Lesson 3 Vessels.pptx

Lesson 3 Great Vessels Sonography: Introduction to Normal Structure and Function 5th edition by Reva Curry, Marilyn Prince Chapter 9 and 10 Outline of Today’s class Abdominal Vasculature Arteries and Veins Basic anatomy and function Great Vessels Aorta Inferior Vena Cava Lab tests to do with bleedin...

Lesson 3 Great Vessels Sonography: Introduction to Normal Structure and Function 5th edition by Reva Curry, Marilyn Prince Chapter 9 and 10 Outline of Today’s class Abdominal Vasculature Arteries and Veins Basic anatomy and function Great Vessels Aorta Inferior Vena Cava Lab tests to do with bleeding Abdominal Vasculature Arteries and Veins Abdominal vasculature arteries , arterioles, capillaries, venuoles, veins https://www.google.com/search? q=vascular+system&rlz=1C1GCEA_enCA9 21CA921&source=lnms&tbm=isch&sa=X &ved=2ahUKEwimk_GLvJXyAhUOTt8KHbr BDcUQ_AUoAXoECAEQAw&biw=1536&bih =826#imgrc=7kPva3SbIzdXhM Basics Arteries carry blood away from heart smaller than veins travel away from heart Veins carry blood to the heart larger as travels toward heart Artery and Vein Anatomy- 3 Layers Tunica Intima (or Interna) endothelium, very smooth Tunica media muscular component Tunica externa (or adventitia) connective tissue ***Exception- Capillaries 1 layer**** Thibodeau textbook (Anatomy) https://www.google.com/search? q=vessels+walls&rlz=1C1GCEA_enCA921CA 921&source=lnms&tbm=isch&sa=X&ved=2 ahUKEwjUp8GavZXyAhWQdd8KHX7ABJsQ_A UoAXoECAEQAw&biw=1536&bih=826&dpr= 1.25#imgrc=gO_vMuMvFh6b7M Great Vessels Aorta and Inferior Venal Cava Aorta Page 129 Curry Location 4 Sections Function Why do we scan the Aorta? Clinical Indications Positions and windows Sonographic Normal Parameters Branches we see (useful Landmarks) Normal anatomy surrounding Aorta Normal Congenital Variations AORTA – Location Lies more left of midline Bifurcates at L-4 From heart travels more posterior to Superior vena cava at approximately level of the renal arteries travels more anterior to the Inferior Vena Cava https://www.google.com/search? q=Arteries+of+ureters+and+urinary+bladder&rlz=1C1GCEA_enCA921CA9 21&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjD8pmM25XyAhUpMVkF He7ECoUQ_AUoAXoECAEQAw&biw=1536&bih=826#imgrc=lmloTJcDZQINJM 4 sections to Aorta Ascending Aortic Arch Descending – thoracic and abdominal Bifurcates at approx level of umbilicus into: Common Iliac Arteries https:// my.clevelandclinic.org/ health/articles/17058aorta-anatomy What is the function? Main artery of the body High pressure from heart carry oxygenated blood from heart to the organs Abdominal Aorta Sonographically How the exam starts, what we ask, How we scan and what is normal Patient Positions Used to visualize Aorta Supine most common Left lateral decubitus Right lateral decubitus Why would we be asked to scan Aorta? Clinical Indications or patient history: Requisition: Family history of AAA, palpable (pulsating) mass on exam, vascular surgery Symptoms and risk factors for atherosclerotic disease. High BP High cholesterol Smoking Hx. Of heart problems Diabetes AORTA Aorta routinely scanned in an Abdominal ultrasound exam Use 3.5 to 5 MHz Transducer Patient Fasting 6 to 8 Hours Windows Anterior Can use lt lobe liver as a window for the proximal portion of the vessel. Coronal SONOGRAPHIC PARAMETERS NORMAL AORTA Curry pg.133 SIZE 2 -2.5 CM PROX, Approximately 1.5CM DISTALLY >3cm abnormal Common iliac arteries- 0.8 to 1.0 cm Varies with sex and age SHAPE parallel walls, tubular shape Echogenicity lumen is anechoic, walls are echogenic Aorta and Ultrasound Abdominal Aorta is broken up into 3 sections How do we know determine where we are? Proximal Mid Distal Branches can help us with location Proximal Aorta (landmarks) 1st Branch Proximal Aorta (diaphragm to CT) Celiac Trunk (Celiac Artery CA) ◦Left gastric artery (smallest) ◦Splenic artery (tortuous and largest branch) ◦Common Hepatic Artery Aortic branches https://www.researchgate.net/ profile/Paul-Atkinson-15/ publication/258198736/figure/ fig1/ AS:392660075466758@147062 8865412/llustration-of-theabdominal-aorta-andbranches.png Sag Aorta Prox https://www.google.com/search? source=univ&tbm=isch&q=proximal+aorta+u ltrasound&fir=nFWETM44fiupCM %252CmUu2J3rxWO4McM%252C_ %253BQUJF44OR2ExefM %252CmZFhYPI_qvShOM%252C_ %253B5qEiO_KR1rrhsM %252CdcFzMP5TaomTKM%252C_ %253BVKWNZXqTD2WtNM %252CmUu2J3rxWO4McM%252C_ %253B6m2diyMd7wy69M %252CaClWBZbSYDfJyM%252C_%253BbZPV8zNwSefLM%252CqQ0b1p4IOtgXCM%252C_ %253BAy-GTCdDzX5uXM %252CH3sAsQ3zDpAdqM%252C_ %253BtvuF6M8FeESFUM %252CmUu2J3rxWO4McM%252C_ %253BBpXly34Wpoc6zM %252CWiNRTaZU2Ep0cM%252C_ %253BdG021mnuJsEMlM %252CSsdgg1JkxaW8hM%252C_%253BXIv40RbjWQerM%252CznvCi-FeMHnc1M %252C_%253BanjMYXa3CoDbLM %252C6pPqtBHk5rb2dM%252C_ %253Blce9gLvt5Jx2NM %252CmUu2J3rxWO4McM%252C_ %253BbXXXjZSU53PIHM %252CZPQ2goieKI3zZM%252C_&usg=AI4_kSi105yk4yElNlzCzv9nBYKtnEUOg&sa=X&ved =2ahUKEwjl6OOwvtL3AhVoposKHYwNC0AQsA R6BAgCEAM&biw=1536&bih=746&dpr=1.25 #imgrc=anjMYXa3CoDbLM Trans Aorta Prox ( Celiac Trunk) Second Branch we see Superior Mesenteric Artery (SMA) Anterior branch of the Aorta about 1 cm below the celiac trunk Very echogenic walls SMA runs to be parallel to Aorta Aortic branches https://www.researchgate.net/ profile/Paul-Atkinson-15/ publication/258198736/figure/ fig1/ AS:392660075466758@147062 8865412/llustration-of-theabdominal-aorta-andbranches.png Sag Aorta Prox Celiac Trunk and SMA C – CT D - SMA https://www.google.com/search? source=univ&tbm=isch&q=proximal+aorta+u ltrasound&fir=nFWETM44fiupCM %252CmUu2J3rxWO4McM%252C_ %253BQUJF44OR2ExefM %252CmZFhYPI_qvShOM%252C_ %253B5qEiO_KR1rrhsM %252CdcFzMP5TaomTKM%252C_ %253BVKWNZXqTD2WtNM %252CmUu2J3rxWO4McM%252C_ %253B6m2diyMd7wy69M %252CaClWBZbSYDfJyM%252C_%253BbZPV8zNwSefLM%252CqQ0b1p4IOtgXCM%252C_ %253BAy-GTCdDzX5uXM %252CH3sAsQ3zDpAdqM%252C_ %253BtvuF6M8FeESFUM %252CmUu2J3rxWO4McM%252C_ %253BBpXly34Wpoc6zM %252CWiNRTaZU2Ep0cM%252C_ %253BdG021mnuJsEMlM %252CSsdgg1JkxaW8hM%252C_%253BXIv40RbjWQerM%252CznvCi-FeMHnc1M %252C_%253BanjMYXa3CoDbLM %252C6pPqtBHk5rb2dM%252C_ %253Blce9gLvt5Jx2NM %252CmUu2J3rxWO4McM%252C_ %253BbXXXjZSU53PIHM %252CZPQ2goieKI3zZM%252C_&usg=AI4_kSi105yk4yElNlzCzv9nBYKtnEUOg&sa=X&ved =2ahUKEwjl6OOwvtL3AhVoposKHYwNC0AQsA R6BAgCEAM&biw=1536&bih=746&dpr=1.25 #imgrc=anjMYXa3CoDbLM Trans Aorta Mid (SMA) Right and Left Renal Arteries (Left Renal Vein) Originates laterally from aorta Just inferior to SMA Right Renal A Longer than LRA Courses posteriorly to IVC Transverse Aorta Mid (useful landmark) can also see Left Renal Vein coursing anterior to Aorta in location Aortic branches https://www.researchgate.net/ profile/Paul-Atkinson-15/ publication/258198736/figure/ fig1/ AS:392660075466758@147062 8865412/llustration-of-theabdominal-aorta-andbranches.png Trans Aorta Mid (Right Renal Artery and Left Renal Vein) Trans Aorta Mid(left renal vein) Trans Aorta Distal Trans Aorta Distalhttps://www.google.com/search? sca_esv=93371214c77afbba&sca_upv=1&rlz=1C1CHBF_enCA1076CA1076&q=distal+aorta+ultrasound&uds=ADvngMgiPmsFSnX7QtZmBAeJzn8vJyiy3HjG6 _ilb3gAwAp-yOP7ZURTHU-84yUFpZiJG-AIWgaVR5r0Ik0R_rHfzNylyPIV72hu0JMqGbEofpsr3xt8agJ0VR2SpJPy9LGwp3YSry2vz3h_z3SPd8OUoDaOcMw_sYqCM2hmOV7zGg8xD2XaJyjwPBxUxMxJQoREgcQQJ1TlbEcgxch0xuDPNccCM7FaLWuf1mTuIcZloXw3BjDTbDyHRN1lHNamr7jWFJLL0PZzu97gVrYlvuH Pi5SvumdycsUiOre0BB9OawGpgltzt684AXbylshSqKIdL5zfHXKhYoFvStsFab5PLLeIycioA&udm=2&prmd=ivsnmbtz&sa=X&ved=2ahUKEwirsX2tomGAxU_E1kFHe6iA7oQtKgLegQICxAB&biw=1366&bih=599&dpr=1#vhid=9QtUAvAEBOJU7M&vssid=mosaic Bifurcation of Aorta Trans Bifurcation Normal Anatomy seen surrounding the Aorta Anatomical Structures seen in Aorta Sonographic evaluation  Gastroesphogeal junction (donut or target appearance) ◦ Muscular layer is hypoechoic to surrounding tissues ◦ anterior to aorta ◦ superior to celiac trunk ◦ Seen in sagittal view of proximal aorta  Diaphragmatic Crura (or crus)  linear muscular portions of the diaphragm ◦ Right Crus is seen in sagittal view of proximal aorta inferior to GE junction and anterior to aorta (don’t usually see left crus on Ultrasound) Sag. Aorta Proximal (arrow points to GE Junction) Sag Aorta Example of Labelling Anatomy Normal Congenital Variants of Aorta Normal Congenital Variations  3 renal arteries  Common Hepatic artery can come off SMA  Right hepatic artery can come off SMA  Left hepatic artery originates from left gastric artery  Rt. Sided Aorta (transposition) Sagittal image of the IVC arrows point to 2 right renal arteries Superior and Inferior Vena Cava Location Function Tributaries Differences from Aorta Why do we scan? Sonographic Parameters Scan and Images Normal Variants Page 145 Curry Ch. 10 Inferior Vena CavaLocation Right of midline Confluence at approx. L-5 Function: Drain the blood  Superior Vena Cava  head, neck, thorax, upper extremities  Inferior Vena Cava(abdominal ultrasound)  lower trunk and extremity ◦ Bifurcates (confluence)at L5 more inferiorly than Aorta ◦ Returns blood from below the diaphragm to the right atrium INFERIOR VENA CAVA tributaries pg. 147 Common iliac veins Right Gonadal Vein (Left Gonadal comes into Left Renal Vein) Renal Veins Hepatic Veins Ultrasound scan of IVC Typically scanned as part of the Abdominal Exam Using 3.5 to 5 MHZ transducer, patient fasting Diaphragm to right renal artery more inferiorly if able (GAS, collapses) Sag/ long- Sag IVC Proximally Trans/Short axis- hepatic veins (note these images are usually taken with Liver images) Sagittal IVC pages 148 149 Right Renal artery seen posterior to IVC IVC IVC Trans Hepatic Veins page 150 Trans Hepatic Veins Remember can see Left Renal Vein in Aorta image page 150 Trans Bifurcation can you identify Distal IVC Sonographic parameters of IVC  Size  usually 2.5 cm not routinely measured (should not be > 3.7cm)  Shape  walls changes shape  Echogenicity  anechoic lumen, may see particulate echoes (slow flow blood)  Thin echogenic walls typically not as bright as walls of Aorta Normal Variations in Abdominal Veins Congenital Anomalies Duplication (double) of the IVC (most common statistically) Left- sided IVC (transposition) Absence of a portion of IVC ***Rare Normal Variants Multiple veins Lt Renal Vein travelling posterior to Aorta Variations in Veins (renal v. travelling posterior and duplicate IVC) Another Specular Reflector smooth large interface Strong echo Aorta- parallel walls (bright echoes) IVC- not parallel walls typically less bright Remember Other example is Diaphragm Using the PP and book in group of two answer questions on the next slides. How is Inferior Vena Cava different from Aorta? How is it different in appearance than the Aorta? Walls Shape Does it react with changes in Respiration? Does the shape change when pressure is applied? Why do we scan the IVC? Clinical indications See on Curry page 151 under Sonographic Applications for reasons Lab tests associated with Bleeding look in Curry pages 142, 153 Hematocrit Both Arterial and Venous - % of RBC’s to whole blood CBC – complete blood count, evaluate RBC’s WBC’s and platelets PT Prothrombin time – tests clotting factor Make a chart- its important to know for future organs learned list Abdominal Aorta Branches and what organs they supply (in general ie. SMA GI Tract) Inferior Vena Cava – its tributaries and what organs they drain Helpful if put in chart form or draw diagram Drawing pages 135 and 136 Using ideal images and Curry textbook, please draw these diagrams and label as much anatomy surrounding for the images that you have in the rubric for lab #1 Pages 135 figure 9-5, 9-6 Sag Prox Aorta Page 136 figure 9-7,9-9 and 9-10