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Abdominal Scanning > IVC Physiology and Pathology > Flashcards

IVC Physiology and Pathology Flashcards

1
Q

CBD is _______ to the Portal Vein

A

Anterior

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2
Q

The CHD is _______ to the Portal Vein

A

Anterior

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3
Q

Portal Vein is _______ to the IVC

A

Anterior

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4
Q

SMV lies __________ to the Portal Vein

A

Inferior

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5
Q

SMV lies _________ to the Uncinate Process

A

Anterior

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6
Q

SMV lies _________ to the Pancreas Neck

A

Posterior

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7
Q

Pancreas Head lies______ to the IVC

A

Anterior

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8
Q

SMV and SMA lies________ to the 3rd portion of the duodenum

A

Anterior

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9
Q

MPV is a combination of

A

SMV Splenic and IMV

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10
Q

IVC displaced _________ by Right Liver Mass

A

Posterior

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11
Q

IVC displaced ________ by Right Renal Artery Aneurysm

A

Anterior

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12
Q

IVC displaced ______ by tortuous Aorta

A

Right

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13
Q

IVC displaced _______ by Right Adrenal Mass

A

Anterior/Medial

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14
Q

IVC displaced _______ by Right Renal Mass

A

Medial/ Left

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15
Q

Splenic Vein displaced _______ by left adrenal mass

A

Anterior

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16
Q

2 vessels in ventral cavity

A

Aorta and IVC

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17
Q

Whats the purpose of the IVC

A

Brings de-oxygenated blood back to the heart

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18
Q

What does the lumen of veins contain to help veins fight gravity

A

Valves

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19
Q

If valves are leaking or damaged what is it called when blood moves backwards

A

retrograde

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20
Q

Does venous system usually demonstrate a pulsatile flow

A

No

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21
Q

What happens when the valsalva maneuver is utilized

A

distends and dilates

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22
Q

Which vessels join to form the common iliac veins

A

External and Internal Iliac Veins

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23
Q

The IVC lies________ to the Liver

A

Medial and Posterior

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24
Q

What reason do we ultrasound the IVC

A

Look for thrombus and tumor invasion

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25
Q

What is rouleaux flow

A

The aggregation of RBCs

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26
Q

What are the 4 sections of the IVC

A

Hepatic
Pre-renal
Renal
Post-renal

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27
Q

If a tumor is in the renal veins what other vessel do you investigate

A

IVC

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28
Q

Where do the hepatic veins originate

A

Liver

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29
Q

What vessels drain all the blood from the liver

A

Hepatic Veins

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30
Q

The RHV empties which lobe

A

RLL

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31
Q

LHV empties which lobe

A

LLL

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32
Q

The MHV empties which lobe

A

Caudate Lobe

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33
Q

Do hepatic veins decrease in diameter as they approach IVC

A

No

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34
Q

What do you call blood flow toward the liver

A

hepatopedal

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35
Q

What do you call blood flow away from the liver

A

hepatofugal

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36
Q

What other vein enters the left renal vein besides the gonadal

A

left suprarenal

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37
Q

What does the right gonadal vein drain into

A

IVC

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38
Q

The major abdominal venous system constist of

A 
IVC- from common iliac to diaphragm
Splenic Vein
IMV
SMV
Hepatic Veins
Renal Veins
Portal Veins
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39
Q

The proper hepatic artery shares circulatory supply with what

A

MPV

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40
Q

What does the IVC look like with Ultra Sound

A

Tube like
Well defined borders (echogenic)
Walls less echogenic and are thinner than arteries

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41
Q

How do you differentiate the artery from the vein

A

You can see pulsations of the arteries more than the veins. Also vein walls are collapsible

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42
Q

How do veins act during respiration

A

Inspiration - decrease size of lumen and blood flow decreases
Expiration - increases size of lumen and blood flow increases

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43
Q

How does Valsalva Maneuver affect the veins

A

Dilation/Distention and stops flow in the vessels

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44
Q

How are arteries affected by respiration and Valsalva

A

They aren’t

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45
Q

What two vessels combine to make the IVC

A

Left and Right common iliac

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46
Q

Where is the anatomical orientation of the IVC

A

Courses through retro-peritoneal
Right of Aorta
Anterolateral to vertebra

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47
Q

How does IVC relate to surrounding structures

A

Liver- posterior
Kidney- medial
Diaphragm- Anterior

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48
Q

What are the tributaries to IVC that can not be seen by ultrasound

A

Lumbar
Right suprarenal
Right gonadal vein

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49
Q

Is the venous system pulsatile

A

No

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50
Q

What is the Valsalva Maneuver

A

Patient takes deep breath and holds it and bears down, as if having a bowel movement

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51
Q

What shape is the lumen of the IVC

A

Elliptical

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52
Q

How should you measure the IVC

A

A/P

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53
Q

What is rouleaux formation

A

an aggrigation of the RBC in order to better facilitate the upward movement through the veins. Blood cells are stacked together. May make inner vessel appear complex.

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54
Q

Where is the Hepatic section of IVC

A

where hepatic dumps into IVC

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55
Q

Where is pre renal

A

Inferior to hepatic veins but superior to renals

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56
Q

Where is renal

A

Where renal veins are

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57
Q

Where is post renal

A

Proximal to the Renal veins to the bifurcation

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58
Q

Where does tumor invasion most likely occure

A

renal veins and extend into the IVC

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59
Q

Most common renal tumor

A

Renal Cell Carcinoma

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60
Q

What are the normal variants of IVC

A

Double IVC, IVC on left, absent portion

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61
Q

Hepatic Veins originate in

A

Liver

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62
Q

Where do hepatic veins empty

A

superior to renal veins

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63
Q

Do the hepatic veins increase or decrease as they approach IVC

A

Increase

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64
Q

Are hepatic Veins pulsatile

A

Yes

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65
Q

Are hepatic Veins hepatofugal or hepatopedal

A

hepatofugal

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66
Q

What are caudate lobe veins

A

Small veins that drain directly into the IVC, occasionally seen with ultrasound

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67
Q

Which renal veins is longer

A

Left

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68
Q

Left renal vein receives which two veins

A

Left Suprarenal Vein and Left Gonadal Vein

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69
Q

The Renal Veins are ______ to the Renal Arteries

A

Superior (VAU)

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70
Q

What is the nutcracker

A

LRV is caught between aorta and SMA

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71
Q

Where does the Right suprarenal vein and maybe also left gastric vein feed into

A

IVC

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72
Q

What is another name for the gonadal veins

A

Ovarian veins and gonadal veins

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73
Q

What are Azigos and Hemi Azigos

A

They are veins that run parallel to the IVC and can bypass the IVC if need be.
Left - Hemi azygos
Right - Azygos

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74
Q

What structure may be mistaken for the RRA or RRV

A

Right Crus of the Diaphragm

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75
Q

Will left and right veins be symmetrical

A

No because they collapes

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76
Q

Can you always see the vein

A

No my be collapsed

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77
Q

Are Renal veins anterior or posterior to renal arteries

A

anterior but crossover can frequently occur. Doppler is helpful

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78
Q

Do the Portal Veins enter the IVC

A

NO

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79
Q

What is the function of the Portal Veins

A

It delivers blood from the spleen, gastrointestinal tract to the liver

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80
Q

Is the portal vein system similar to the arterial system

A

No different from the arterial and venous blood supply to the liver

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81
Q

What vessels make up the portal system

A

Portosplenic confluence
Main portal vein
Right portal vein and branches
Left portal vein and its branches

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82
Q

Which is more tortuous splenic vein or artery

A

Artery

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83
Q

Where does the splenic vein begin

A

Helium of the spleen

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84
Q

How does splenic vein travel

A

Travels transversely across posterior abdominal wall inferior inferior to splenic artery and posterior to the pancreas tail

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85
Q

What are the landmarks that are anterior and posterior to pancreas

A

Anterior- splenic artery

Posterior- Splenic vein

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86
Q

What vein joins the Splenic vein as it drains distal colon and rectum

A

IMV

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87
Q

Is IMV normally seen by ultrasound

A

No

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88
Q

When is IMV seen by ultrasound

A

When it dilates with Portal HTN may be confused for Splenic Vein

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89
Q

Where does SMV originate

A

Ileocecal valve where the ilium and small intestines join the cecum of the large intestines

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90
Q

How does SMV travel

A

Superiorly near midline

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91
Q

When does it become the portosplenic confluence

A

When SMV joins the Splenic vein and IMV

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92
Q

Portosplenic confluence then travels laterally and becomes

A

MPV

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93
Q

MPV passes____________ to the 1st portion of the duodenum CBD, PHA and GDA

A

posteriorly

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94
Q

How much blood does main portal vein supply to the IVC

A

80% or 4/5

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95
Q

Where does MPV begin

A

Posterior to the neck of the pancreas

96
Q

Where does MPV enter the liver

A

Porta hepatis

97
Q

What are the division of the MPV

A

Left and right portal veins inside the liver

98
Q

What is the portal veins connected to GB by the main lobar fissure

A

Right portal vein

99
Q

What 3 vessels make up the Porta Hepatis

A

Main Portal Vein
Common Hepatic Duct
Proper Hepatic Artery

100
Q

What sign is the porta hepatis made of

A

Mickey Mouse Sign-Mashed (main portal vein) Potatoes (Proper Hepatic Artery), and Corn (Common Bile Duct)

101
Q

What scanning plane can you find mickey mouse

A

Oblique

102
Q

Which is longer R portal vein or L portal vein

A

Left and has smaller diameter

103
Q

What does Left portal vein branches feed

A

Caudate lobe and Left lobe of liver

104
Q

How does Left portal vein travel

A

Origin- MPV and courses medially

105
Q

What are two segments of Left portal vein

A

MEDIAL AND Lateral

106
Q

What sign does Left portal vein make when it branches

A

Steer sign

107
Q

What veins originates from the Right Portal Vein

A

Cystic vein

108
Q

Cystic vein gives branch to

A

Caudate lobe before entering into the right lobe of the liver

109
Q

What does Right portal veins branch into

A

Anterior and posterior

110
Q

What makes Portal Veins stick out

A

Highly echogenic walls- due to high collagen in the walls

111
Q

Why do we evaluate the portal veins

A

Tumor or thrombus which causes portal HTN

112
Q

What flow should portal veins show

A

Hepatopedal

113
Q

What are all the hepatic arteries

A

Common hepatic which branches into the Proper hepatic and GDA

114
Q

The Common Hepatic Arteries pass _________ to the MPV just proir to bifurcation

A

Anteriorly

115
Q

How does the proper hepatic flow

A

Bifurcates from CHA and enters through portahepatis within the folds of the hepatoduodenal ligament

116
Q

Proper Hepatic artery divides into

A

Left Hepatic Artery and Right Hepatic Artery, the Right Hepatic Artery gives rise to the cystic artery

117
Q

What does cystic artery feed

A

GB, hepatic ducts and part of CBD

118
Q

Will CBD have color on doppler

A

NO

119
Q

Does portal venous system enter the IVC

A

No

120
Q

Function of the portal system

A

Brings oxygenated blood from spleen and gastrointestinal tract to liver for oxygenation and detoxification

121
Q

Name 4 segments of the portal vein system

A

Portasplenic confluence
Main Portal Vein
Right Portal Vein
Left Portal Vein

122
Q

What is vessel that landmarks the Pancreas

A

Splenic Vein

123
Q

Name the ligament that crosses the celiac axis

A

Medain Arcuate Ligament

124
Q

3 vessels of the portasplenic confluence

A

SMV IMV and splenic vein

125
Q

What supplies 80% of the Liver blood supply

A

MPV

126
Q

What is the steer head sign

A

The branches of the Left Portal Vein (median and lateral

127
Q

What makes up porta hepatis

A

MPV, PHA, CHD - MICKEY MOUSE SIGN if in oblique

128
Q

Cystic originates in

A

R portal and branches to Caudate lobe

129
Q

What are Azygo and Hemi Azygo

A

Back up for IVC

130
Q

How does inspiration affect IVC

A

Smaller diameter

Less venous return

131
Q

How does expiration affect IVC

A

Larger diameter

Greater venous return

132
Q

How does valsalva maneuver affect IVC

A

Venous return is blocked because flow is temporarily reversed causing it to bulge

133
Q

How should exams be done in order to be consistent

A

Examine as patient examines on suspended inspiration

134
Q

How does an obstruction affect the IVC

A

Increases in diameter BELOW (proximal) the point of obstruction

135
Q

What is the most common cause of IVC occlusion

A

Right sided heart failure

136
Q

What is right sided heart failure

A

When the right side of the heart can’t pump out blood in an efficient manner
The blood isn’t pumped out and it gets backed up into the IVC

137
Q

What is it indicative of when the IVC does not collapse at least 50% with deep breath

A

A right sided filling pressure issue- Right sided Heart Failure

138
Q

Other causes of IVC obstruction

A

Enlarged liver (crushed from the front)
Para-aortic lymph node enlargement (crushed from the left)
Retroperitoneal mass or tumors (crushed from all sides)
Pancreatic tumors (crushed from the front)
Congenital IVC valve issues

139
Q

What are the signs of IVC obstruction

A

Abdominal pain
Ascites
Tender hepatomegaly
Lower extremity edema

140
Q

How does IVC obstruction appear on ultra sound

A

With all causes- Dilation below obstruction
With CHF- Decreased collapse with breath,
congestion of hepatic veins, Ascites, Hepatomegaly

141
Q

How do tumors appear in ultrasound

A

Irregular borders

internal echoes

142
Q

What can be the result of any impinging tumor or structure on the IVC

A

Thrombus

143
Q

What is the most encountered intraluminal anomaly of the IVC

A

Thrombus

144
Q

Where will the thrombus usually spread from

A

Vein in pelvis
Lower Limb
Liver
Kidney

145
Q

How is thrombosis sonographically diagnosed as

A

an intraluminal filling defect that usually expands the diameter of the vessel

146
Q

Why is important to look at the IVC from thrombus or obstruction

A

To avoid a fatal PE

147
Q

How do you determine the age of a thrombi

A

Echogenicity- more echogenic the older it is

148
Q

How does doppler appear on an occluded IVC

A

No signal

149
Q

What is the most like place from a thrombus to occure

A

Kidneys

150
Q

What is an IVC filter

A

metal device placed in the IVC which will filter out any blood clots over 5mm. May be permanent or temporary

151
Q

What complication can occur with an IVC filter

A

Filter fracture

152
Q

What are the symptoms and intervention of IVC filter fracture

A

Asymptomatic- do nothing

symptomatic- CT and consider surgery

153
Q

What are the three types of IVC tumors

A

Primary
Metastatic
Extension from primary

154
Q

What is a primary tumor

A

Leiomyomas or leiomyosarcomas (2%)
Usually in women around 61
With leiomyosarcoma 40-50% spread to liver or lung

155
Q

Where can metastasis of tumors occur from

A 
Renal Carcinoma 
Adrenal Tumors 
Retroperitoneal sarcoma
Hepatocellular Carcinoma
Teratoma
Lymphomas
156
Q

Signs and symptoms of tumor (primary/metastatic)

A

Symptoms are unremarkable but depends on tumor size
Leg edema
Ascites
Abdominal Pain

157
Q

Sonographer apprearence of tumor

A

Echogenic foci but maybe isodense and hard to see.
If primary- may be heterogeneous, with areas of necrosis
Increase in IVC diameter before Block and decrease change with respiration

158
Q

What different diagnosis can the Radiologist contribute to invading tumor

A

Primary Vascular Neoplasm
Malignant IVC Mass
Chronic Thrombus
Large primary tumors outside the vessel

159
Q

What is in alternative to a tumor in the vessel

A

A tumor out of the vessel but distorting into the vessel and may be hard to tell the difference

160
Q

What do you need to ID when you locate an IVC mass

A

Presence of a primary tumor and its site
The cranial extent of the tumor mass (hepatic veins or right atrium)
Possible tumor involvement or invasion of the wall of the vessel

161
Q

What happens to the blood flow pattern when there is an obstruction

A

They are changed

Speeds where it is narrowed

162
Q

What is the symptom seen most often which an IVC tumor invasion

A

Leg Edema

163
Q

When an IVC mass is identified what 2 things must be identified

A

Involvement of hepatic mass or right atrium

Involvement of tumor or invasion of the wall of the vessel

164
Q

What are the most common causes of renal vein enlargement

A

1) Increased blood flow do to a splenorenal or gastrorenal shunt
2) Thrombus or portal htn
3) Tumor involvement from renal cell carcinoma
4) Increased flow from an AV malformation in the kidney

165
Q

What are sign and symptoms of a renal vein enlargement

A

1) Associated with another disease process
2) No specific systems that would make suspicious of tumor extension
3) Renal veins are enlarged past 1.5cm
4) IVC enlargement around the renal veins

166
Q

Sonographer appearance of enlarged renal veins

A

1) Evaluation symmetry between renal veins (ID causing disease
If bilateral- IVC
If only one veins- portal htn, tumor involvement, AV fistula

167
Q

What will happen in the kidney veins if patient has portal htn

A

Formation of collateral pathways cause Left Kidney vein fistula

168
Q

What other problems may cause isolated kidney vein enlargement

A

AV fistula

Tumor

169
Q

How prevalent is renal cell carcinoma in renal vein enlargement

A

21-55%

170
Q

What happens in AV fistula

A

Connection of artery in vein causes artery to force blood into the vein

171
Q

Why might an AV fistula occur

A

1) Blunt trauma
2) Biopsy complication
3) Tumor
4) Nephrectomy
5) Idiopathic (unknown)

172
Q

How does doppler appear in portal htn which causes AV fistula associated with a gastrorenal or splenorenal shunt

A

Turbulent blood flow in veins

Increased velocity

173
Q

If a sonographer finds an echogenic area in the lumen what should he/she then do

A

Closely inspect IVC from extension of the tumor

174
Q

What pitfall might one experience when examining the renal veins

A

1) In tumor free- reverberation artifact which mimics tumor or thrombus
2) Isogenic tumors
3) Left renal vein may appear enlarged when crossing the aorta which is normal
4) Duplicate IVC could appear as left renal enlargement

175
Q

What disorder may cause renal vein thrombus

A

1) Nephrotic syndrome
2) Renal tumors
3) Renal transplants
4) Trauma
5) Infant dehydration (common)
6) Compression of the renal vein secondary to tumor

176
Q

Signs and symptoms of renal vein thrombus

A

1) Loin or flank pain
2) Hematuria
3) Leg swelling
4) Protenuria

177
Q

What is the sonographic appearance of a renal vein thrombus

A

1) Dilation proximal to thrombus
2) Visible thrombus in renal vein or IVC
3) Increased renal size and loss of structure
4) Doppler flow increases

178
Q

How does thrombus appear (staging of a blood clot)

A

Echogenic foci- especially old thrombus

Acute phase- isochoic to surrounding blood

179
Q

How common are venous aneurysms

A

Very RARE

180
Q

What causes venous aneurysms

A

1) Weakened vessel wall by pancreatitis
2) Portal HTN
3) Embryonic malformations

181
Q

What are signs and symptoms of venous aneurysm

A

None associated with small ones in portal venous system

182
Q

Sonographic appearance of portal vein aneurysm PVA

A

1) PVA anechoic in portal hepatis- may or may not be thrombus
2) Doppler can be used to see if there is an echo free structure
- Portal htn resembles all other venous aneurysms

183
Q

Where does Portal vein drain blood from

A

Spleen, pancreas, stomach, gallbladder, small and large intestines

184
Q

What does the left portal vein receive

A

umbillical and paraumbillical vein

185
Q

What does the coronary vein receive

A

Distal esophageal veins- enlarge with portal htn

186
Q

How does coronary vein run

A

Along lesser curvature of stomach

187
Q

Where do thrombus usually occur in portal vein during cirrhosis and hepatic maglignancies

A

Intrahepacally and will spread to extrahepatically

188
Q

Where do all other etiologies cause portal vein thrombus

A

starts at the point of origin

189
Q

What vessel can clot and leaded to thrombus in portal vein

A

Splenic vein- results from an adjacent inflammatory process such as the pancreas

190
Q

What is the normal size of the portal vein

A

13mm

191
Q

What causes portal venous thrombus

A

1) Portal htn
2) Inflammatory - appendicitis, peritonitis, pancreatitis
3) Trauma
4) Postsurgical complications
5) Hypercoagulability states
6) Abdominal neoplasm
7) Renal transplant
8) Benign ulcer disease
9) Idiopathic

192
Q

What is a complication of portal vein thrombus

A

Bowell ischemia and perforation

193
Q

Signs and symptoms of portal vein thrombus

A 
Abdominal pain
Low grade pain
Leukocytosis
Hypovolemia
Shock
Abdominal Rigidity
Elevated LFTs
N & V 
Hematemesis
Melena
194
Q

Sonography appearance of portal htn

A

Stage 1- Echogenic thrombus in vessel lumen
Stage 2- Thrombus and small collaterals
Stage 3- Large collaterals and no identifiable portal veins

195
Q

Direct signs of portal venous thrombus

A
  • Visualization of a clot in the lumen
  • Clot appears echogenic
  • If acute, clot may be hard to identify
  • Local bulge of the vein at clot level
  • Total occlusion: no venous doppler
  • Partial occlusion: normal doppler but decreased flow
196
Q

Indirect evidence of portal vein clot

A
  • No portal vein landmarks
  • Collateral vessel formation
  • Increased SMV and splenic vein caliber
197
Q

What is cavernomatous Transformation

A

Multiple worm like serpiginous vessels in the portal region- will replace clotted portal veins

198
Q

What causes cavernomatous transformation

A

long standing portal thrombus and collateral vein formation

199
Q

What is portal htn

A

Increase in pressure in the portal veins

200
Q

What features accompany portal htn

A
  • Superficial collateral vessels- Cruveilhier- Baumgarten syndrome
  • Left gonadal vein varix
  • Spontaneous splenorenal shunt
201
Q

What are steystemic vein connection to collateral veins to relieve pressure

A

Varicose veins

202
Q

What are varicose veins most frequent

A

Esophagus
Stomach
Rectum
Rupture may cause death

203
Q

What is the most common cause of portal htn

A

Cirrhosis

204
Q

Sign and symptoms of cirrhosis

A 
Ascites
Gastrointestinal bleeding
Poor renal function
Impaired coagulation
Recannalization
205
Q

What is recannalization

A

Under extreme pressure the round ligament (tere) will reopen to move blood

  • Common in cirrhosis or portal htn
  • Results in rapid growth of scar tissue in liver
206
Q

How does recannalization occur

A

So much pressure on vessels surrounding the liver that it forces the round ligament open

207
Q

Sonographer’s appearance

A
  • Portal vein enlarged/or normal or small due to collaterals
  • Secondary effect of increased pressure results in collateral channel development and recannalization and abnormal respiratory responses
208
Q

Collateral network may involve

A
  • Coronary vein
  • Gastroesophageal vein
  • Umbilical vein
  • Pancreatic duodenal vein
  • Gastrorenal and splenorenal vein
209
Q

How often does identifying coronary dilation and esophageal varices indicate portal htn

A

80-90% of the time

210
Q

How often will umbilical vein recannalization be present

A

10-20% of the time

211
Q

How can you locate the coronary vein

A

Locate the splenic vein in midline sagital veiw and move the probe right. It courses cephalad from the splenic vein near the porto-splenic confluence

212
Q

Portal htn from is

A

Hepatofugal- away from the liver, supposed to be hepatopedal

213
Q

What is the most significant clinical consequence of portal htn

A

Variceal Hemorrhage

214
Q

What are pericholecystic varices

A

They are vascular areas of increased flow within the gallbladder wall- associated with portal htn

215
Q

What does Caput Medusae describe

A

Distended and engorged umbilical veins which are seen radiating from the umbilicus across the abdominal wall to join the splenic vein

216
Q

What does the presence of caput medusae indicate

A

Posthepatic and intrahepatic portal htn due to recannalization of the umbilical vein which connects with left portal vein. Wont occur if obstruction if below the umbilical vein

217
Q

What is Caput Medusae and indication of

A

Portal htn which shunting through umbilical veins

218
Q

Where did Caput Medusae derive its name

A

Medusa’s hair of snakes

219
Q

How do normal Portal veins appear

A
  • No intralumenal echoes
  • low velocity and respiratory variation
  • Smooth fill with color
220
Q

How do Portal vein with thrombus appear

A
  • Enlarged or normal with low lever echoes in the lumen, may be isoechoic in the liver
  • Decreased low velocity to absent Doppler
  • Hepatofugal flow
  • No color
221
Q

How does Portal HTN appear

A
  • Enlarged Portal Veins with recannalization of the umbilical vein
  • Look for Hepatofugal flow
  • Hepatofugal flow with good color flow
222
Q

How does Cavernous Transformation look

A
  • Multiple vascular channels near the poral hepatis or splenic hilum
  • Thrombus of the extrahepatic portal vein
  • Recannalized umbilicus
  • Continuous velocity flow
  • Color fills dilated collateral vessels
  • Portal vein hard to fill with color
223
Q

How does a normal Hepatic artery appear

A
  • Hepatic artery should be anterior to portal vein
  • Should be level with the celiac axis
  • Distal HA should seen in intercostal coronal view level with MPV and CBD
224
Q

How does a thrombosis in the hepatic artery appear

A
  • Increased low level echoes
  • Obstruction causes increased waveforms
  • Turbulence or absence of flow if completely obstructed
225
Q

How does normal IVC appear

A
  • Low level echoes that changes with respiration
  • Returns to right atrium
  • Coninuous triphasic waveform with respiratory variation
  • Color filled lumen
226
Q

How does a thrombosis in the IVC appear

A
  • Increase echogenicity within the lumen returning to the Right Atrium
  • Evaluate Renal Veins for extension of thrombus
  • Decreased Doppler waveform for secondary to degree of thrombus
  • Decreased color in the lumen
  • Color will outline the walls of the thrombus
227
Q

How does the IVC appear in right sided heart failure

A
  • Dilation of lumen that does not change in respiration
  • Multiphasic, pullsatile flow
  • Color fills lumen of hepatic veins and IVC
228
Q

How does a thrombosis associated with Budd Chiari appear

A
  • Low level echoes within the lumen of the hepatic veins
  • May restrict blood flow into the IVC
  • Caudate enlargement may mean hepatic vein thrombosis
  • Decreased flow signal
  • Decreased color fill in hepatic veins
  • IVC collapsed with decrease bloodflow
229
Q

What is normal size of portal vein

A

13mm

230
Q

What is the cavernomatous transformation

A

Multiple worm-like vessels in the regions of the portal veins that result from long standing thrombus and collateral vessel formation

231
Q

What is portal hypertension

A

Acute or chronic blocks flow through the liver- causing portal back up. Causes portal blood pressure to increase

232
Q

What helps relieve the high pressure in the portal system

A

Collateral vein formation and varicose formation

233
Q

Where do these collateral vessels usually form

A

Esophagus, stomach, rectum

234
Q

Advances portal HTN can cause what signs and symptoms

A
  • Ascites
  • Gastrointestinal bleeding
  • Poor renal function
  • Impaired Coagulation
235
Q

What is the most significant clinical sign or portal htn

A

Varicose Hemorrhage

236
Q

What kind of blood flow is observed with portal htn

A

Hepatofugal or retrograde

237
Q

Average measurement of IVC

A

2-3.7 cm above 3.7 is considered abnormal

Abdominal Scanning (2 decks)

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