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RVT Review > Abdominal > Flashcards

Abdominal Flashcards

1
Q

In 40% of people, the Hepatic artery arises from what artery rather than the Celiac?

A

Superior Mesenteric Artery (SMA)

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2
Q

Which artery can be identified by its surrounding triangle of fat: Celiac, SMA, or IMA?

A

SMA

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3
Q

Does the Right Renal Artery pass superficial or deep to the IVC?

A

Deep

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4
Q

Loss of the Early Systolic Peak is the first indication of disease in which arteries?

A

Renal Arteries

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5
Q

Which two veins join to form the Portal Vein?

A

Superior Mesenteric vein and Splenic vein.

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6
Q

What percentage of the blood is supplied to the liver by the Portal vein (versus the Hepatic artery)?

A

70-80% from the Portal vein.

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7
Q

List the segments of the Portal vein.

A

External Hepatic Portal Vein
Internal Hepatic Portal Vein
Right Portal Vein (Anterior and Posterior branches)
Left Portal Vein (Transverse and Umbilical branches)

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8
Q

The Doppler signature of the Portal venous system normally has these three attributes:

A

Low velocity
Subtle phasicity
Hepatopedal flow direction

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9
Q

Portal flow away from the liver is given this term:

A

Hepatofugal

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10
Q

The normal diameter of the Portal vein is:

A

< 13mm

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11
Q

Portal vein diameter larger than 13mm and diminished phasicity are signs of:

A

Portal Hypertension

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12
Q

What is the normal effect of deep inspiration on the Portal, Splenic, and Superior Mesenteric veins?

A

Increased diameter

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13
Q

Differentiate hepatic from portal veins in their orientation; where they converge; their change in diameter; and their margins.

A

Hepatic longitudinal, Portal transverse.
Hepatic to IVC, Portal to porta hepatis.
Hepatic larger to IVC, Portal larger to porta hepatis.
Hepatic no sheath, Portal echogenic fibrous sheath.

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14
Q

The normal diameter of the aorta is:

A

< 3 cm

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15
Q

The normal diameter of the iliac arteries is:

A

1.3 cm females, 1.5 cm males.

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16
Q

List three risk factors for abdominal aortic aneuryism:

A

Sex (male)
Age
Smoking

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17
Q

The renal arteries are probably not involved with a AAA if the proximal portion of the aneurysm is how far from the SMA?

A

2 cm

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18
Q

List four potential problems with endovascular grafts.

A

Endoleak (perigraft flow into aneurysm sack)
Endotension (sack diameter increases w/o leak)
Migration/Kinking
Disassociation (graft separates from native vessel)

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19
Q

What are the four types of Endoleaks?

A

Type 1: from anastomosis (1a: prox; 1b: distal)
Type 2: from Aorta branch
Type 3: From graft junctions or fabric tears
Type 4: From graft pores

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20
Q

What is meant by the “Two artery rule” regarding mesenteric ischemia?

A

Two of the three mesenteric (splanchnic) arteries need to be diseased in order to cause mesenteric ischemia.

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21
Q

Compression of the Celiac artery causing pain during exhalation is termed:

A

Median Arcuate Ligament Syndrome

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22
Q

During which phase of respiration does Median Arcuate Ligament Syndrome cause pain?

A

Exhalation

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23
Q

What is the normal fasting waveform of these three arteries: Celiac; SMA; IMA.

A

Celiac: Low resistance

SMA & IMA: High resistance

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24
Q

What is the criteria for an abnormal SMA PSV?

A

≥ 275 cm/sec

25
Q

What is the criteria for an abnormal Celiac PSV?

A

≥ 200 cm/sec

26
Q

What does a low resistance signal in the SMA or IMA suggest while fasting?

A

Mesenteric ischemia, since the distal arterioles are dilated.

27
Q

What is the criteria for abnormal portal vein diameter?

A

> 13mm where PV passes over IVC

28
Q

What is the most common portosystemic shunt?

A

Coronary vein to gastroesophageal collaterals.

29
Q

Endoleak Type I

A

From proximal or distal anastamosis.

30
Q

Criteria for mesenteric ischemia (3)

A

2 of 3 splanchnic arteries stenosed or occluded
Celiac > 200 cm/sec
SMA > 275 cm/sec

31
Q

Endoleak Type II

A

From branch of the aorta (eg. IMA, etc.)

32
Q

Endoleak Type III

A

From junction between modular devices, or tears.

33
Q

Endoleak Type IV

A

Graft porosity.

34
Q

Causes of portal vein occlusion (4)

A

Thrombosis secondary to cirrhosis
Tumor from liver or panceas
Pancreatitis
Schistosomiasis

35
Q

Criteria for portal HTN (6)

A 
Flow < 15 cm/sec
PV diameter > 13mm
Splenomegaly > 13cm
Waveform to/fro or reversed
Hepatofugal direction of flow
Development of shunts
36
Q

Budd-Chiari Syndrome symptoms:(hepatic vein obstruction)

A 
hepatomegaly
abdominal pain
ascites
jaundice
hepatocellular dysfunction
37
Q

Renal artery progression

A 
Renal arteries
  >Anterior - 4 segmental arteries
  >Posterior - 1 segmental artery
  >Segmental arteries: in renal pelvis
    >Interlobar arteries (in parenchyma)
      >Arcuate arteries (curve around corticomedullary junction)
        >Cortical branches (in cortex)
38
Q

Criteria for Renal Artery Stenosis (5)(RAS)

A 
Renal/Aortic ratio > 3.5
PSV > 180 cm/sec
Accel time > 0.1 sec
Accel index < 300 cm/sec2
Loss of early systolic peak
39
Q

Criteria for aneurysm (1)

A

Diameter ≥ 1.5 times normal

40
Q

Types of aneurysms (4)

A

True: all layers stretched
Pseudo: hole in atrial wall
Dissecting: separation of intima and media
Mycotic: infection destroys part of wall causing rupture

41
Q

Renal artery doppler signature (2)

A

Low resistance

Early systolic peak

42
Q

Forms of aneurysms (4)

A

Fusiform/Diffuse (gradual)
Bulbous/Focal (sharp)
Concentric: equal all around
Saccular: off to one side

43
Q

Indications of Renovascular HTN (3)

A

Hypertension, esp. in younger patients
Decreased renal function
Abdominal bruit

44
Q

Hepatic vein Doppler signature

A

Phasic with pulsations from RA, often above and below baseline.

45
Q

Most common location for AAA?

A

Distal to the renal arteries.

46
Q

Symptoms of AAA?

A

Pain in abdomen, back, or legs.

47
Q

What is the 2 cm rule?

A

If the proximal portion of AAA is ≥2 cm beyond SMA origin, the renal arteries are probably not involved.

48
Q

3 objectives of aneurysm repair surveillance:

A

To determine if anastomoses feeding AAA.
To check for fluid collection.
To examine for hematoma, abcesses, pseudoaneurysms.

49
Q

Describe Median Arcuate Ligament syndrome:

A

The median arcuate ligament compresses the celiac artery during exhalation, causing pain.

50
Q

Describe the surgical anastomoses for renal allografts.

A

Renal artery: end-to-end for internal iliac artery, end-to-side for external iliac artery.
Renal vein: end-to-side for external iliac vein.
Ureter: to bladder with anti-reflux device.

51
Q

Kidney transplant complications (3):

A

Renal artery stenosis: from intimal damage.
Renal artery or Renal vein thrombosis: from surgical complications.
Pseudoaneurysms or artery to vein fistula (AVF).

52
Q

Portal vein HTN shunts (4):

A

Coronary-gastroesophageal
Splenorenal
Umbilical vein
Hemorrhoidal

53
Q

Criteria for renal parenchymal disease:

A

If Resistive Index > 80 then parenchymal disease, and fixing stenosis will not improve renal function.

54
Q

Formula for Resistive Index

A

RI = (PSV - EDV) / PSV

55
Q

Criteria for Aortic Aneurysm

A

> 3 cm diameter

56
Q

Criteria for Iliac Aneurysm

A

> 1.5 cm diameter

57
Q

Budd-Chiari Doppler signal

A

Changes from normal triphasic to monophasic, absent, reversed, or turbulant.

58
Q

Portal Cavernoma duplex signs (3)

A

Extrahepatic portal vein not visualized (no flow)
Multiple periport collaterals
Phasic flow in periport collaterals

59
Q

Thrombosis (Portal/IVC/Renal vein) duplex signs (3)

A

Visualization of thrombus
Lack of Doppler signal
Dilated vessel

RVT Review (5 decks)

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