Abdominal vessels
1 / 99

ABDOMINAL VESSELS - PowerPoint PPT Presentation

  • Uploaded on

ABDOMINAL VESSELS. I. Introduction/General Information A. Uses for ultrasound 1. Screening procedure for abdominal abnormalities 2. Localize/Characterize masses 3. Measurement, rate, direction of blood flow via Doppler .

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about ' ABDOMINAL VESSELS' - gage-pace

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  • I. Introduction/General Information

  • A. Uses for ultrasound

  • 1. Screening procedure for abdominal abnormalities

  • 2. Localize/Characterize masses

  • 3. Measurement, rate, direction of blood flow via Doppler

  • General Information, continued …

    B. Heart:

    1. CVT used on adults

    2. Ultrasound used in utero

    • C. Abdominal vessels

  • 1. Abdominal aorta

  • a. Ultrasound can delineate contour, course & size

General Information, continued …

b. Can evaluate entire course

c. Used to diagnose, follow progress of aneurysms

d. Can distinguish between normal and aneurysm aortic pulsations

Abdominal Vessels, continued …

2. Celiac axis (trunk, artery)

a. First unpaired branch off abdominal aorta (~ L-1)

b. Originates from ventral surface

c. Gives rise to splenic, common hepatic, & left gastric arteries

Abdominal Vessels, continued …

3. Superior Mesenteric Artery

a. Second, unpaired branch of abdominal aorta

b. Originates ~ lower L-1 body

c. 1 – 2 cm below celiac axis

d. Supplies small intestines, pancreas, omentum, ascending and transverse colon

Abdominal vessels con t
Abdominal Vessels, con’t…

4. Inferior Mesenteric Artery

a. Arises just above the bifurcation of the aorta (~L-3/4)

b. Last unpaired branch of aorta

c. Supplies jejunum, descending and sigmoid colon, rectum

Abdominal Vessels, continued … Arteries

4. Renal arteries

a. First major paired branches from aorta

b. Arise opposite each other 1-2 cm below SMA (~L-2)

c. Multiple renal arteries occur in 20% of patients

Renal arteries
Renal Arteries Arteries

Figure 19.11

Abdominal Vessels, continued … Arteries

5. Common Hepatic Artery

a. Right branch of celiac a.

b. Continues to GDA, then…

6. Proper Hepatic Artery

a. Branches within liver

b. Begin at ~porta hepatis

Abdominal Vessels, continued … Arteries

7. Inferior Vena Cava

a. Formed at ~ L-5

b. by union of Common Iliac Veins

c. Largest vein in body

d. Dilation may be due to:

1. right-sided CHF

2. Portal hypertension

Major veins of the abdomen
Major Veins of the Abdomen Arteries


Figure 19.21

Abdominal Vessels, continued … Arteries

8. Veins of Portal Circulation

a. SMV: joins with splenic vein

1. runs parallel to SMA

2. On right side of abdomen

b. IMV: terminates in splenic vein

c. Portal Vein: enters liver

Veins of the hepatic portal system
Veins of the Hepatic Portal System Arteries

Figure 19.23

Abdominal Vessels, continued … Arteries

d. Renal Veins – run parallel to renal arteries

Major veins of the abdomen1
Major Veins of the Abdomen Arteries

Figure 19.21

Veins of the right lower limb and pelvis
Veins of the Right Lower Limb and Pelvis Arteries

e. Femoral Veins - run parallel to femoral arteries

f. Popliteal Veins – run parallel to popliteal arteries

Figure 19.24a

  • 1. Size:

  • a. ~ 2.5 cm – 0.5 mm

  • b. inside diameter

  • c. Arbitrary designation

  • 2. Structure: 3 coats or tunics

    • Detailed Anatomy, con’t… Arteries

      • a. Tunica intima

      • 1. aka: tunica interna

      • 2. innermost layer

      • 3. = endothelium

      • 4. thin: 1 cell layer + basement membrane

    Vascular tunics tunica intima
    Vascular Tunics: Tunica Intima Arteries

    Tunica Intima




    Structure, Arteries, continued … Arteries

    b. Tunica media

    1. thickest layer

    2. smooth muscle & connective tissue (mostly elastic)

    3. in lamina

    4. fibers circularly arranged around lumen

    Vascular tunics tunica media
    Vascular Tunics: Tunica Media Arteries

    Tunica Media

    Structure arteries, continued … Arteries

    c. Tunica externa

    1. thinner than media

    2. thicker than intima

    3. white fibrous C. T.

    4. A few smooth muscle fibers, arranged longitudinally

    Vascular tunics tunica externa
    Vascular Tunics: Tunica Externa Arteries

    Tunica Externa

    Arteries, continued … Arteries

    3. Variability of arteries

    a. larger elastic arteries:

    1. aorta, pulmonary, carotids

    2. have thicker tunica intima

    3. increased elastic tissue

    Arteries, variability, continued … Arteries

    4. very thick tunica media

    a. smooth muscle

    b. obscured by elastic tissue

    5. tunica externa is

    a. thin but strong

    b. limits stretch

    Structure, arteries, continued Arteries

    6. Serve as “shock absorbers”

    a. expand & contract

    b. accommodate the pressure from pumping of the heart

    c. Maintain blood flow

    Structure, arteries, continued Arteries

    7. arteriosclerosis leads to:

    a. decreased elasticity

    b. increased blood pressure

    c. High B.P., aneurysm, rupture of vessels

    Variability, Arteries, continued … Arteries

    b. Muscular arteries

    1. farther from the heart

    2. tunica media

    a. more smooth muscle

    b. Less elastic tissue

    c. controlled by ANS

    Elastic vs muscular arteries
    Elastic vs. Muscular Arteries Arteries

    Elastic Artery

    Muscular Artery

    Variability, Muscular Arteries, continued … Arteries

    3. actively influence blood flow, pressure

    4. ANS:

    a. triggers smooth muscle contraction

    b. Sympathetic and parasympathetic responses

    Variability, arteries, continued … Arteries

    5. have capacity to establish collateral circulation

    6. Especially coronary arteries

    7. contract when injured

    a. ANS reaction

    b. Prevents blood loss

    • Detailed anatomy, continued … Arteries

      • B. Arterioles: small arteries < 0.5 mm

      • 1. Lie close to capillary beds

      • 2. Muscular

      • 3. Primary function: regulate capillary blood flow

      • 4. Allows for exchange of materials between blood and tissues

    • Detailed anatomy, continued … Arteries

      • C. Capillaries (sinusoids)

    • 1. Size: 1 mm long x 10 micrometers diameter

    • 2. Structure

    • a. Wall: 1 cell layer thick (endothelium)

    • b. inner surface contacts blood

    Capillaries, continued … Arteries

    c. outer surface rests on basement membrane

    d. Beyond basement membrane:

    1. loose connective tissue

    2. contains tissue fluid ( = plasma outside of blood stream)

    • Capillaries, continued … Arteries

      • 3. Organization of capillaries:

    • a. Form vast, complex networks

    • b. Penetrate to reach most tissues

    • c. Pre-capillary sphincter:

    • 1. smooth muscle rings

    • 2. regulate blood flow between arterioles & capillary beds

    • Capillaries, continued … Arteries

      • d. Capillary beds: (~ 60,000 miles)

      • 1. Specialized for exchange of materials

      • 2. each pound of adipose tissue contains 200 miles of capillaries

    Capillary networks
    Capillary Networks Arteries

    • Capillaries connect arterioles to venules

    • Blood flow is from the arterial to the venous vessels

    • Every millimeter of tissue has capillary blood supply

  • 1. Vessels closest to capillary beds

  • 2. carry deoxygenated blood

  • 3. Small venules: structurally similar to large capillaries

  • 4. Medium venules: contain a few circular muscle fibers

  • 5. Large venules: have a tunica externa

  • 1. Structure: same tunics, but not as distinct

  • a. Tunica media may be absent

  • b. Tunica externa: usually thickest

  • 1. Provides strength to outer wall

  • 2. Lots of smooth muscle fibers

  • 3. Less elastic tissue

  • Vascular tunics veins
    Vascular Tunics: Veins Arteries

    Tunica Externa

    Tunica Media

    Tunica Interna

  • a. Folds of tunica intima

    • b. Prevent backflow

    • c. Absent in venae cavae, pulmonary & portal veins

  • Valves in veins
    Valves in Veins Arteries

    Venous Valve

    • Valves, continued … Arteries

      • 2. Internal jugular veins have valves

      • a. are “upside down”

      • b. blood is flowing back to heart c. when heart contracts, pushes blood up into SVC

      • d. valves keep -O2 blood from going back up into brain

    Valves assisted by skeletal muscles
    Valves Assisted by Skeletal Muscles Arteries

    • Skeletal muscle contraction, especially in the extremities, assists the flow of blood back to the heart

    • Varicose Veins…..

    Pathways of Major Vessels Arteries

    F. Path of major vessels

    1. Abdominal aorta

    a. Continuous with thoracic aorta @ diaphragm.

    b. Passes through @ T-12/L-1

    c. Most inferior hiatus in diaphragm

    Pathway of Major Vessels, continued … Arteries

    d. Anterior & to the left of vertebral bodies

    e. Decreases in external diameter caudally

    1. 3.0 cm @ left ventricle

    2. 1.5 cm @ bifurcation

    f. Moves toward midline distally

    Path of aorta
    Path of Aorta Arteries

    • Parasagittal section through the thorax and abdomen showing the path of the aorta

    Pathway of Major Vessels, continued … Arteries

    g. Bifurcates into R/L common iliac arteries @ L-3/L-4

    h. Courses posterior to IVC near diaphragm

    i. Curves anteriorly along lumbar curvature

    • Pathway of Major Vessels, continued … Arteries

      • 2. Celiac Artery

    • a. First unpaired branch of abdominal aorta (~T-12)

    • b. Gives rise to:

    • 1. Splenic Artery:

    • a. largest on left

    • b. supplies spleen, pancreas fundus of stomach

    The celiac trunk and its branches
    The Celiac Trunk and its Branches Arteries

    • The celiac trunk is the first unpaired artery of the abdominal aorta

    • It arises ~T-12/L-1 disc

    Celiac Trunk

    Major Paths of Vessels, Celiac Artery, continued Arteries

    c. L. Gastroepiploic Artery

    1. Largest branch of splenic artery

    2. supplies greater curvature of stomach

    Celiac artery, continued … Arteries

    2. Left Gastric Artery:

    a. smallest of 3 branches

    b. Supplies: 1. Cardiac region

    2. lesser curvature of stomach

    3. Lower esophagus

    Celiac artery, continued … Arteries

    3. Common Hepatic Artery:

    a. courses toward right

    b. supplies pyloric region of stomach & duodenum

    c. gives rise to gastroduodenal artery

    d. Continues as proper hepatic artery

    Hepatic artery
    Hepatic Artery Arteries

    Proper Hepatic Artery

    Common Hepatic Artery

    • Path of major vessels, continued … Arteries

      • 4. SMA

    • a. Second unpaired branch

    • b. Arises 1 – 2 cm below celiac artery

    • c. May have common origin

    • d. After ~6”,

    • 1. courses parallel to aorta

    • 2. then turns oblique toward right iliac fossa

    • SMA, continued … Arteries

      • d. Numerous branches that sometimes anastomose

      • e. Supplies:

      • 1. small intestines

      • 2. cecum

      • 3. appendix

      • 4. ascending & transverse colon 5. pancreas

    Superior mesenteric artery
    Superior Mesenteric Artery Arteries

    Superior mesenteric artery

    SMA gives rise to the inferior pancreaticoduodenal artery

    Path of major vessels continued
    Path of major vessels, continued … Arteries

    5. Renal Arteries/Veins: a. First major paired branch of abdominal aorta

    b. Arise ~L-2

    c. more later

    Path of major vessels, con’t… Arteries

    6. IVC: arises ~L-5

    a. lies to right of lumbar vertebrae

    b. Largest vein

    c. Occupies a fossa on posterior surface of liver

    d. Receives hepatic veins


    IVC, continued … Arteries

    e. Penetrates diaphragm at T-10

    f. passes through pericardium

    g. empties into right atrium

    h. IVC receives blood from lower extremities, lumbar v., renal v., adrenal v.

    IVC and its Tributaries Arteries

    Pathway of IVC and its major contributing veins

  • a. Receives blood from digestive organs

  • b. Is high in nutrients  enters portal vein  then to liver sinusoids

  • c. then to hepatic veins  into IVC

  • Portal system, continued … Arteries

    d. Portal Vein:

    1. formed ~L-2 by union of SMV & splenic vein

    2. travels superiorly surrounded by lesser omentum

    3. Enters liver at porta hepatis

    Portal vein formation
    Portal Vein Formation Arteries


    • III. Gray Scale Anatomy Arteries

    • A. Abdominal aorta

    • 1. Circular in T.S.

    • 2. Tubular in L.S.

    • 3. Differences from IVC:

    • a. IVC lies to the right

  • d. Aorta pulsates

  • 4. Slopes anteriorly to L-3/4

  • Gray scale anatomy, continued … Arteries


    1. Extends from ~3 cm below diaphragm to umbilicus

    2. Horizontal course on L.S.

    3. Origin is 1 – 2 cm below celiac

    4. Lies anterior to aorta

    SMA, continued … Arteries

    4. In T.S.:

    a. sonolucent circular structure

    **b. posterior to body of pancreas

    5. Surrounding fat  collar

    a. Different from SMV

    b. SMV larger & to the right

    • Gray scale anatomy, continued … Arteries

      • C. Celiac trunk/axis/artery

      • 1. ID-ed on T.S. as tubular branching structure

      • 2. Originates from anterior aorta

      • 3. Short, “vertical” (really anterior) course superior to lesser curvature

      • 4. Hepatic and splenic artery branches produce “seagull” sign

    The “Seagull” Sign Arteries

    Splenic Artery

    Hepatic Artery

    Celiac Trunk

    IV. Vascular Pathology Arteries

    A. Tortuosity of abdominal aorta

    1. Aorta becomes elongated, dilated & less elastic with age

    2. Due to plaque & calcification

    3. May become tortuous

    4. May lie to right of midline

    5. May mimic an aneurysm

  • 1. Definitions:

  • a. circumscribed dilation of an artery

  • b. blood-containing tumor connecting with lumen of artery

  • 2. Fusiform or saccular dilations

  • 3. Usually appear distal to renal arteries

  • Aneurysms, continued … Arteries

    4. Measurements abnormal if:

    a. External A-P diameter >3.5 cm in upper abdomen

    b. > 2.5 cm in distal aorta

    5. Patent vessel lumen contains blood, is echolucent

    Aneurysms, continued … Arteries

    6. Thrombus-filled lumen is echogenic

    7. Ectatic (dilated) aorta difficult to depict on single scan

    8. Associated with arteriosclerotic plaque

    Aneurysms, continued … Arteries

    9. Excess plaque causes:

    a. loss of elasticity

    b. weakening in tunica media

    c. Tears in tunica interna

    Aneurysms, continued … Arteries

    10. Fusiform aneurysms

    a. usually project anterior & to the left

    b. path of least resistance

    c. Laminar blood flow absent in dilation

    d. Eddy currents increase likelihood of thrombus

    Aneurysms, continued … Arteries

    11. Ultrasound is > 95% accurate in identifying AAA

    a. Presence/location & serial growth

    b. Diameter determination

    c. Thrombus presence

    d. Incidence of rupture of aneurysm increases after 7.0 cm

  • 13. Less common to find aneurysm above renal arteries

  • 13. If dilation is above renal arteries, suspect dissecting thoracic aneurysm

  • 14. If dilation extends distally, survey common iliac arteries

    • Aneurysms, continued … Arteries

      • B. Aortic Dissection

    • 1. Usually secondary to dissecting thoracic aortic aneurysm

    • 2. Dilation of abdominal aorta with double lumen

    • 3. Characteristics:

    • a. Intimal flap

    • b. Diffuse dilation

    Aortic dissection, continued … Arteries

    4. Pulsations of flap are visible

    5. Aneurysms of ascending aorta enlarge anterior and to the right

    a. May extend to mediastinum

    b. May erode sternum

  • 1. Atherosclerosis (reversible)

  • a. deposits of fatty materials b. in tunica intima of arteries

  • c. Genetic predisposition-- leads to 

  • 2. Arteriosclerosis (irreversible)

  • a. infiltration of intima by plaque

  • b. reduces lumen size

  • c. Reduces blood supply

  • d. “hardening of the arteries”

  • Vascular Pathology, con’t… Arteries

    • E. Types of aneurysms

      • Axial – involves entire circumference of artery

      • Compound –some tunics ruptured, some intact

      • Dilation – axial or fusiform; general enlargement

      • a. Active – growing in diameter

      • b. Passive – wall is stretching

    Types of aneurysms, continued … Arteries

    4. Dissecting – splitting, tearing of intima

    a. Rarely encircles entire lumen

    b. Usually one side only

    c. May involve entire length to bifurcation

    d. Usually originates from thoracic aorta (high B.P.)

    Aneurysms Arteries

    Berry Aneurysm


    Dissecting Aneurysm

    Types of aneurysms, continued … Arteries

    5. Ectatic – axial or dilating, but unruptured

    6. Endogenous – stretched tunica

    7. Exogenous – due to trauma

    8. Fusiform – long skinny expansion

    Types of aneurysms, continued … Arteries

    9. False

    a. bleeding from another source

    b. pulsating encapsulated hematoma

    c. fused with aneurysm

    d. communicates with lumen of artery

    Types of aneurysms, continued … Arteries

    10. Saccular – sac like bulge

    a. tunica externa expanded

    b. tunica intima intact

    11. Tubular –

    a. AKA axial; passive dilation

    b. Uniform dilation of entire vessel

    Types of aneurysms, continued … Arteries

    12. Varicose –

    a. result of varicose veins

    b. blood containing sac connecting artery & vein

    c. seen in antecubital fossa

    d. due to repeated IV sticks