abdomen duplex Flashcards
What anatomy is interrogated by abd doppler
Ao - Iliac vessels renal artery kidney mesenteric arteries liver
What anatomy is interrogated by abd doppler
Ao - Iliac vessels renal artery kidney mesenteric arteries liver
Ao iliac Doppler purpose
stenosis
bypass graft f/u
aneurysms
Renal artery
Kidney
> 60% diameter reduction
presence of disease (nephrosclerotic)
patient renal vessels in Tx
Mesenteric arteries
stenosis
liver
r/o portal HTN
patient liver vessels s/p liver Tx
pre op for liver transplant
Limitation
the usual obvious reasons + SOB and rapid respiration
parameter for
a. Ao-Iliac artery stenosis
b. aneurysm
a. 2:1 velocity increase (same as LE)
b. > 3 in aorta
*note that parameter for iliac is x 1.5 cm size increase from adjacent segment -
just like any other vessel outside of the Ao
most AAA are caused by what and occur mostly where
atherosclerotic disease
infrarenal
what is the most common type of aneurysm
true
what types of true aneurysm is most common
fusiform , saccular
what is the most frequent complication of aortic aneurysm?
peripheral aneurysm ?
Rupture for Aortic aneurysm
embolization from peripheral aneurysm
what 3 conditions can cause renovascular HTN
atherosclerosis
Fibromuscular dysplasia
occlusion
anything that would result in decreased profusion to kidney paranchyma
what is the mechanism for hypertension
Renin (when kidney parenchyma perfusion is suboptimal- renin production is increased
Renin stimulates angiotensinogen to be converted into angiotensin which causes increase in systemic HTN
what is the landmark for identifying the left renal artery
left renal vein
Describe the teq for RA interpretation
celiac artery and SMA velocity data
obtain aorta PSV near SMA level
turn trans- find renal arteries
image the kids and measure them + survey for cortex thinning and abnormal findings
Obtain PSV and EDV bilaterally @
renal artery :P, M, D
Upper/ Lower pole of the kidney in segmental arteries
OBSERVE FOR SECONDARY RENAL ARTERIES
what abdominal arteries should show low resistance on Doppler
renal
celiac
hepatic
splenic
what abdominal organs are typically high resistant
fasting SMA & IMA
Aorta
what is being referred to as splanchnic circulation ?
celiac trunk, SMA , IMA
what is RAR
highest RA PSV
////////////////////////////////////////
highest Ao PSV
what two conditions render the RAR insignificant
AAA
abnormal Ao PSV :
>90 cm/s
<40 cm/s
with abnormal aortic PSV what criteria is used instead of RAR
renal artery PSV of
> 180-200 cm/s
+ post stenotic turbulence
RAR parameters
normal <3.5
abnormal > 3.5 = greater than 60% diameter reduction
normal pole to pole length of a kidney
10-12 cm
what ratio’s are used to interpret renal artery study
EDR end diastolic ratio
(parenchymal reisitance ratio)
&
Resistivity Index
what is the resistivity index formula
PSV - EDV
//////////////
PSV
Normal velocity for RI of renal artery or parenchymal vessels
what is parenchymal resistance ratio
EDV
/////////////////////////
PSV
what is normal parenchymal resistance ratio value
> .2 anything below that is abnormal
what is considered abnormal AT time for renal waveform indicating >60% stenosis somewhere along the vessel
> 100 m/sec
what is normal value of renal doppler AT time ?
70 m/sec
mesenteric artery patient history
dull achy or crampy abdominal pain 15-30 minutes after meals
mesenteric angina
explain technique for mesenteric study
Obtain PSV and EDV on following areas celiac artery SMA : P,M, D IMA AORTA
what is the “food challenge test”
Pt ingest high caloric meal (document how much was consumed)
exam is repeated 20-30 minutes after or sooner with symptoms (document when sx started or duration of time between ingestion and beginning the exam)
PSV and EDV measurements obtained at areas of fasting test
(hyperemic response begins after about 10 -30min after eatin
Doppler characteristics and velocities:
SMA
High resistance (pre-prandial) converts to lower resistance post prandal
normal 110-177 cm/sec
abnormal PSV >275 = >70% stenosis
Doppler characteristics and velocities:
CA
unaffected by eating
can be taken in TRV
Normal velocities 50-160 cm/sec
> 70% stenosis = PSV >200cm/sec
what predicts distal mesenteric disease?
high resistant waveform persists after eating
name the two collaterals that exist between the sma and the ima
marginal artery of drummond
arc of riolan
what is criteria for chronic mesenteric ischemia
2-3 mesenteric vessels have problems
what is celiac band syndrome
extrinsic compression via the median arcuate ligament of the diaphragm
reversible CA stenosis
expiration- breath out = stenosis
inhilation-breath in = normal flow
what is clinical indication for celiac band syndrome
bruie
or can be asymptomatic
what might indicate acute rejection of renal transplant regarding doppler ?
increased arterial resistance
Ao iliac Doppler purpose
stenosis
bypass graft f/u
aneurysms
Renal artery
Kidney
> 60% diameter reduction
presence of disease (nephrosclerotic)
patient renal vessels in Tx
Mesenteric arteries
stenosis
liver
r/o portal HTN
patient liver vessels s/p liver Tx
pre op for liver transplant
Limitation
the usual obvious reasons + SOB and rapid respiration
parameter for
a. Ao-Iliac artery stenosis
b. aneurysm
a. 2:1 velocity increase (same as LE)
b. > 3 in aorta
*note that parameter for iliac is x 1.5 cm size increase from adjacent segment -
just like any other vessel outside of the Ao
most AAA are caused by what and occur mostly where
atherosclerotic disease
infrarenal
what is the most common type of aneurysm
true
what types of true aneurysm is most common
fusiform , saccular
what is the most frequent complication of aortic aneurysm?
peripheral aneurysm ?
Rupture for Aortic aneurysm
embolization from peripheral aneurysm
what 3 conditions can cause renovascular HTN
atherosclerosis
Fibromuscular dysplasia
occlusion
anything that would result in decreased profusion to kidney paranchyma
what is the mechanism for hypertension
Renin (when kidney parenchyma perfusion is suboptimal- renin production is increased
Renin stimulates angiotensinogen to be converted into angiotensin which causes increase in systemic HTN
what is the landmark for identifying the left renal artery
left renal vein
Describe the teq for RA interpretation
celiac artery and SMA velocity data
obtain aorta PSV near SMA level
turn trans- find renal arteries
image the kids and measure them + survey for cortex thinning and abnormal findings
Obtain PSV and EDV bilaterally @
renal artery :P, M, D
Upper/ Lower pole of the kidney in segmental arteries
OBSERVE FOR SECONDARY RENAL ARTERIES
what abdominal arteries should show low resistance on Doppler
renal
celiac
hepatic
splenic
what abdominal organs are typically high resistant
fasting SMA & IMA
Aorta
what is being referred to as splanchnic circulation ?
celiac trunk, SMA , IMA
what is RAR
highest RA PSV
////////////////////////////////////////
highest Ao PSV
what two conditions render the RAR insignificant
AAA
abnormal Ao PSV :
>90 cm/s
<40 cm/s
with abnormal aortic PSV what criteria is used instead of RAR
renal artery PSV of
> 180-200 cm/s
+ post stenotic turbulence
RAR parameters
normal <3.5
abnormal > 3.5 = greater than 60% diameter reduction
normal pole to pole length of a kidney
10-12 cm
what ratio’s are used to interpret renal artery study
EDR end diastolic ratio
(parenchymal reisitance ratio)
&
Resistivity Index
what is the resistivity index formula
PSV - EDV
//////////////
PSV
Normal velocity for RI of renal artery or parenchymal vessels
what is parenchymal resistance ratio
EDV
/////////////////////////
PSV
what is normal parenchymal resistance ratio value
> .2 anything below that is abnormal
what is considered abnormal AT time for renal waveform indicating >60% stenosis somewhere along the vessel
> 100 m/sec
what is normal value of renal doppler AT time ?
70 m/sec
mesenteric artery patient history
dull achy or crampy abdominal pain 15-30 minutes after meals
mesenteric angina
explain technique for mesenteric study
Obtain PSV and EDV on following areas celiac artery SMA : P,M, D IMA AORTA
what is the “food challenge test”
Pt ingest high caloric meal (document how much was consumed)
exam is repeated 20-30 minutes after or sooner with symptoms (document when sx started or duration of time between ingestion and beginning the exam)
PSV and EDV measurements obtained at areas of fasting test
(hyperemic response begins after about 10 -30min after eatin
Doppler characteristics and velocities:
SMA
High resistance (pre-prandial) converts to lower resistance post prandal
normal 110-177 cm/sec
abnormal PSV >275 = >70% stenosis
Doppler characteristics and velocities:
CA
unaffected by eating
can be taken in TRV
Normal velocities 50-160 cm/sec
> 70% stenosis = PSV >200cm/sec
what predicts distal mesenteric disease?
high resistant waveform persists after eating
name the two collaterals that exist between the sma and the ima
marginal artery of drummond
arc of riolan
what is criteria for chronic mesenteric ischemia
2-3 mesenteric vessels have problems
what is celiac band syndrome
extrinsic compression via the median arcuate ligament of the diaphragm
reversible CA stenosis
expiration- breath out = stenosis
inhilation-breath in = normal flow
what is clinical indication for celiac band syndrome
bruie
or can be asymptomatic
what might indicate acute rejection of renal transplant regarding doppler ?
increased arterial resistance
