Term
| What are the major abdominal venous system? |
|
Definition
1. IVC - from the common illiac veins to the diaphragm
2. IMV
3. Renal Vein
4. SMV
5. Splenic vein
6. Portal vein
7. Hepatic Vein |
|
|
Term
| How does the venous vessels look like in ultrasound? |
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Definition
| The venous vessels will demonstrate tube like structures with well defined, echogenic walls and an echofree lumen, but the wall of arteries and portal venous sturctures will be more echogenic than the thinner walled veins |
|
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Term
| What are the great vessels of the ventral cavity? |
|
Definition
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|
Term
| What is the function of the IVC? |
|
Definition
| The IVC transports deoxygenated blood towards the heart |
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|
Term
| What does the veins contain in them and how is it helpful? |
|
Definition
| The venous system contains valves, which prevent back flow of blood (called retrograde flow) during diastole |
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Term
| In real time imaging arteries show |
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Definition
|
|
Term
| The lumens in the veins open and close with ___________ |
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Definition
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Term
| What produces a more variable response with respiration? |
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Definition
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Term
| What happens when a patient does valsalva maneuver? |
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Definition
| The vessel distention may be greater when the patient holds his breath after a deep inspiration |
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Term
| Why is arteries not influenced by respiration? |
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Definition
| Arteries are not influenced by respiration since the arterial blood is under high pressure and the arterial walls are thick and strong which enables the vessel to withstand and alterations in intra-abdominal pressure caused by breathing |
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Term
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Definition
| The IVC is formed by the union of the two common iliac veins |
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|
Term
| How are the common iliac veins formed? |
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Definition
| The common iliac veins are formed by the union of the internal and external iliac veins |
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|
Term
| Where does the IVC course? |
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Definition
| IVC normally courses through the retroeritoneum, it lies to the right of the aorta and anerolateral to the vertebral processes |
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Term
| The IVC lies _________ to the right kidney and _________ to the liver |
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Definition
|
|
Term
| What multiple tributaries does the IVC gives rise to which can be accessible with ultrasound through vascular exams? |
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Definition
Lumbar veins
Right suprarenal vein
Right gonadal vein |
|
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Term
| Whats the only vessel posterior to the IVC? |
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Definition
|
|
Term
| What are the names of the 2 great vessels in the ventral cavity? |
|
Definition
|
|
Term
| What is the purpose of the IVC? |
|
Definition
| To transport deoxygenated blood back to the heart and lungs to oxygenate it again |
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Term
| What does the venous system contain within the lumen of the vessel that helps the blood more forward? |
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Definition
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Term
| If those valves are leaking or damaged, what do we call the flow of blood in those vessels when it goes in reverse or backwards? |
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Definition
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|
Term
True or False
The venous system usually demonstrates pulsatile flow? |
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Definition
False
The venous system does not usually contain pulsatile flow unless close to the heart or in right sided CHF patients. Flow is in and out with the patients respiration |
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|
Term
| What is the purpose of the Valsalva maneuver and are there any changes to the vessel itself with this maneuver is being performed? |
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Definition
| The valsalva maneuver is where the patient will take in a deep breath, hold it and bear down as if having a bowel movement. Normally the venous system will distend or dilate |
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|
Term
| What vessels form the common iliac veins? |
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Definition
| Internal and external iliac vein union |
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|
Term
| The IVC lies __________ to the right kidney and __________ to the liver |
|
Definition
|
|
Term
| How does the IVC look in ultrasound? |
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Definition
| The IVC is more elliptical than round with smaller AP measurement |
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|
Term
| Where does the IVC begin to widen? |
|
Definition
| at the level of the renal veins |
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|
Term
| What is rouleaux formation? |
|
Definition
| The normal IVC is usually anechoic, however, occasionally there are internal echoes. This is refered to as red cell aggregation or rouleaux formation |
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|
Term
| When is rouleaux formation observed? |
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Definition
| Rouleaux formation may be observed in any large vein as larger veins have slower flow. Slow flow is throught to enhance rouleaux formation |
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|
Term
| What are the sections of IVC? |
|
Definition
1. Hepatic
2. Pre-renal
3. Renal
4. Post-renal |
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|
Term
| Which is the Hepatic section? |
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Definition
| Hepatic section is where the hepatic veins empty into the IVC |
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|
Term
| Which is the pre-renal section? |
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Definition
| Pre-renal section is inferior to the hepatic veins, but superior to the renal veins |
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|
Term
| Which is the renal section? |
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Definition
| Where the renal veins and the multiple tributaries are |
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|
Term
| Which is the post renal section? |
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Definition
| post renal section extends just inferior to the renal veins until the bifurcation |
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|
Term
| Why do we look at the IVC? |
|
Definition
| The IVC is primarily evaluated to detect intraluminal thrombus or tumor invasion |
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|
Term
| The tumor invasion most commonly occurs in the _______ _______ and extends into the _______ |
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Definition
|
|
Term
| What is the most common tumor to involve the IVC? |
|
Definition
|
|
Term
| What are some normal variants of the IVC? |
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Definition
| There may be some normal variants of the IVC like a double IVC or a left positioned IVC or a portion of the vessel may be absent, but these variants are not common |
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|
Term
| Where does the Hepatic veins originate and where does it empty into? |
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Definition
| Originates in the liver and empties into the IVC |
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|
Term
| The Hepatic veins are located ________ to the renal veins |
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Definition
|
|
Term
| What are the 3 major hepatic veins? |
|
Definition
|
|
Term
| Which vein is responsible for draining all the venous blood out of the liver? |
|
Definition
|
|
Term
| which lobe does the right, left and the middle hepatic vein empty? |
|
Definition
| right lobe, left lobe and the caudate lobe |
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|
Term
| The hepatic vein ________ in diameter as they approach the IVC |
|
Definition
|
|
Term
| What causes the playboy bunny or a moose head sign? |
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Definition
| Transversely the hepatic veins look like anechoic linear structures that empty into the IVC causing a playboy bunny or a moose head sign |
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|
Term
| The hepatic veins exhibit ______, which is a reflection of _________ and _______ activity |
|
Definition
| pulsatility, cardiac and respiratory |
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|
Term
| The flow direction away from the organ is called |
|
Definition
|
|
Term
| There are small veins that drain directly into the IVC which are these veins? |
|
Definition
| Caudate lobe veins. Occasionally normal caudate veins are seen with ultrasound |
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|
Term
| Suprarenal veins are also called as |
|
Definition
adrenal veins
not normally seen with ultrasound |
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|
Term
| From where does the renal vein return blood and where does it empty? |
|
Definition
|
|
Term
| Renal vein lies _________ to the level of the renal arteries |
|
Definition
|
|
Term
| Left renal vein is ___________ than the right renal vein |
|
Definition
|
|
Term
| Which other veins does the left renal vein receive? |
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Definition
| Left renal vein receives the left gonadal vein and the left suprarenal vein |
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|
Term
| The left renal vein passes posterior to the ________ vein and __________ ______ & ______ prior to entering the IVC |
|
Definition
| splenic vein, pancreas body & tail |
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|
Term
| The LRV courses anterior to the _______ and lies between the _________ _______ and the ______ |
|
Definition
| aorta / aortic wall and the SMA |
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|
Term
| Why does the left renal vein engorge? |
|
Definition
| due to the compression by the SMA and aorta |
|
|
Term
| Where does the LRV appear dilated? |
|
Definition
| Prior to the crossing between the SMA and aorta |
|
|
Term
| Which renal vein is shorter? |
|
Definition
|
|
Term
| Where does the right gonadal vein come off? |
|
Definition
|
|
Term
| The right renal vein may also receive the _______ ________ ________ |
|
Definition
|
|
Term
| Representing the gender the gonadal veins are also known as |
|
Definition
| testicular and ovarian veins |
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|
Term
| Where does the left and right gonadal veins drain into? |
|
Definition
| the left gonadal vein opens into the left renal vein and the right gonadal vein drains directly into the IVC just inferior to the right renal vein |
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|
Term
| What does the azygos and hemi azygos vein provide? |
|
Definition
| The azygos and hemi azygos veins provide an alternate pathway for venous retun in the case of IVC obstruction |
|
|
Term
| Where is the azygos vein located? |
|
Definition
|
|
Term
| Where is the hemi azygos located? |
|
Definition
|
|
Term
| What can be mistaken for the right crus? How must this mistake be checked? |
|
Definition
| The right crus can be mistaken for either the right renal artery or vein if care is not taken to follow vessels to see if they arise from the aorta or empty into the IVC |
|
|
Term
| Why won't the left and right veins be symmetrical? |
|
Definition
| Veins open and close so the left and right veins may not be symmetrical |
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|
Term
| Why would the veins appear as large as the IVC |
|
Definition
| Since veins change in their diameter, especially prior to entering the IVC or conversely |
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|
Term
| Why would the renal veins and artry be confusing and what must be done to be sure? |
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Definition
| Renal veins are generally anterior to he renal arteries, however, crossing over frequently happens. If the anatomy is confusing, using pulsed wave or color doppler would be helpful |
|
|
Term
| What are the reasons for the IVC to get displaced? Why does it get displaced? |
|
Definition
The reasons for IVC to be displaced is
1. a liver mass
2. right renal artery aneurysm
3. lymphadenopathy
4. a tortuous aorta
5. a right renal or adrenal mass
The reason the IVC can be so easily displaced is because it is not anchored strongly
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|
|
Term
| What would be a reason to ultrasound the IVC? |
|
Definition
| to detect intraluminal thrombus or tumor invasion |
|
|
Term
|
Definition
| Red cell aggregation, red cells stack together in a similar fashion to a roll of coins. This may be observed in any large veins as larger veins have slower flow. Slow flow is throught to enhance rouleaxu formation |
|
|
Term
| What are the 4 sections of the IVC? |
|
Definition
1. Hepatic
2. Pre-renal
3. Renal
4. Post renal |
|
|
Term
| If a tumor is seen in the renal veins, what other vessel would one interrogate and why? |
|
Definition
| Tumors in the renal veins will most likely invade the IVC. Therefore a sonographer shoud also look at the IVC for tumor extension |
|
|
Term
| Where do the Hepatic veins originate, where do they end and what are their names? |
|
Definition
The hepatic veins originate in the liver and end at the IVC. There are 2 Hepatic veins -
Right, Middle and left Hepatic veins |
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|
Term
| What vessels drain all of the venous blood out of the liver? |
|
Definition
|
|
Term
| The RHV empties the RLL and the LHV empties he LLL. What does the MHV empty? |
|
Definition
|
|
Term
True or False:
The hepatic veins decrease in diameter as they approach the IVC |
|
Definition
False
The Hepatic veins increase in diameter as they approach the IVC |
|
|
Term
| What is the name of the flow of blood if it is flowing away from the liver? |
|
Definition
|
|
Term
| What is the opposite of Hepatofugal blood flow? |
|
Definition
| Hepatopetal - going towards the liver |
|
|
Term
| What 2 veins enter the left renal vein instead of the IVC? |
|
Definition
| Left Gonadal Veins and Left suprarenal veins |
|
|
Term
| Where does the right gonadal vein drain into? |
|
Definition
|
|
Term
| The _________ _______ system does not enter the IVC |
|
Definition
|
|
Term
| What is the function of the portal venous system? |
|
Definition
| The function of this system is to deliver blood from the spleen and gastrointestinal tract to the liver for metabolism and detoxification. This system is much different from the arterial and venous blood supply to the liver |
|
|
Term
What is the portal venous system made up of? |
|
Definition
1. portosplenic confluence
2. Main portal vein
3. Right poral vein with branches
4. left portal vein with branches |
|
|
Term
| Which vein is the largest vein? |
|
Definition
|
|
Term
True or False
Splenic vein is less tortuous than the splenic artery. |
|
Definition
|
|
Term
| Where does the splenic vein begin? |
|
Definition
| Splenic vein begins at the hilum of the spleen |
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|
Term
| The splenic vein passes transversely to the ______ across the posterior abdominal wall _______ to the splenic artery and _________ to the body and tail of the pancreas |
|
Definition
| right / inferior / posterior |
|
|
Term
| What does the splenic vein drain? |
|
Definition
| Splenic Vein drains part of the pancreas and stomach and the spleen |
|
|
Term
| what is used as a landmark for locating the pancreas? |
|
Definition
|
|
Term
| The splenic vein is located ________ to the pancreatic body and tail |
|
Definition
|
|
Term
| The splenic artery is tortuous but usually follows the ________ border of the pancreatic body and tail |
|
Definition
|
|
Term
| What vessels form the portosplenic confluence? |
|
Definition
| SMV, IMV and splenic vein |
|
|
Term
| What vessel joins the splenic vein to form the portospleniv confluence? |
|
Definition
|
|
Term
| What organs does the IMV drain? |
|
Definition
| The IMV drains the inferior part of the large intestines, primarily the area along the rectum, sigmoid area and the descending colon |
|
|
Term
| From its origin, the IMV courses _______ |
|
Definition
|
|
Term
| When is the IMV seen with ultrasound? |
|
Definition
| When IMV dilates with Portal HTN then it can be visible with ultrasound |
|
|
Term
| Where does the SMV originate? |
|
Definition
| SMV originates at the ileocecal valve where the ileum and small intesting join the cecum of the large intestine |
|
|
Term
| Where does the SMV course? |
|
Definition
| SMV courses superiorly towards the midline |
|
|
Term
| Prior to the confluence which 3 veins were separate entities? Once they join what is it called? and when continued laterally it is known as the _______ _______ _______. |
|
Definition
SMV, IMV & splenic vein
porto splenic confluence
main portal vein |
|
|
Term
| The main portal vein ascends obliquely to the _____ passing posterior to the superior portion of _________, _______, ________ and ________ and anterior to the ______ |
|
Definition
| right, duodenum, common bile duct, proper hepatic artery and GDA, IVC |
|
|
Term
| How much blood does the main portal vein supply to the liver? |
|
Definition
|
|
Term
| How much blood does the Hepatic artery supply to the liver? |
|
Definition
|
|
Term
| How long is the main portal vein and where does it begin? |
|
Definition
| The main portal vein is 8 cm long and begins posterior to the neck of the pancreas |
|
|
Term
| What landmark is used for the pancreatic neck? |
|
Definition
|
|
Term
| The MPV courses _________ and _______ about ________ before it enters the liver |
|
Definition
| superiorly, laterally, 5-6 cm |
|
|
Term
| Where does the MPV enter the liver? |
|
Definition
|
|
Term
| After the MPV enters the liver it divides into the ______ and ______ _______ ________ |
|
Definition
| right and left portal veins |
|
|
Term
| What vessels make up the porta hepatis? |
|
Definition
Main Portal Vein
Proper Hepatic artery
Common Hepatic duct |
|
|
Term
| why is the porta hepatis called the mickey mouse sign? |
|
Definition
| In an oblique scanning plane, the 3 vessels look like the head and ears of the mickey mouse and therefore it is called the micky mouse sign |
|
|
Term
| Which portal vein is longer and has a smaller diameter? |
|
Definition
| The left portal vein is longer and has smaller diameter than the RPV |
|
|
Term
| Before entering the left lobe of the liver the left portal vein gives branches to which lobe? |
|
Definition
|
|
Term
| what is the origin of the LPV and where does it course? |
|
Definition
| The origin of the LPV is the MPV and it courses medially |
|
|
Term
| The LPV branches into the ______ and _______ segment |
|
Definition
|
|
Term
| What does the LPV and its medial and lateral branches look like in a transverse scanning plane? Hence what is it called? |
|
Definition
| The LPV and its medial and lateral branches looks like horns of a steer hence it is called steer head sign |
|
|
Term
| What portal vein is shorter and larger? |
|
Definition
| The right portal vein is shorter and larger in diameter than the LPV |
|
|
Term
| Which vein originates from the RPV? what does it do before entering the right lobe of the liver? |
|
Definition
| The cystic vein originates from the RPV and gives a branch to the caudate lobe before entering the right lobe of the liver |
|
|
Term
| The RPV courses _________ _________ and then divides into branches called the __________ and __________ segments |
|
Definition
| right, laterally / anterior and posterior segments |
|
|
Term
| How can the portal vein be distinguished from other structures, especially the hepatic vein? |
|
Definition
| It has highly echogenic walls |
|
|
Term
| Why does the portal vein get an echognic walls around them? |
|
Definition
| The portal vein gets this echogenicity due to the high collagen content in the walls |
|
|
Term
| Why are the portal veins evaluated? |
|
Definition
| Portal veins are evaluated for thrombosis and tumor invasion and for portal HTN |
|
|
Term
| How must the portal vein be evaluated? |
|
Definition
| The portal vein is evaluated with color doppler and duplex doppler and should show blood flowing into the liver or "hepatopetal" flow |
|
|
Term
| Where does the common hepatic artery arise from? what does it bifurcate into? |
|
Definition
| Common Hepatic Artery arises from the celiac axis and bifurcates into the GDA and proper hepatic artery |
|
|
Term
| Just prior to the bifucation the CHA passes _______ to the MPV |
|
Definition
|
|
Term
| Where does the proper hepatic artery begin? Where does it ascend to? |
|
Definition
| Proper hepatic artery begins at the bifurcation and ascends to the porta hepatis of the liver within the folds of the hepatoduodenal ligament. |
|
|
Term
| What does the proper hepatic artery divide into? |
|
Definition
| It divides within the porta hepatis into the right and left hepatic arteries. |
|
|
Term
| What does the right hepatic arery give rise to? What does it supply? |
|
Definition
| The right hepatic artery gives rise to the cystic artery. The cystic artery supplies the GB, hepatic ducts and part of the CBD |
|
|
Term
True or false
The portal venous system enters the IVC |
|
Definition
|
|
Term
| What is the function of the portal venous system? |
|
Definition
| The function of this system is to deliver blood from the spleen and gastrointestinal tract to the liver for metabolism and detoxification |
|
|
Term
| Name the 4 components or segments of the portal venous system |
|
Definition
portosplenic confluence
Main portal vein
right portal vein with branches
left portal vein with branches |
|
|
Term
| What vessel is a definite landmard for the locating the pancreas? |
|
Definition
| The splenic vein, which cradles the posterior aspect of the pancreas |
|
|
Term
| What is the name of the ligament that crosses over the celiac axis? |
|
Definition
|
|
Term
| What 3 veins make up the porto splenic confluence? |
|
Definition
| SMV, IMV and the splenic vein |
|
|
Term
| What vessel supplies the liver with 80% of its blood supply and originates behind the pancreas neck? |
|
Definition
|
|
Term
| What is the porta hepatis? |
|
Definition
An area in the liver hilum that is made up of 3 vessels
1. MPV
2. CHD
3. PHA |
|
|
Term
| What is the steerhead sign? |
|
Definition
| The medial and lateral branches of the left portal vein |
|
|
Term
| What is the mickey mouse sign? |
|
Definition
|
|
Term
| What segments do the right portal vein branch into? |
|
Definition
|
|
Term
| What does the proper hepatic artery divide into? |
|
Definition
| right and left hepatic artery |
|
|
Term
| What vessel does the right hepatic artery give rise to? |
|
Definition
| cystic artery which feeds the gall bladder |
|
|
Term
| Where does the cystic vein originate and what does a branch of that vessel feed? |
|
Definition
| It comes off the right portal vein and the branch of the cystic vein feeds the caudate lobe |
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|
