Chapter 9 (Vascular Pathology)

Front 1

What pathologies of the Aorta are there?

Back 1

1. Arteriosclerosis

2. Abdominal aortic aneurysm (AAA)

3. aortic dissection

4. Pseudo-pulsatile abdominal masses

Front 2

Arteriosclerosis

Back 2

Atheromatous disease (atheroma)

Front 3

Atheroma is a vascular wall disorder characterized by the presence of lipid deposits in the _

Back 3

Intima (inner layer)

Front 4

_ _ is a soft material that can break off into the lumen to create an embolus or local thrombus

Back 4

Atheromatous plaque

Front 5

Most aneurysms are

Back 5

Infrarenal

Front 6

Arteriosclerosis causes _ of the vessel over time

Back 6

Narrowing

Front 7

_ usually occurs inferior to the renal vessels

Back 7

Arteriosclerosis

Front 8

Arteriosclerosis is found most commonly in late middle ages _ and may involve the common Iliad arteries

Back 8

Men

Front 9

Arteriosclerosis is most commonly associated with the development of an _

Back 9

Aneurysm

Front 10

AAA

Back 10

Abdominal aortic aneurysm

Front 11

AAA is defined as a permanent localized dilation of an _, with an increase in diameter.

Back 11

Artery

Front 12

The normal aortic lumen should measure less than _ _

Back 12

3 cm

Front 13

An AAA may be described as:

Back 13

1. Fusiform

2. Bulbous

3. Saccular

4. Dumbbell

Front 14

The most common presentation if atherosclerotic aneurysm is a _ aneurysm of the distal aorta at the aortic bifurcation

Back 14

Fusiform

Front 15

A _ aneurysm is typically spherical and larger than fusiform aneurysms (5-10cm) and is connected to the vascular lumen by a mouth that varies in size

Back 15

Saccular

Front 16

Back 16

AAA

Front 17

Back 17

AAA-fusiform

Front 18

Back 18

AAA- transverse

Front 19

Back 19

AAA-saccular

Front 20

Back 20

Saccular AAA

Front 21

AAA risk factors

Back 21

1. Tobacco

2. Hypertension

3. Vascular disease

4. Chronic obstructive pulmonary disease (COPD)

5. Family history for AAA

Front 22

AAA causes

Back 22

1. Atherosclerosis

2. Trauma

3. Congenital defects

4. Syphilis

5. Cystic medial necrosis

6. Increased pressure

Front 23

AAA symptoms

Back 23

1. Palpable abdominal mass

2. Back pain

3. Drop in hematocrit (rupture)

4. May be asymptomatic

Front 24

Aneurysms <4 cm in diameter are :

Back 24

Followed every 6 months with intervention of the patient becomes symptomatic

Front 25

For aneurysms >5 -6 cm in diameter:

Back 25

Surgical intervention may be suggested if the patient is in good health

Front 26

The _ _ branches into the splenic artery, common hepatic artery, and left gastric artery

Back 26

Celiac trunk

Front 27

The celiac trunk is _ to the pancreas

Back 27

Superior

Front 28

The _ _ courses along upper border of head of Pancreas, behind posterior layer of peritoneal bursa, to upper margin of superior part of the duodenum

Back 28

Gastroduodenal artery

Front 29

The _ runs posterior to the neck of the pancreas and anterior to the uncinate process

Back 29

SMA

Front 30

The _ _ _ courses from aorta posterior to IVC and anterior to vertebral column to enter the hilus of the right kidney

Back 30

Right renal artery

Front 31

Tributaries of the _ --> 3 anterior hepatic veins, 3 lateral tributaries- right suprarenal vein, renal veins, right testicular and ovarian vein, five lateral abdominal wall tributaries- inferior Phrenic vein and 4 lumbar veins, 3 veins of origin- 2 common Iliac veins, median sacral vein

Back 31

IVC

Front 32

The IVC is posterior to the head of the _

Back 32

Pancreas

Front 33

The left renal vein flows from left kidney posterior to the _ and anterior to the Aorta to enter lateral wall of IVC

Back 33

SMA

Front 34

The left renal vein accepts branches from the left adrenal, left _, and lumbar veins

Back 34

Gonadal

Front 35

The _ _ _ appears as a tubular structure posterior to the SMA and anterior to the Aorta in transverse

Back 35

Left renal vein

Front 36

The _ _ _ flows directly from the right kidney into posterolateral aspect of the IVC

Back 36

Right renal vein

Front 37

The left _ vein enters the left renal vein or left adrenal vein

Back 37

Gonadal

Front 38

_ _ are the largest visceral tributaries of the IVC

Back 38

Hepatic veins

Front 39

The hepatic vein resembles a "_" or "_" sign in transverse

Back 39

"Bunny", or "reindeer"

Front 40

The _ _ formed posterior to the pancreas by the union of the SMV and splenic vein, at the level of L2

Back 40

Portal vein

Front 41

The portal vein courses posterior to the first portion of the _ between layers of lesser omentum to enter the porta hepatis where it bifurcates

Back 41

Duodenum

Front 42

The _ _ runs along the posteromedial border of the pancreas

Back 42

Splenic vein

Front 43

The splenic vein joins the _ posterior to the neck of the pancreas to form the portal vein

Back 43

SMV

Front 44

The _ is posterior to the neck of the pancreas, where it joins the splenic vein to form the main portal vein

Back 44

SMV

Front 45

The SMV is the anterior border of the _ _ of the pancreas

Back 45

Uncinate process

Front 46

Risk factors for AAA

Back 46

Over age of 60 who smoke, hypertension, vascular disease, chronic pulmonary disease and positive family history of AAA

Front 47

Main cause of AAA

Back 47

Atherosclerosis

Front 48

Atherosclerosis and arteriosclerosis are the most common causes for _

Back 48

Aneurysms

Front 49

_ aneurysm: most common presentation of atherosclerosis

Back 49

Fusiform

Front 50

_ _ :

- complete is life threatening

- patients present with leg edema, low back pain, pelvic pain, GI complaints, and renal and liver abnormalities

- homogeneous echo mass

Back 50

IVC thrombosis

Front 51

_ has is a highly resistive vessel with decreased diastolic flow in the fasting state, with little or no flow in diastole

Back 51

SMA

Front 52

_ - low resistive vessel demonstrating enhanced diastolic flow after eating (non fasting patient)

Back 52

SMA

Front 53

_ _ _:

- thrombosis of hepatic veins

- Doppler duplex screens patients that are suspected

- hepatic veins are small with echogenic material

- presence of normal flow excludes this syndrome

- collateral vessels may be present

- rare disease; 30% are idiopathic

- associated with hematologic disorders, oral contraceptives, collagen disease, echinococcus, and periods before and after pregnancy.

Back 53

Budd Chiari syndrome

Front 54

_ _ has continuous flow patterns at low velocities; varies slightly with respiration

Back 54

Portal vein

Front 55

_ _ of the portal vein:

- seen in patients with chronic portal vein obstruction

- extrahepatic portal vein not visualized

- echogenic area present in portal hepatis

- periportal collaterals- multiple tubular structures present in porta hepatis

Back 55

Cavernous transformation

Front 56

_ _ causes patent umbilical vein

Back 56

Portal hypertension

Front 57

_ _ -(a type of spontaneous shunting) appears as a continuation of the left portal vein and extends down the anterior abdominal wall to the umbilicus

Back 57

Paraumbilical vein