorta. |
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What should the average size of the aorta be? |
Between 2-2.5cm wide proximally, and 1.5cm distally. |
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How long is the celiac trunk? |
about 1cm it should exit the aorta about 2-3cm below the diaphragm. |
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What are the branches of the celiac trunk? |
The common hepatic artery (right), the splenic artery (left), and the left gastric artery (left). |
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Where does the LGA travel to and what does it supply? |
LGA courses superiorly and to the left, and doubles back to supply the left side of the lesser curvature of the stomach. It will eventually anastomose with the right gastric artery. This artery gives off smaller branches to supply the stomach and the esophagus. |
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Where does the right gastric artery originate from, and where does it supply? |
RGA originates off of the hepatic artery proper, and supplies the right side of the lesser curvature of the stomach. |
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Where does the splenic artery travel to and what does it supply? |
This is the largest branch of the CT, it is tortuous, and feeds the pancreatic body, head, and tail, and the left side of the greater curvature of the stomach (gastroepiploic artery-branch of SA). It courses horizontally to the left with slight inferior to superior angulation posterior to the pancreas and anterior to the kidney. |
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What are the "Gull Wings"? |
The celiac trunk, splenic artery, and common hepatic artery in transverse. |
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What does the common hepatic artery branch into and where does it travel? |
Courses horizontally to the right and branches into the gastroduodenal artery and proper hepatic artery. Supplies the liver, gallbladder, duodenum, and pancreatic head. It lies anterior to the main portal vein and medial to common bile duct. |
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Where is the origin of the GDA and what does it supply? |
The GDA is a branch off of the common hepatic artery and courses inferiorly, supplying the right side of the greater curvature of the stomach (right gastroepiploic artery) and the pancreatic duodenal area (pancreatic duodenal arteries). It passes anterior or through the pancreatic head. |
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What vessel does the GDA anastomose with? |
Branches of the SMA. |
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What is the hepatic artery proper? |
A continuation of the CHA after the GDA origin, it travels obliquely, to the right and superior to the hepatic hilum. It lies anterior to the main portal vein and medial to CBD and gives rise to the left, middle, and right hepatic arteries. |
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What do the right left and middle HAs supply within the liver? |
They each supply their respective liver (middle supplies the whole liver), and all of them supply the caudate lobe. |
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Where does the cystic artery arise and what does it supply? |
The CysticA arises off of the right hepatic artery, and feeds the gallbladder, cystic duct, and extra hepatic biliary ducts. |
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What anatomy does the SMA supply? |
The small bowel, cecum, ascending, and most transverse colon. |
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What are the tributaries of the SMA and what do they supply? |
Inferior-anterior pancreatic duodenal artery and the inferior-posterior duodenal artery feed the pancreatic head and duodenal area. |
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Why is the SMA so easily visible in transverse images? |
There is a rim of hyperechoic fat surrounding the vessel, this is used as a landmark. |
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What renal artery has a longer course to supply their respective kidney? |
The Right Renal Artery - most course posterior to the IVC and anterior to the spine to reach the kidney. |
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Explain the "nutcracker phenomenon" |
When the left renal vein courses anterior to the Aorta but posterior to the SMA, the vein can get compressed between the two vessels. |
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Are the arteries anterior of posterior to the veins? |
In the upper abdomen the arteries are posterior to the veins, in the lower abdomen the arteries are anterior to the veins. |
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Where do the gonadal arteries originate and what anatomy do they supply? |
They originate from the anterior aspect of the aorta and course inferiorly to their respective organs (left originates slightly superior to the right). The male gonadals termed the testiclular arteries, and the female gonadals are termed the ovarian arteries (they supply that anatomy). |
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Where does the IMA travel and what does it supply? |
It travels anteroinferiorly and supplies the transverse colon, sigmoid colon, descending colon and the rectum. |
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What is the most common anomaly for the great vessels? |
Vessel duplication |
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What is the average diameter of the Iliac arteries? What landmark to they originate at? |
0.8-1cm The level of the umbilicus at about the 4th or 5th lumbar vertebrae. |
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Where does the IVC drain blood from? |
From below the diaphragm to the right atrium of the heart. |
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What anatomy is located posterior to the IVC? |
Spine, right crus, right adrenal, right renal artery. |
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What anatomy is anterior to the IVC? |
liver, main portal vein, pancreatic head, the stomach (pyloric part), and the 1st and 3rd part of the duodenum. |
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Where do the hepatic veins originate, and what do they drain? |
HVs originate at the most superior aspect of the IVC and they drain the lobes of the liver. |
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Which is the largest hepatic vein? |
The Right |
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Where does the RHV travel and what does it drain? |
It travels superiorly, medially, and somewhat posteriorly to drain the right lobe of the liver. |
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What does the left/middle hepatic vein drain and how does it travel? |
Both the middle and left travel superior and posterior to reach the IVC. The middle drains the caudate lobe and the left drains the left lobe. |
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What is the "playboy bunny"? |
The left and middle hepatic veins have a common trunk that drains into the IVC creating a bunny image. |
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Where do the renal veins travel and what do they drain? |
Both veins course laterally to the kidneys that they drain. the left renal vein passes through the aorta/sma nutcracker and the RRV is depressed due to pressure from the liver. |
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What do the gonadals drain? What do they drain into? |
"pampiform plexus" drains the ovarian/testicular area into the gonadals, the right gonadal drains into the IVC, and the left gonadal drains into the LRV. |
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What does a routine scan of the IVC look like? |
Starting at the diaphragm and ends at the level of the right renal artery or even more inferior if the image allows it, assessing for anechoic lumen, echogenic thin walls, and any change in caliber with respiration. |
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What is the average size of the IVC? |
The sizes vary with respiration, but an average is 3.5cm |
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Where do many of the anomalies for the IVC arise? |
Below the level of the renals. |
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What happens if the IVC is compromised? |
The azygous vein will drain the body of deoxygenated blood. |
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What width should the IVC not exceed? |
3.7cm |
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Why are the venous walls thinner than those of arteries? |
Veins have thinner tunic media layers because the venous system is a low pressure system. |
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What does the portal venous system drain? |
The digestive system, the pancreas, and the spleen. |
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What kind of blood does this transport to the liver? |
Nutrient rich |
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How much blood is supplied by the portal system vs the arterial system? |
60-80% is provided by the portal system and 20-40% is supplied by the arterial system. |
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How is the portal vein formed? |
The confluence of the splenic vein and the SMV posterior to the neck of the pancreas at the level of the second lumbar vertebrae. |
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What are the alternate names for the left and right gastric veins? What do they drain? |
LGV - Coronary RGV - pyloric They drain the lesser curvature of the stomach |
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What is the average size of the main portal vein? |
11mm plus or minus 2, just superior to the confluence (SMV-6-7mm and SV-4-6mm). |
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Are there usually anomalies within the portal system? |
Not normally, a non-pathologic anomaly would be the joining of the IMV at the portal confluence or on the SMV. |
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What are the branches of the main portal vein? |
Right portal and left portal veins |
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What are the divisions of the right portal vein? |
Anterior and posterior branches |
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How is the RPV different from the LPV? |
The RPV is shorter and fatter than the left, which is long and thin. The RPV is also more posterior and caudal than the anterior and cranial LPV. |
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What does the right portal vein supply? |
supplies the right and caudate lobes of the liver, intralobar. |
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Which have more echogenic walls: portal veins or hepatic veins? |
PORTAL VEINS, this is due to the rim of connective tissue around the portal system. |
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What are the divisions of the LPV? |
Medial and lateral branches |
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What lobes does the LPV supply? |
left lobe, and caudate lobe. |
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What portal vein is not intrasegmental? |
The ascending left portal vein divides the left lobe into medial and lateral segments. It lies within the left intersegmental fissure. |
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What are some pathologies relating to the liver? |
neoplasia, inflammatory processes, metabolic processes, and parasites. |
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What is the Glisson's capsule? |
The liver is intraperitoneal and lives within a capsule made of connective tissue called the glisson's capsule. This capsule folds and travels within the liver to form part of the fibrous sheath of the portal triad. |
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What is the liver's anatomical relationship to the diaphragm? |
the liver is inferior, anterior, and medial to the diaphragm. |
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What is the lesser sac? |
The intraperitoneal compartment between the stomach and the pancreas. |
