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abdominal doppler Flashcards

1
Q

4 vascular anastomoses?

A
  1. Suprahepatic vena cava
  2. Infrahepatic vena cava
  3. Hepatic artery
  4. Portal vein

Also biliary duct anastomosis

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2
Q

sonogrpahers role in anastomoses?

A
  • each anastomosis must be assessed with ultrasound using a combination of grey scale and spectral doppler
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3
Q

Anastomotic regions have higher chance of developing?

A

a stenosis or occulsion

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4
Q

anastomosis sequelae of events?

A
  • necrosis- fibrosis- stenosis

- all branches of the portal vein should be interrogated

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5
Q

most significant vascular complication, high mortality rate?

A

Hepatic artery thrombosis

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6
Q

Hepatic artery stenosis occurs where?

A

11% of recipients-near anastomosis

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7
Q

Portal vein complications?

A

1-13%-narrowing of vessel lumen at anastomotic site

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8
Q

IVC complications?

A

stenosis is a rarity-recurrent HCC may cause tumor in Hepatic Veins/IVC

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9
Q

Vascular patency post transplant ensure what vessels are working? (4)

A

Hepatic artery
Portal vein
IVC
Hepatic veins

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10
Q

vasular patency?

A
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11
Q

vasular patency?

A
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12
Q

post transplant inspect for?

A

Narrowed diameter
Thrombus
Normal spectral waveform and direction

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13
Q
A

portal vein stenosis

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14
Q
A

portal vein stenosis

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15
Q

Renal transplant-vascular complications (4)?

A

Renal artery stenosis: months to years after
Renal artery occlusion: first few days
Primary renal vein thrombosis: originates RV
Secondary renal vein thrombosis: into Iliac V

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16
Q

sonographers role- all anastomoses must be assessed with doppler when?

A
  • iliac A&V prior to the anastomoses
  • RV and RV at the iliac anastomoses
  • colour image of both vessels long axis to show patency/aliasing
  • intrarental RI- arcuate or interlobar
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17
Q
A

Renal artery stenosis

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18
Q

Main right renal artery is prone to?

A

prone to stenosis at the ostium (takeoff from Aorta) due to its sharp angle superiorly and then inferiorly toward the right kidney

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19
Q

A ratio between the RA stenosis flow and proximal Ao flow is a good indicator of?

A

disease

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20
Q

Renal artery (native)?

A
  • Technically difficult due to overlying gas and patient body habitus
  • Decubitus position is helpful
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21
Q

How to obtain RA/AO ratio?

A
  • Angle correct must be used for both measurements
  • Measure the PSV in Aorta just proximal to RA takeoff
  • Measure the PSV within the RA stenosis (aliasing is a tipoff)
  • Open the gate size as it is a small vessel
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22
Q

RA PSV/AO PSV not condisered hemosynamically significant?

A

< 3.5 is not considered hemodynamically significant

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23
Q

Renal artery flow pattern? and PSV?

A
  • Low resistant flow pattern
  • Distal RA – usually no window is seen
  • PSV of up to 180 cm/s is considered normal
  • Low resistance waveforms demonstrate broad systolic peaks and forward flow throughout diastole
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24
Q

Resistant index also known as?

A

pourcelot index

25
Q

How to obtain the RI measurement?

A
  • Index of pulsatility and opposition to flow
  • Angle correct is not used as it is angle independent
  • RI: PSV-EDV/PSV
  • Obtain a signal in the arcuate or segmental arteries at UP, mid and LP cortex
  • Measure the PSV and EDV-use the calculation package on the US unit
26
Q

RI=

A

PSV-EDV/PSV

27
Q

In the arcuate vessels, an RI ___ indicates resistance to flow due to main RA stenosis?

A

<0.7

28
Q

High resistance waveforms demonstrate?

A

tall, narrow, sharp systolic peaks and reversed or absent diastolic flow

29
Q

Other Examples of high resistant waveforms?

A
  • Infrarenal aorta, iliacs and fasting SMA

- Due to many small branches encountered

30
Q

Origin of SMA is prone to?

A

stenosis due to and angle of takeoff from the aorta

31
Q

normally SMA has what type of flow pattern?

A
  • high resistant flow pattern in fasting state
  • It attains a low resistant flow pattern post prandial due to the capillaries allowing for nutrients to pass into tissues (capillaries control resistance)
32
Q

CA is prone to?

A

stenosis due to its short caliber and 3 immediate branches

33
Q

Celiac Axis flow patteren?

A
  • normally a low resistant flow pattern as its 3 branches supply the viscera
  • PSV and diastolic flow will also increase post prandially
34
Q

MPV normal AP measurement should not exceed?

A
  1. 3cm in an adult

- diameter will increase after a meal

35
Q

MPV flow pattern?

A
  • phasic low flow velocited toward the liver (hepatopetal)
36
Q

MPV flow with inspiration?

A

Blood flow will decrease with inspiration and increase with expiration due to the increased and decreased abdominal pressure respectively

37
Q

Splenic vein flow pattern?

A

Demonstrates spontaneous phasic flow away from the spleen and toward the liver

38
Q

splenic vein normal adult size?

A

<10mm

39
Q

splenic vein with increases with?

A
  • inspiration

- portal hypertension

40
Q

spenic vein drains? (3)

A

Drains spleen, pancreas and a portion of the stomach

41
Q

Superior Mesenteric V flow pattern?

A
  • Demonstrates spontaneous phasic flow toward the liver
42
Q

SMV normal adult measurement?

A

<10mm

43
Q

SMV increases caliber with?

A
  • inspiration
  • following a meal
  • portal hypertension
44
Q

SMV drains?

A
  • small intestines
  • ascending
  • transverse colon
45
Q

hepatic A demonstrates what waveform?

A

a low resistant waveform with continuous flow through diastole

46
Q

hepatic artery increased flow velocity is associated with? (4)

A
  • jaundice
  • cirrhosis
  • lymphoma
  • metastases
47
Q

Normal hepatic arterial PSV and EDV in a fasting adult patient is approximately

A

PSV 30–40 cm/sec, and EDV is 10–15 cm/sec

48
Q

HA aneurysm is?

A
  • Rare

- fatal if ruptures

49
Q

Splenic artery flow?

A

Demonstrates low resistant flow pattern with continuous flow through diastole

50
Q

splenic artery gives rise to?

A

to gastroepiploic artery and branches to the pancreas and stomach

51
Q

splenic artery route?

A

Very tortuous route to the spleen

52
Q

splenic artery may have a pseudoaneurysm if?

A
  • contained in a pseudocyst
  • Use color on collection to see turbulent
    blood flow within
53
Q

IVC waveform proximal ?

A
  • The waveform of the inferior vena cava varies according to the specific segment sampled
  • The flow in the proximal inferior vena cava is influenced by the activity of the right atrium
  • And shows back-pressure changes identical to those seen in hepatic venous flow
54
Q

IVC waveform distal?

A
  • Distally, the cardiac activity has a lesser effect on flow velocities
  • Variations in thoracic or abdominal pressure cause greater variability in forward flow
55
Q

IVC Occlusion s/s? (4)

A

Bilateral leg swelling-sign
Extrinsic compression-nodes
Renal cell carcinoma
Hepatocellular carcinoma

56
Q

Right heart failure can lead to?

A
  • overdistension of IVC and Hepatic veins

- These vessels will appear larger than normal due to backup of blood flow

57
Q

HV flow pattern?

A
  • The normally phasic flow due to respiratory movements are absent
  • The IVC will measure almost the same in AP during expiration and inspiration
58
Q

Budd Chiari syndrome?

A

thrombus or hepatoma extension into hepatic veins

59
Q

Renal vein thrombosis?

A
  • Underlying disease usually
  • Dehydration
  • Hypercoagulability
  • Tumors of left kidney and adrenals grow into veins
  • Extrinsic compression-tumor, fibrosis, trauma
  • Large edematous kidney evident

Vasc (13 decks)

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