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DMS 500 Vascular > Lecture 19: Abdomen Vascular Duplex Imaging > Flashcards

Lecture 19: Abdomen Vascular Duplex Imaging Flashcards

1
Q

what is the seagull sign on ultrasound in regards to the abdominal vessels?

A

in TRV, sonographer can see the splenic artery & CHA

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2
Q

what is the celiac trunk composed of?

A

left gastric artery, CHA, splenic artery

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3
Q

what are you evaluating when scanning the aorta or the iliacs?

A

stenosis/occlusion
follow up on bypass grafts, aneurysms

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4
Q

what are you evaluating when scanning the renal arteries?

A

stenosis of 60%
renovascular HTN

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5
Q

what are you evaluating when scanning the kidneys?

A

transplants
nephrosclerotic disease

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6
Q

what are you evaluating when scanning the SMA & IMA?

A

stenosis of 70% related to mesenteric angina/ischemia

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7
Q

what are you evaluating when scanning the liver?

A

portal HTN
pre & post liver transplants

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8
Q

3 patient positions for abdominal imaging techniques?

A
  1. supine
  2. RLD
  3. LLD
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9
Q

transducer used for abdominal scanning?

A

curvilinear 2.5-5.0 MHz

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10
Q

what is true renal vascular hypertension?

A

when the renal artery is the cause for hypertension

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11
Q

when is duplex imaging ordered for renal arteries?

A

for patients with controlled/uncontrolled hypertension

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12
Q

what is the most common reason for reno-vascular hypertension?

A

renal artery stenosis

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13
Q

3 indications for a renal artery exam?

A
  1. uncontrolled hypertension
  2. decreased renal function
  3. abdominal bruit
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14
Q

what are 2 renal doppler exam methods?

A
  1. direct method
  2. indirect method
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15
Q

what is the pathway of blood from the renal artery to the renal vein?

A

renal artery –> segmental a –> interlobar a –> arcuate –> interlobular a –> interlobular v –> arcuate v –> interlobar v –> segmental v –> renal vein

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16
Q

where can you find the segmental arteries of the kidneys?

A

hilum

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17
Q

where can you find the interlobar arteries of the kidneys?

A

pyramids

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18
Q

where can you find the arcuate arteries of the kidneys?

A

cortico-medullary junction

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19
Q

where do accessory renal arteries arise from? (3)

A
  1. may rise from AO above or below the main RA
  2. accessory RT RA may pass anterior to IVC instead of posterior
  3. may rise from SMA or iliac arteries
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20
Q

patient prep for renal artery exam

A
  • fasting
  • bisacodyl (10mg) for anti-gas (optional)
  • AM exam
  • hydrated
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21
Q

how to complete a renal artery direct method scan?

A
  1. scan kidneys SAG & TRV w/ measurements
  2. scan AO LONG (DIST to SMA & with waveform)
  3. scan main RA PROX, MID, DIST, waveform with PSV & EDV
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22
Q

what is the normal PSV for renal artery

A

100 +- 20 cm/s

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23
Q

what is the normal EDV for renal artery?

A

30 +- 5 cm/s

24
Q

what is the flow resistance for the renal artery?

A

low resistance: high systole & high diastole

25
Q

what is the resistive index for the renal arteries?

A

< 0.75

26
Q

what is an abnormal PSV for the renal arteries?

A

> 180 cm/s

27
Q

what is diagnostic criteria for renal artery stenosis?

A

> 60% diameter reduction

28
Q

stenotic profile of the renal arteries?

A
  • spectral broadening
  • post-stenotic turbulence
  • tardus parvus waveform
  • increased resistance to flow
29
Q

what does RAR stand for?

A

renal to aorta ratio

30
Q

what is the RAR equation?

A

RAR = RA PSV/AO PSV

31
Q

what is a normal RAR?

A

< 0.35

32
Q

what does EDR stand for?

A

end diastolic ratio

33
Q

what is the equation for EDR?

A

EDR = EDV/PSV

34
Q

what is a normal EDR?

A

> = 0.33

35
Q

what is another name for pourcelot’s ratio?

A

resistivity index

36
Q

what is pourcelot’s ratio used for?

A

to determine if resistance is increasing

37
Q

equation for the resistivity index?

A

RI = PSV - EDV/PSV

38
Q

normal range for the RI?

A

< 0.7

39
Q

a pitfall in imaging the renal arteries includes a high technical failure rate. T/F?

A

true

40
Q

it’s difficult to image renal arteries with early kidney failure. T/F?

A

false – late kidney failure

41
Q

poor doppler angles in the renal artery can lead to ___ ___

A

different resistivity index

42
Q

how to complete an indirect method of scanning the renal arteries?

A

evaluating the segmental & interlobar artery waveforms to indirectly assess the main renal artery

43
Q

4 patient positions for the indirect method for scanning the renal arteries?

A
  1. flank approach
  2. supine
  3. slightly oblique
  4. RLD or LLD
44
Q

a normal waveform for the indirect method for scanning the renal arteries has an ___ systolic peak

A

early (ESP)

45
Q

what is the AT/RT for the indirect method of scanning the renal artery?

A

< 0.7 sec

46
Q

what is the purpose for assessing the mesenteric arteries?

A

to assess for mesenteric ischemia/angina

47
Q

what is mesenteric ischemia caused by?

A

stenosis or occlusion of 2 of 3 of the mesenteric arteries

48
Q

S&S of mesenteric angina?

A

dull, achey, crampy abdominal pain 15-30 minutes after a meal

49
Q

1st part of scanning the mesenteric arteries?

A
  1. patient is NPO
  2. get PSV & EDV for mesenteric arteries & aorta
50
Q

2nd part of scanning the mesenteric arteries?

A
  1. give patient high caloric meal
  2. document how much is ingested
  3. document how long between ingestion & onset of symptoms
  4. study repeated after 20-30 minutes (sooner if patient experiences symptoms)
51
Q

when do the SMA & IMA high resistance flow?

A

pre-prandially

52
Q

when do the SMA & IMA have low resistance flow?

A

post-prandially

53
Q

when is stenosis diagnosed in the mesenteric arteries?

A

> 70% DR

54
Q

celiac axis PSV with stenosis?

A

> 200 cm/sec

55
Q

SMA PSV with stenosis?

A

> 275 cm/sec

DMS 500 Vascular (20 decks)

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