Vascular ARDMS 2023 with complete solution

average velocity of the aorta 60-100 cm/s what aortic pathologies affect the branches stenosis, aneurysm, plaque what are the normal waveforms of the proximal aorta low resistance flow pattern with continuous forward diastolic flow by the liver spleen, and kidneys (similar to ICA waveform) normal waveforms for distal aorta higher resistance flow pattern what causes the distal aorta to be more high resistive peripheral resistance and due to the triphasic nature of the aortic branches (reversal during diastole) why is the proximal aorta more high low resistive the highly metabolic organs of the abdomen need forward flow in systole and diastole whats the most superior brach of the aorta arising from the anterior surface celiac artery where to 95% of celiac arteries bif 1-3 cm from origin what does the eliac artery bif into common hepatic, splenic, and left gastric which pane is the celiac best seen in transverse what is the normal waveform for the celiac low resistance flow due to the vascular beds of the liver and spleen with continuous forward flow during diastole what happens if the celiac occludes collateralization throught the pancreaticoduodenal arterial arcade-network of small vessels surrounding the pancreas and duodenum (feed into duodenum then into the common hepatic) how does the splenic artery run it follows a tortuous course long the posterior, superior pancreatic body and tail with several pancreatic and gastric branches where does the splenic artery originate it is a branch off of the celiac axis where does the splenic artery terminate ends as branches in the splenic hilum what is the normal splenic artery waveform turbulent flow due to tortuosity (fig 26-3, 441) what is the best way to evaluate the spenic artery in the transverse plane from the anterior midline along the tail, eval distal from left lateral window at splenic hilum wheredoes the common hepatic artery lay in the superior border of the pancreatic head, its the right branch of the celiac what does the common hepatic give rise to the GDA where does the common hepatic artery turn into the proper hepatic artery past the GDA what occurs after the proper hepatic artery enters the liver it divides into right and left branches what is the normal wave form for the common hepatic artery low resistance continuous forward diastolic flow where is the best place to evaluate the common hepatic artery eval from anterior abdominal window at the porta hepatis where does the sma arise? anterior aorta distal to celiac trunk what is the course of the SMA it has a short anterior segment then turns inferiorly and ends near the ileoceccal valve what is the normal waveform of the SMA and IMA in a fasting patient high resistance flow with sharp systolic peaks and absent late diastolic flow What is the normal waveform of the SMA and IMA 30-90 minutes post prandial low resistance pattern with broad systolic peaks and continuous diastolic flow whats the best way to eval the SMA and IMA eval in transverse from anterior what does the sma supply branches supply the jejunum, ileum cecum, ascending colon, proximal 2/3rds of the transverse colon, portions of the duodenum, and the pancreatic head where does the sma lie in relation to the smv and the left renal vein to the right of the smv and the left renal vein courses between the sma and aorta what is the function of the portal venous system it transports nutrient rich blood from the intestines and spleen to the liver what is the normal flow of the PV system hepatopedal (unidirectional forward flow) with subtle phasic variation produced by respiratory and cardiac hemodynamic effects and unidirectional; sounds like a windstorm what does the normal portal vein measure no larger than 13 mm in diameter but increases with sustained deep inspiration (splenic and SMV can increase 50-100 percent in size with this). this response negates portal HTN what occurs in the portal system in a patient with CHF the main portal vein may demonstrate a doppler waveform that is bidirectional with pulsatile flow what is the origin of the portal vein begins at junction of splenic and SMV immediately posterior to pancreas neck and courses superior to the right and passes posterior to the first portion of the duodenum and terminates at the porta hepatis what joins to form the MPV the SMV runs superior from the intestines to join the SV and form the MPV what is the largest tributary to the IVC the hepatic veins what is the normal flow of the hepatic veins hepatofugal flow that is chaotic pulsatile flow pattern from transmission of RA pulsatations what effect does CHF have on the hepatic veins they become enlarged Which lobe do the hepatic veins not drain the caudate lobe where does the right hepatic vein run coronal betwen the anterior and posterior segments of the right lobe where does the middle hep v run between the right and left lobes where does the left hep v run between the medial and lateral segments of the left lobe where is the IVC located anterior to the spine and to the right of the aorta what is the normal size for the IVC seldom exceeds 2.5 cm but varies with respiration and cardiac cycle (inspirations limit venous return and enlarge IVC) what is the normal waveform for the IVC somewhat pulsatile due to the close proximity to the RA where do most IVC anomalies occur below the renal veins (duplication, transposition) what happens if the IVC is interrupted flow enters the heart through the azygos and hemiazygos veins and the hepatics drain directly into the right atrium what occurs with dupication and transposition the left sided IVC joins left renal vein and crosses over to join normal right sided IVC what occurs with azygos and hemiazygos IVC results from failure of intrahepatic segment of IVC to form, flow is diverted to heart vi the azygos and hemiazygos veins and hep veins drain directly into the rt atrium