Deck 11: Abdominal Vasculature

Question 1

Which is NOT a tributary of the inferior vena cava?

A) Hepatic vein
B) Portal vein
C) Renal vein
D) Right suprarenal vein

Answer 1

B
The hepatic, renal, and right suprarenal veins are all tributaries of the IVC. The portal vein is an intraabdominal vein.

Question 2

Blood flow in the right, middle, and left hepatic veins is characterized by

A) four phases of flow: two away from the heart and two toward the heart.
B) three phases of flow: two toward the heart and a phase of systolic flow reversal.
C) three phases of flow: one toward the heart and then two away from the heart.
D) four phases of flow: two toward the heart followed by two away from the heart.

Answer 2

B
The hepatic veins demonstrate three phases of flow. The first two are toward the heart and represent reflections of right atrial and ventricular diastole. The third phase is represented by systolic flow reversal and is caused by contraction of the right atrium.

Question 3

Which are characteristics of a Doppler spectral waveform from a normal infrarenal abdominal aorta?

A) Rapid systolic upstroke, delayed deceleration, and low diastolic flow
B) Rapid systolic upstroke and rapid deceleration with constant forward diastolic flow
C) Rapid systolic upstroke and rapid deceleration with flow reversal in late systole
D) Rapid systolic upstroke, reversed late systolic flow, and constant forward diastolic flow

Answer 3

C
Flow in the infrarenal segment of the aorta is to the lumbar arteries and the high resistance muscles of the legs. Therefore, the Doppler spectral waveform shows a reverse flow component. The suprarenal segment of the aorta supplies blood to the low resistance vascular beds of the liver, spleen, and kidneys. Given that, answers "b" and "c" are eliminated. Delayed deceleration most often is seen in vessels supplying low resistance end organs; therefore, answer "a" is also eliminated.

Question 4

Which does NOT affect portal venous flow?

A) Posture
B) Dietary state
C) Hematocrit
D) Exercise

Question 5

The left renal vein serves as a valuable landmark for locating the renal arteries. It courses

A) anterior to the abdominal aorta and posterior to the superior mesenteric artery.
B) posterior to the abdominal aorta and anterior to the left renal artery.
C) posterior to the inferior vena cava and anterior to the abdominal aorta.
D) anterior to the inferior vena cava and anterior to the abdominal aorta.

Question 6

The blood flow pattern in the normal renal artery can be characterized as

A) high resistance with high diastolic flow.
B) low resistance with high diastolic flow.
C) high resistance with high diastolic flow.
D) low resistance with low diastolic flow.

Question 7

Which of the following best describes the blood flow pattern in the superior mesenteric artery after ingestion of a meal?

A) Peak systolic velocity greater than 200 cm/sec with low diastolic flow and systolic flow reversal
B) Peak systolic velocity less than 200 cm/sec with low diastolic flow
C) Peak systolic velocity greater than 200 cm/sec with high diastolic flow
D) Peak systolic velocity greater than 200 cm/sec, systolic flow reversal, and high diastolic forward flow

Question 8

Which statement is NOT true about the portal vein?

A) It supplies approximately 70% of the oxygenated blood flow to the liver.
B) It is an intraabdominal vein.
C) It is formed by the confluence of the umbilical, splenic, and superior mesenteric veins.
D) Blood flow in the portal vein normally is hepatopetal in direction.

Question 9

The Doppler spectral waveform form the normal renal artery demonstrates:

A) constant forward diastolic flow
B) intermittent forward diastolic flow
C) constant flow reversal during diastole
D) intermittent flow reversal during diastole

Question 10

Which statement is NOT true about blood flow to the kidney?

A) The Doppler velocity signal from the interlobar arteries demonstrates significant forward diastolic flow.
B) The velocity spectral waveforms from the medulla and cortex of a kidney are normally pulsatile.
C) Because of the high metabolic demands of the kidney, flow is forward during diastole.
D) The spectral waveform from the arcuate vessels of the kidney of a patient in chronic renal failure show decreased diastolic flow.

Question 11

Which statement is NOT true about the celiac artery?

A) The celiac artery feeds organs that have low vascular resistance.
B) The celiac artery originates from the posterolateral wall of the abdominal aorta.
C) The celiac artery has three branches: the common hepatic, splenic, and left gastric arteries.
D) The superior mesenteric artery and the celiac artery may share a common trunk at their origin.

Question 12

High resistance Doppler spectral waveforms recorded throughout the renal medulla and cortex suggest

A) proximal renal artery stenosis.
B) flow-limiting disease in the distal renal artery.
C) intrinsic medical renal disease.
D) the presence of accessory renal arteries.

Question 13

Which statement is NOT true about the renal arteries?

A) The left renal artery lies superior to the left renal vein.
B) The proximal renal arteries follow the crus of the diaphragm.
C) The right renal artery courses posterior to the inferior vena cava.
D) The renal arteries originate from the lateral wall of the abdominal aorta.

Question 14

Which statement is correct?

A) The inferior mesenteric artery lies anterolateral to the abdominal aorta and enters the pelvis as the superior hemorrhoidal artery.
B) The suprarenal abdominal aortic Doppler velocity waveform is triphasic because of the high resistance vascular bed of the fasting superior mesenteric artery.
C) The kidneys and liver are high resistance end organs.
D) A Doppler spectral waveform from the postprandial superior mesenteric artery demonstrates low diastolic flow because of the change in the vascular resistance of the stomach and small intestine that occurs with digestion.

Question 15

Which structure does NOT border the abdominal aorta anteriorly?

A) Portal vein
B) Superior mesenteric artery
C) Celiac axis
D) Stomach

Question 16

The hepatic artery enters the porta hepatis along with the

A) right hepatic and splenic veins.
B) main portal vein and common bile duct.
C) right hepatic vein and common bile duct.
D) left portal vein and right branch of the hepatic artery.

Question 17

Normally, flow patterns in the portal vein and its branches are characterized by

A) continuous, minimally phasic, disordered flow with high mean velocities.
B) pulsatile, biphasic, disordered flow with low mean velocities.
C) continuous or minimally phasic disordered flow with low peak and mean velocities.
D) phasic flow with low peak and mean velocities.