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Liver Vasculature Flashcards

1
Q

Liver Vasculature includes evaluation of

A

Hepatic veins
Portal veins
Hepatic artery
IVC
Collaterals?

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2
Q

3 disorders we look at

A

Portal hypertension
Shunts/stents
Transplants

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3
Q

2 things causing portal hypertension

A

Portal vein thrombosis
Hepatic vein thrombosis

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4
Q

___ HV and ___ HV typically join before the IVC

A

MHV
LHV

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5
Q

___ HV is commonly duplicated

A

Left

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6
Q

HV waveforms are ___ and ___

A

Respirophasic
Pulsatile

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7
Q

Assess HV for ____ or ____

A

Patency
Distension

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8
Q

HV are ___ segmental

A

Inter (between)

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9
Q

PV drain blood from the (3)

A

Bowel spleen liver

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10
Q

PV supply approximately ___ of blood to liver

A

75%

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11
Q

MPV comprises of

A

SV
sMV

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12
Q

MPV enters liver through the

A

Porta hepatis

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13
Q

Hepatopetal

A

Towards the liver

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14
Q

Hepatofugal

A

Away from the liver

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15
Q

What means towards the liver

A

Hepatopetal

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16
Q

What means away from the liver

A

Hepatofugal

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17
Q

Portal veins have a ___ velocity normal (range for MPV is ____)

A

Low
16-40 cm/s

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18
Q

Portal veins flow increases ____

A

Post-prandial

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19
Q

Normal MpV diameter should be less than or equal to ___

A

13mm

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20
Q

HA supplies ___ of blood to liver

A

25%

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21
Q

Proximal HA seen at

A

Celiac axis

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22
Q

Distal hepatic artery is ___ and seen at

A

Intercostal
MPV/RPV

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23
Q

HA should be ___ resistance

A

Low

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24
Q

Is there spectral broadening go in HA

A

Small amount due to small vessel

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25
Q

HA has variable velocities so ___ is used to assess for pathology

A

RI

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26
Q

Normal RI for HA

A

0.55-0.7

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27
Q

Post-prandial

A

After eating

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28
Q

Angle for MPV angle correct has to be ___

A

60 degrees or less

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29
Q

____ is tortuous

A

HA

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30
Q

RI

A

Resistive index

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31
Q

Greater than __ is considered dilated for the IVC

A

2.5cm

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32
Q

IVC spectral trace has a ____ waveform

A

Spontaneous

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33
Q

IVC spectral influenced by ___ and ____

A

Heart
Respiration

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34
Q

IVC is ___ proximally and ___ distally

A

Pulsatile
Phasic

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35
Q

Portal hypertension can be categorized as (3)

A

Pre-hepatic
Intrahepatic
Post-hepatic

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36
Q

What a the most common portal hypertension category

A

Intrahepatic

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37
Q

What is the leading causes of portal hypertension

A

Cirrhosis

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38
Q

What is the first and second leading cause of cirrhosis

A

Hepatitis C
Alcoholism

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39
Q

signs/symptoms of portal hypertension

A

jaundice
abnormal LFTs
ascites
splenomegaly
GI bleed (hematemesis, melena)

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40
Q

LFT

A

liver function test

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41
Q

hematemesis

A

vomiting blood

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42
Q

melena

A

dark tarry stools

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43
Q

caput medusae (what/seen with)

A

dilated abdominal wall veins sometimes seen with portal hypertension

44
Q

hepatic encephalopathy

A

confusion due to poor liver function

45
Q

4 reasons for pre-hepatic obstruction

A

portal/splenic vein thrombosis
portal/splenic vein invasion (tumor within)
extrinsic compression by a tumor
pancreatitis

46
Q

pancreatitis

A

inflammation of the pancreas

47
Q

in pre-hepatic obstruction the liver is ____ and the spleen is ____ (size)

A

typically normal
enlarged

48
Q

5 causes for portal vein thrombosis

A

cirrhosis (20%)
malignancies (20%)
hypercoagulable states
intra-abdominal inflammation/infection
trauma (from surgery)

49
Q

T/F chronic PHT always has symptoms

49
Q

normal PV diameter

50
Q

can PV be enlarged with PV thrombosis

51
Q

T/F the lumen of PV may be any echogenicity with PV thrombosis

52
Q

cavernous transformation

A

other V and PV dilated (looks like can of worms at porta hepatis)

53
Q

can the HA be enlarged/have increased flow with a PV thrombosis

54
Q

does PVT tend to be permanent or not

55
Q

what does permanent PVT commonly lead to

56
Q

5 causes of PHT

A

cirrhosis
hepatitis
hepatic fibrosis
nonalcoholic steatohepatitis (NASH)
inflammation of normal liver tissue

57
Q

PHT leads to _____ and _____

A

tissue death and fibrosis

58
Q

with intrahepatic obstruction, it can damage what 3 things

A

liver
sinusoids
hepatocytes

59
Q

with intrahepatic obstruction, there is an ______ resistance to blood flow at the ______ level

A

increased
sinusoid

60
Q

with intrahepatic obstruction, there may be a shunting of blood to _____

A

collateral vessels

61
Q

can varices develop with intrahepatic obstruction

62
Q

with intrahepatic obstruction, the liver with _____ in size in the end stage and the spleen will ____ in size

A

decrease
increase

63
Q

3 causes of post-hepatic obstruction

A

chronic right-sided heart failure (CHF)
tricuspid regurgitation (TR)
Budd Chiari

64
Q

what is Budd Chiari

A

thrombosis of the HV’s or IVC

65
Q

if post-hepatic obstruction is acute, the liver _____ in size, and the spleen ____ in size

A

increases
increases

66
Q

with CHF or TR, the PV will appear ____ on spectral, the HV normal waveform will change as the ___ wave will ___, and there will be a ____ IVC

A

pulsatile
S
decrease
dilated

67
Q

Budd Chiari is most commonly caused by ______ like _____

A

a hypercoagulable state
polycythemia

68
Q

polycythemia

A

too many RBC

69
Q

can oral contraception lead to post-hepatic obstruction

A

yes; thrombosis

70
Q

with post-hepatic obstruction, _____ may form and the ____ may help drain the liver

A

collaterals
caudate lobe

71
Q

4 things we look for when scanning liver vasculature

A

patency of MPV and branches
direction of flow
phasicity
MPV velocity

72
Q

what is the normal range for MPV velocity

A

16-40cm/sec

73
Q

the major 3 congenital shunts are

A

portocaval (PV to IVC)
mesocaval (SMV to IVC)
splenorenal (SV to Lt. RV)

74
Q

left gastric vein AKA

A

coronary vein

75
Q

what is the most prevalent portosystemic collateral

A

left gastric (coronary vein)

76
Q

increased pressure in the coronary vein may cause _____ varices

A

esophageal

77
Q

visualization of the coronary vein implies an increased risk for ____

A

hemorrhage

78
Q

with PHT the remnant of the _____ recanalizes in the lig teres from ___ to ____. Flow is ____ (in comparison to liver)

A

umbilical vein
LPV
umbilicus
hepatofugal

79
Q

surgical shunts can be placed ___ or with an ______ technique

A

surgically
endovascular technique

80
Q

the most common way to place a shunt for PHT is

81
Q

TIPS

A

trans-jugular intrahepatic portosystemic shunt

82
Q

TIPS shunts blood from ___ to ___

83
Q

TIPS: catheter passed down ___ into HV, advancing through liver tissue into PV branch

84
Q

technical success rate of TIPS is

A

nearly 100 percent

85
Q

normal TIPS velocity range ____ with velocities increasing from the ___ end to the ___ end

A

90-190cm/s
portal
hepatic

86
Q

normal PV velocity is at least after TIPS

87
Q

TIPS: flow is ____ in the right and left portal

A

retrograde

88
Q

TIPS: compensatory HA flow ____

89
Q

with early TIPS complication, we will see increased velocities in ____ and decreased velocities in ___

A

stenosis
MPV

90
Q

late complication fo TIPS

A

neo-intimal hyperplasia invades stent

91
Q

if stenosis is detected in TIPS what is done (2)

A

balloon angioplasty
thrombolysis

92
Q

is transplant liver always whole

93
Q

the post-opperative US is used to confirm patency, flow direction and size of what 4 things after liver transplant

A

HA
PV
IVC/HV
SV/mesenteric V

94
Q

the PV can be larger in the transplant patient with normal size up to

95
Q

pseudo aneurysm

A

where leak happens and body walls it off making it look like an aneurysm

96
Q

hepatic infarction (what, usual shape/echogenicity)

A

death of tissue (usually wedge shaped/hypo)

97
Q

air can act as an ____

98
Q

AV fistulas

A

arterial-venous connection due to surgery

99
Q

US is done ___ after transplant and at regular intervals afterwards

100
Q

HA should have a ___ upstroke and an RI in the range of

A

rapid
0.5-0.8

101
Q

AT time for HA

102
Q

if AT is high what does it mean

A

proximal stenosis

103
Q

PSV of HA is variable and not reliable but should be less than

104
Q

if PSV high this means

A

stenosis with jet

105
Q

HV can have a ______ waveform immediately after surgery but will normalize over time

A

monophasic (never crosses baseline)

Vascular 1 (7 decks)

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