Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MIDS 237 > Ch 20 Hepatoporal System > Flashcards

Ch 20 Hepatoporal System Flashcards

1
Q

What is ascites?

A

Abnormal accumulation of fluid within peritoneal cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ascites is the m/c complication of ____?

A

Cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is budd-chiari syndrome?

A

-Hepatic venous outflow obstruction at any level from the small HVs to the junction of the IVC + RA
-Due to hypercoagulable states

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Differentiate hepatopetal + hepatofugal?

A

Hepatopetal:
-antegrade flow towards liver
-normal direction of flow within portal-splenic venous system

Hepatofugal:
-retrograde flow away from liver
-abnormal direction of flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is helical PV flow?

A

Spiraling/swirling helix flow pattern demonstrating hepatopetal, hepatofugal, or bidirectional flow (uncommon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is helical PV flow associated with?

A

-Advanced chronic liver disease
-Portal hypertension
-Portosystemic shunts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a hepatic arterial buffer response?

A

Mechanism to maintain perfusion to the liver by arterial vasodilation, when PV flow is obstructed in pt’s with advanced cirrhosis

(when PV perfusion decreases, HA flow increases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is hepatic hydrothorax?

A

-Pleural effusion in pt’s with cirrhosis + absent cardiopulmonary disease
-Ascites from peritoneal cavity travels to pleural space via diaphragmatic defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is portal hypertension?

A

Elevated pressure b/w the PV + IVC or HVs of >10-12mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are portosystemic collaterals?

A

Formation of abnormal blood vessels that shunt PV flow bypassing the liver to the systemic circulation, which decompresses PV pressure

(abnormal communications between the portal system and the systemic circulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is sinusoidal obstruction syndrome (SOS)?

A

-Aka hepatic veno-occlusive disease
-Syndrome of tender hapatomegaly, RUQ pain, jaundice + ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SOS most commonly occurs after ___?

A

Pt’s undergo hematopoietic cell transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is transjugular intrahepatic portosystemic shunt (TIPS)?

A

-Created connection within the liver b/w the HV + PV, allowing blood to bypass the liver + reduce portal pressure in pt’s with portal hypertension

-Manages variceal bleeding + ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The liver receives a dual blood supply from what vessels (hepatic blood inflow)?

A

HA (25%) + PV (75%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain the hepatic blood outflow?

A

-PV enters the sinusoids to reach the central veins (start of HV drainage)

-Central veins enter interlobular veins (forms 3 HVs)

-HVs drain into IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The MPV begins at the junction of ___?

A

SV + SMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

___ drains into the SV prior to the portal/splenic confluence?

A

IMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

___ drains into the portal system near the portal/splenic confluence?

A

Left gastric vein (aka coronary vein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the porta hepatis?

A

-TRV fissure on posterior surface of liver b/w caudate + quadrate lobes

-Where MPV + HA enters liver + hepatic duct exits liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Differentiate the characteristics b/w LPV + RPV?

A

LPV:
-Smaller, anterior, cranial
-Splits into med/lat branches

RPV:
-Larger, posterior, caudal
-Splits into ant/post branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

List 3 characteristics of PVs?

A

-Intrasegmental (within liver segments)
-No valves
-Walls contain a minor amount of collagen
-Hyperechoic walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

___ is the primary outflow route of blood from the liver?

A

HVs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which HV is the largest?

A

RHV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

___ joins to form a common trunk before entering the IVC?

A

MHV + LHV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

List 4 characteristics of HVs?

A

-Intersegmental (b/w lobes)
-No valves
-Walls composed of mostly collagen
-Only hyperechoic when perpendicular to it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

___ drains caudate lobe directly into IVC?

A

Caudate vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

___ branches off the celiac trunk towards the pt’s right?

A

CHA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When does the CHA become the PHA?

A

After the gastroduodenal artery branches off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

At the porta hepatis, the PHA splits into ___?

A

RT + LT branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Where is the HA in the mickey mouse sign?

A

RT ear

(lies anteromedial to PV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

HAs run with ___ veins?

A

Portal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the hepatoporal protocol?

A

2D images of spleen, liver, pancreas, GB + associated vasculature

Spectral doppler:
-HVs + IVC
-Intrahepatic PVs (MPV, RPV, LPV)
-Extrahepatic PVs (SV + SMV)
-PHA

Measure:
-MPV diameter (inner to inner)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which vessels should we use angle correct with?

A

MPV + PHA

34
Q

What is the normal MPV diameter with quiet respiration?

A

< 13mm

35
Q

What can the MPV diameter increase to with deep inspiration?

A

16mm

36
Q

Normal portal venous flow is ___?

A

Hepatopetal

37
Q

What would helical flow look like on CD?

A

Alternating red + blue bands

38
Q

PV velocity will increase + decrease during what?

A

Increase: during expiration + ingestion of food
Decrease: during inspiration + exercise

39
Q

Normal SV diameter is ___ with quiet respiration?

A

< 10mm

40
Q

SV > 10mm indicates ___?

A

Portal hypertension

41
Q

Normal SV flow direction is ___?

A

Antegrade

(going towards portal-splenic confluence)

42
Q

The SV will decrease in velocity during ___ + increase during ___?

A

Inspiration, expiration

43
Q

Normal SMV diameter with quiet respiration is ___?

A

< 10mm

44
Q

Normal SMV flow is ___?

A

Antegrade

45
Q

What is the normal RHV diameter?

A

< 6mm

46
Q

What is the normal RHV diameter in pt’s with CHF?

A

< 9mm

47
Q

Normal HV flow is ___?

A

Pulsatile

48
Q

Explain the HV waveform?

A

S: systole, below baseline
D: diastole, below baseline

V: end systole, above baseline
A: atrial contraction, above baseline

49
Q

The HA is larger or smaller in diameter than the PV?

A

Smaller

50
Q

Normal HA flow is ___?

A

Hepatopetal

51
Q

What would cause the HA flow to decrease?

A

Ingesting food, this increases pulsatility

52
Q

Normal IVC diameter?

A

15-25mm

53
Q

SF of an obstructed IVC?

A

Dilated + loss of phasicity

54
Q

Normal IVC flow is ___?

A

Antegrade (to RA), pulsatile + have respiratory phasicity

55
Q

What is the normal pressure in the hepatoportal system?

A

5-10 mm Hg

56
Q

What is the m/c cause of portal hypertension?

A

Sinusoidal obstruction due to cirrhosis

57
Q

SFs of the 3 stages of cirrhosis?

A

Stage 1: liver enlarged + echogenic
Stage 2: coarse + heterogeneous
Stage 3: nodular, RLL atrophied + enlarged caudate

58
Q

How does cirrhosis affect the PV + HV flow?

A

PV: increases resistance
HV: obstructs

59
Q

3 SFs of portal hypertension?

A

-Loss of phasicity
-Bidirectional flow
-Hepatofugal flow (severe)

60
Q

What is the most specific finding of portal hypertension?

A

Portosystemic collateral veins (varices)

61
Q

What is the most prevalent collateral vein associated with portal hypertension?

A

Left gastric vein (>7mm is dilated)

62
Q

What causes gastroesophageal varices?

A

Reverse flow in the left gastric/coronary vein

63
Q

Where do splenorenal varices shunt blood to?

A

To the LRV, then the IVC (decompresses portal circulation)

64
Q

What is recanalization of the PUV?

A

-Fetal remnant arising from the LPV coursing along anterior edge of falciform ligament to the abdominal wall
-Connects to systemic veins around umbilicus “caput medusa” sign

65
Q

Where is recanalization of the PUV located?

A

In fissure for the ligamentum teres

66
Q

What is arterialization?

A

PV obstruction (due to cirrhosis or PVT) which increases resistance + decreases PV flow

67
Q

What happens to the HA when arterialization occurs?

A

-Enlarged with high velocity flow
-Tortuous corkscrew appearance on CD

68
Q

What is an AVF?

A

Abnormal connection b/w artery + vein

1) arterioportal (HA to PV)
2) portosystemic venous (PV to HV/IVC)
3) arteriosystemic (HA to HV)

69
Q

PVT can be caused by what 2 things?

A

-Flow stasis secondary to cirrhosis + portal hypertension
-Extrinsic compression from malignancy

70
Q

What is cavernous transformation?

A

-The formation of periportal collateral veins within or around a previous PVT
-Occurs if PVT goes untreated for up to 12 months

71
Q

What is cardiac cirrhosis (congestive hepatopathy)?

A

Term used to describe liver disorders that occur due to right sided heart failure

Includes:
-Hepatomegaly
-Portal-hepatic venous system + IVC dilation with absence of wall motion with respiration
-Pulsatile PV flow (antegrade + retrograde)
-HV waveform has very pulsatile “W” type pattern

72
Q

What causes primary + secondary BCS?

A

Primary: endoluminal thrombus or webs
Secondary: malignant tumor, etc

73
Q

SF of BCS?

A

-Dilated HVs or IVC
-Stenosis or occlusion of HVs or IVC
-Absence of flow in HVs or IVC
-Slow or reversed flow in PV
-Enlarged caudate lobe (>3.5cm)
-Enlarged caudate vein (>3mm)

74
Q

SF of SOS?

A

Patent + large HVs and PVs

75
Q

TIPS is done under ___ guidance?

A

Fluroscopic

76
Q

Where does the catheter get inserted with TIPS insertion?

A

Enters RJV, through wall of RHV, then through liver to get to the RPV

77
Q

TIPS reroutes blood from the ___ to ___?

A

From RPV to RHV + back to IVC

78
Q

What type of flow should a functioning TIPS have?

A

-Hepatopetal flow in MPV
-Hepatofugal flow in intrahepatic PV branches, beyond the stent

79
Q

SF of TIPS?

A

2D:
Echogenic structure around hepatic parenchyma that extends into the PV + RHV

CD:
-Hepatopetal flow at PV end
-Hepatofugal flow at HV end

80
Q

Normal velocities within a TIPS stent range from ____?

A

90-190 cm/s

(take velocity at MPV, PV end, midstent, HV end + HV outflow)

81
Q

What velocity would indicate a TIPS stenosis?

A

> 190 cm/s

82
Q

SF of a TIPS occlusion?

A

-Echogenic material within stent
-Absent flow with spectral + CD

MIDS 237 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions