GI Section V: Hepatioc Doppler Flashcards

1
Q

‘‘Duplex” means

A

Color

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2
Q

“spectral” means

A

Color with Waveform

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3
Q

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

A

Low resitance

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4
Q

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

A

Constrict

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5
Q

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

A

“Resitive Index (RI)”

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6
Q

RI is defined as?

A

V1-V2/V1

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7
Q

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

A

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

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8
Q

What is this ‘‘Tardus” ?

A

Refers to a slowed systolic upstroke.

an be measured by:

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

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9
Q

An acceleration time > 0.07 sec correlates with

A

> 50% stenosis of renal artery

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10
Q

What is “Parvus”?

A

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

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11
Q

An acceleration index <3.0 m/sec- correlates with

A

> 50% stenosis of renal artery

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12
Q

Blood that has NOT yet passed through the stenosis

A

Upstream

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13
Q

Blood that has passed through the area of stenosis

A

Downstream

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14
Q

Direct Signs of stenosis?

A

those found at the stenosis itself

Elevated Peak Systolic Velocity
Spectral Broadening (Immediate post stenotic)

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15
Q

Indirect signs of stenosis?

A

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

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16
Q

Describe the flow of hepatic veins

A

Complex
Alternating foreward and backward flow

17
Q

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

A

should be antegrade

Liver —> heart

18
Q

What are the things that mess with the wavefrom?

A

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

19
Q

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

A

Slope upward

“A” represents atrial contraction.

20
Q

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

A

Slope downward

21
Q

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

A

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

22
Q

Increased HV Pulsatility

A

Tricuspid Regurg
Right Sided CHF

23
Q

Decreased HV Pulsatility

A

Cirrhosis
Hepatic Venous Outflow Obstruction (any cause)

24
Q

Tricuspid Regurg =

Right heart failure =

A

Tricuspid Regurg = D deeper than S

Right heart failure = S deeper than D

25
Flow in the portal vein should always be?
Towards the liver
26
Velocity in the normal portal vein
between 20-40 cm/s.
27
You have three main waveform patterns of portal vein
28
Causes of Portal Vein Pulsatility:
Right-sided CHF Tricuspid Regurg Cirrhosis with Vascular AP shunting
29
Causes of Portal Vein Reversed Flow
The big one is Portal HTN (any cause).
30
Absent Flow of the portal vein causes
It’s seen in thrombosis, tumor invasion, and stagnant flow from terrible portal HTN.
31
most common cause of slow flow (Velocities < 15 cm/s)
Portal HTN
32
Causes of PV slow flow
* Pre - Portal Vein Thrombosis * Intra - Cirrhosis (any cause) * Post - Right-sided Heart Failure, Tricuspid Regurg, Budd-Chiari
33
“what should the Doppler angle be?” Why?
The answer is “less than 60. ” - the doppler strength follows the Cos.