Chapter 09: The Vascular System

Front 1

anastomosis

Back 1

a communication between two blood vessels without any intervening capillary network

Front 2

aneurysm

Back 2

permanent localized dilation of an artery, with an increase in diameter of 1.5 times its normal diameter

Front 3

arteriosclerosis

Back 3

a disease of the arterial vessels marked by thickening, hardening, and loss of elasticity in the arterial walls

Front 4

arteriovenous fistula

Back 4

communication between an artery and a vein

Front 5

atherosclerosis

Back 5

condition in which the aortic wall becomes irregular from plaque formation

Front 6

Budd-Chiari syndrome

Back 6

thrombosis of the hepatic veins

Front 7

cavernous transformation of the portal vein

Back 7

periportal collateral channels in patients with chronic portal vein obstruction

Front 8

cystic medial necrosis

Back 8

weakening of the arterial wall

Front 9

dissecting aneurysm

Back 9

tear in the intima and/or media of the abdominal aorta

Front 10

Doppler sample volume

Back 10

the sonographer selects the exact site to record Doppler signals and sets the sample volume (gate) at this site

Front 11

fusiform aneurysm

Back 11

circumferential enlargement of a vessel with tapering at both ends

Front 12

inferior mesenteric artery (IMA)

Back 12

arises from the anterior aortic wall at the level of the third or fourth lumbar vertebra to supply the left transverse colon, descending colon, sigmoid colon, and rectum

Front 13

inferior mesenteric vein (IMV)

Back 13

drains the left third of the colon and upper colon and joins the splenic vein

Front 14

left gastric artery (LGA)

Back 14

arises from the celiac axis to supply the stomach and lower third of the esophagus

Front 15

left hepatic artery (LHA)

Back 15

small branch supplying the caudate and left lobes of the liver

Front 16

left renal artery (LRA)

Back 16

arises from the posterolateral wall of the aorta directly into the hilus of the kidney

Front 17

left renal vein

Back 17

leaves the renal hilum and travels anterior to the aorta and posterior to the superior mesenteric artery to enter the lateral wall of the inferior vena cava

Front 18

Marfan’s syndrome

Back 18

hereditary disorder of connective tissue, bones, muscles, ligaments, and skeletal structures

Front 19

nonresistive

Back 19

vessels that have a high diastolic component and supply organs that need constant perfusion (i.e., internal carotid artery, hepatic artery, and renal artery)

Front 20

portal vein (PV)

Back 20

formed by the union of the superior mesenteric vein and the splenic vein near the porta hepatis of the liver

Front 21

portal venous hypertension

Back 21

caused by increased resistance to venous flow through the liver; sonographic findings include dilation of the portal and splenic and mesenteric veins, reversal of portal venous blood flow, and the development of collateral vessels

Front 22

pseudoaneurysm

Back 22

pulsatile hematoma that results from leakage of blood into soft tissues abutting the punctured artery with fibrous encapsulation and failure of the vessel wall to heal

Front 23

resistive

Back 23

vessels that have little or reversed flow in diastole and that supply organs that do not need a constant blood supply (e.g., external carotid artery, brachial arteries)

Front 24

resistive index

Back 24

peak systole minus peak diastole divided by peak systole (S − D/S = RI)

Front 25

What resistive index means good perfusion? Bad perfusion?

Back 25

An RI of 0.7 or less indicates good perfusion; an RI of 0.7 or higher indicates decreased perfusion

Front 26

right gastric artery (RGA)

Back 26

supplies the stomach

Front 27

right hepatic artery (RHA)

Back 27

supplies the gallbladder via the cystic artery

Front 28

right renal artery (RRA)

Back 28

arises from the posterolateral wall of the aorta and travels posterior to the inferior vena cava to supply the kidney

Front 29

right renal vein (RRV)

Back 29

leaves the renal hilum to enter the lateral wall of the inferior vena cava

Front 30

saccular aneurysm

Back 30

localized dilation of the vessel

Front 31

spectral broadening

Back 31

change in spectral width that increases with flow disturbance

Front 32

splenic artery (SA)

Back 32

one of the three vessels that arise from the celiac axis to supply the spleen, pancreas, stomach, and greater omentum

Front 33

splenic vein (SV)

Back 33

drains the spleen; travels horizontally across the abdomen (posterior to the pancreas) to join the superior mesenteric vein to form the portal vein

Front 34

superior mesenteric artery (SMA)

Back 34

arises inferior to the celiac axis to supply the proximal half of the colon and the small intestine

Front 35

superior mesenteric vein (SMV)

Back 35

drains the proximal half of the colon and small intestine; travels vertically (anterior to the inferior vena cava) to join the splenic vein to form the portal veins

Front 36

TIPS

Back 36

transjugular intrahepatic portosystemic shunt

Front 37

true aneurysm

Back 37

permanent dilation of an artery that forms when tensile strength of the arterial wall decreases

Front 38

tunica adventitia

Back 38

outer layer of the vascular system; contains the vasa vasorum

Front 39

tunica intima

Back 39

inner layer of the vascular system

Front 40

tunica media

Back 40

middle layer of the vascular system; veins have thinner tunica media than arteries

Front 41

vasa vasorum

Back 41

tiny arteries and veins that supply the walls of blood vessels

Front 42

What are the Doppler Flow patterns for the Renal Vein?

Back 42

• Variable flow like IVC
• Evaluate with renal transplants

Front 43

What are the Doppler Flow patterns for the IVC & Hepatic Vein?

Back 43

• Vary with respiration
• Flow above and below baseline
• Affected by Rt. atrium contraction

Front 44

What are the Doppler Flow patterns for the Budd-Chiari Syndrome?

Back 44

• Thrombosis of hepatic veins
• Hepatic veins are small and echogenic
• Normal flow = No Budd-Chiari

Front 45

What are the Doppler Flow patterns for the Portal Vein?

Back 45

• Hepatopetal flow
• Continuous flow pattern; Varies slightly with respirations

Front 46

What are the Doppler Flow patterns for the Cavernous Transformation of the Portal Vein?

Back 46

• Complication of chronic portal vein obstruction
• No Extrahepatic portal vein visualized
• Echogenic porta hepatis
• Periportal collaterals

Front 47

What are the Doppler Flow patterns for Portal Venous Hypertension?

Back 47

• Hepatopetal vs Hepatofugal
• Low velocity in Portal Vein
• Patent Umbilical Vein (Definitive diagnosis)
• No respiratory variation

Front 48

What are the Doppler Flow patterns for Renal Artery Stenosis?

Back 48

• Stenoses difficult to visualize
• Collaterals may form

Front 49

What are the Doppler Flow patterns for the Renal Hydronephrosis?

Back 49

Doppler needed to rule out prominent vessels.

Front 50

What are the Doppler Flow patterns for Renal Transplants?

Back 50

• Turbulence near anastomosis
• 12% of transplants = renal artery stenosis
• Occlusion easier to diagnose in transplant than in native kidney

Front 51

What are the Doppler Flow patterns for the Aorta?

Back 51

• Flow varies at different levels
• Proximal AO has high systolic and low diastolic
• Distal has triphasic flow

Front 52

What are the Doppler Flow patterns for the Celiac Axis?

Back 52

• Spectral broadening
• Unchanged after meals

Front 53

What are the Doppler Flow patterns for the Hepatic Artery?

Back 53

• Spectral broadening
• Review after heart transplants

Front 54

What are the Doppler Flow patterns for the Splenic Artery?

Back 54

• Very turbulent flow
• Very prone to aneurysm

Front 55

What are the Doppler Flow patterns for the SMA?

Back 55

• Highly resistive for fasting
• Non resistive for eating

Front 56

What are the Doppler Flow patterns for the Renal Artery?

Back 56

• Nonresistive
• Spectral broadening

Front 57

True or False. Aneurysms smaller than 6 cm have high growth patterns. Those higher than 6 cm has low growth patterns.

Back 57

False. Aneurysms SMALLER than 6 cm have LOW growth patterns. Those HIGHER than 6 cm has HIGH growth patterns.

Front 58

What is your survival rate with an aneurysm of less than 6 cm?

Back 58

75% chance of 1 year survival.

Front 59

What is your survival rate with an aneurysm of larger than 6 cm?

Back 59

50% chance of 1 year survival.

Front 60

What is your survival rate with an aneurysm of larger than 7 cm?

Back 60

25% chance of 1 year survival.

Front 61

What is your risk of fatal rupture with an aneurysm larger than 7 cm?

Back 61

75%

Front 62

What percent of aneurisms are smaller than 5 cm?

Back 62

1%

Front 63

What is the mortality rate of surgery before aneurysm rupture? For surgery after rupture?

Back 63

5% ; 50%

Front 64

What are some MOST COMMON features of abdominal aortic aneurisms? List 5

Back 64

• Most are TRUE aneurysms
• 95% are INFRARENAL
• MURAL thrombus common in large ones
• Mycotic (infection)
• Atherosclerosis


TIMMA !

Front 65

When should surgery of aneurism be considered?

Back 65

> 5cm