GI Section V: Hepatioc Doppler

Question 1

‘‘Duplex” means

Answer 1

Color

Question 2

“spectral” means

Answer 2

Color with Waveform

Question 3

When an organ needs to be “on,” its arteriolar bed dilates, and the waveform becomes?

Answer 3

Low resitance

Question 4

When an organ goes to “power save” mode, it directs the arterioles to?

Answer 4

Constrict

Question 5

To help quantify this low resistance high resistance thing in Doppler, we use this

Answer 5

“Resitive Index (RI)”

Question 6

RI is defined as?

Answer 6

V1-V2/V1

Question 7

Just remember that things that need blood all the time, will have?

Answer 7

Just remember that things that need blood all the time, will have continuous diastolic flow - and thus a low resistance wave form.

Question 8

What is this ‘‘Tardus” ?

Answer 8

Refers to a slowed systolic upstroke.

an be measured by:

Accelaration time, time from end diastole to teh first systole peak

Question 9

An acceleration time > 0.07 sec correlates with

Answer 9

> 50% stenosis of renal artery

Question 10

What is “Parvus”?

Answer 10

decreased systolic velocity. This can be measured by calculating the acceleration index, the change in velocity from end diastole to the first systolic peak.

Question 11

An acceleration index <3.0 m/sec- correlates with

Answer 11

> 50% stenosis of renal artery

Question 12

Blood that has NOT yet passed through the stenosis

Answer 12

Upstream

Question 13

Blood that has passed through the area of stenosis

Answer 13

Downstream

Question 14

Direct Signs of stenosis?

Answer 14

those found at the stenosis itself

Elevated Peak Systolic Velocity
Spectral Broadening (Immediate post stenotic)

Question 15

Indirect signs of stenosis?

Answer 15

tardus parvus (downstream) - with time ot peak (systolic acceleration) > 70 msec

Low downstream RI < 0.5 (liver is tarved of blood)

High upstream RI > 0.6) blood needs to overcome the area of stenosis

Question 16

Describe the flow of hepatic veins

Answer 16

Complex
Alternating foreward and backward flow

Question 17

What should be the bulk of flow in the hepatic veins?

Answer 17

should be antegrade

Liver —> heart

Question 18

What are the things that mess with the wavefrom?

Answer 18

Pressure changes in the RIGHT heart which are transitted to the hepatic veins (CHF/Tricuspid regurg) or compression of the veins directly (cirrhosis)

Question 19

Anything that increases the right atrial pressure (Atrial contraction) will cause the wavef to?

Answer 19

Slope upward

“A” represents atrial contraction.

Question 20

Anything that decreases right atrial pressure will cause the wave to?

Answer 20

Slope downward

Question 21

Abnormal Hepatic Vein Waveforms can manifest in one of three main categories:

Answer 21

(1) More Pulsatile
(2) Less Pulsatile
(3) Absent = Budd Chiari

Question 22

Increased HV Pulsatility

Answer 22

Tricuspid Regurg
Right Sided CHF

Question 23

Decreased HV Pulsatility

Answer 23

Cirrhosis
Hepatic Venous Outflow Obstruction (any cause)

Question 24

Tricuspid Regurg =

Right heart failure =

Answer 24

Tricuspid Regurg = D deeper than S

Right heart failure = S deeper than D

Question 25

Flow in the portal vein should always be?

Answer 25

Towards the liver

Question 26

Velocity in the normal portal vein

Answer 26

between 20-40 cm/s.

Question 27

You have three main waveform patterns of portal vein

Answer 27

Question 28

Causes of Portal Vein Pulsatility:

Answer 28

Right-sided CHF
Tricuspid Regurg
Cirrhosis with Vascular AP shunting

Question 29

Causes of Portal Vein Reversed Flow

Answer 29

The big one is Portal HTN (any cause).

Question 30

Absent Flow of the portal vein causes

Answer 30

It’s seen in thrombosis, tumor invasion,
and stagnant flow from terrible portal HTN.

Question 31

most common cause of slow flow (Velocities < 15 cm/s)

Answer 31

Portal HTN

Question 32

Causes of PV slow flow

Answer 32

• Pre - Portal Vein Thrombosis
• Intra - Cirrhosis (any cause)
• Post - Right-sided Heart Failure, Tricuspid Regurg, Budd-Chiari

Question 33

“what should the Doppler angle be?”

Why?

Answer 33

The answer is “less than 60. ”

• the doppler strength follows the Cos.