portal venous system Flashcards
normal size of portal vein
less than 13 mm
what 2 veins form the portal vein
splenic vein and SMV
what is the normal pressure in the portal vein
5-10 mmHg
when does the portal flow rate and diameter increase
with inspiration and after eating
when does portal flow rate diameter decreases
after exercise and in the upright postion
how does the pv coarse in the liver
transversely
if the PV diameter doesnt change with respiration what should you suspect
portal HTN
what is the normal flow in the PV
toward the liver
hepatopetal
what are the 2 branches of the RPV
anterior and poster branch
the splenic vein drains the…
spleen, stomach and pancreas
SMV drains the…
small intestine and proximal colon
what is budd chiari
obstruction of hepatic veins by thrombus or tumor
symptoms of budd chiari
pain, jaundice, ascites, hepatomegaly, Portal HTN
what is budd chiari associated w/?
oral contraceptives, hepatocellur CA, renal CA, adrenal CA
sonographic appearance of budd chiari
HV w/ thick walls
hepatomegaly
caudate lobe hypertrophy
r & l lobe atrophy
ascites
compression of IVC
ascites
Splenomegaly
pv slow flow
air in hepatic veins
can lead to PE
caused by bacterial infection
air in HV on sono
mobile echogenic foci w/ dirty shadowing or ring down
most common cause of portal HTN
cirrhosis
signs of portal HTN on a patient
esophageal varices
recanalized umbilical vein
caput medusa
turtuous vessels around the umbilicus due to portal HTN
what collateras will you see with Portal HTN
umbilical vein
splenorenal
gastrorenal
intestinal
portal HTN sono appearance
shrunken right lobe
enlarged caudate
dilated portal greater than 13 mm
reverse of flow or hepatofugal
SMV > 1 cm in diameter
in what plane is the recanalization of the umbilical vein is best seen
sagital plane left of midline at the left of the ligament of teres
what is cavernous transformation
formation of venous varices at porta hepatis
where can varices also be found
splenic/renal hilum or gastroesophageal junction
portal vein thrombosis symptoms
pain
fever
rigid abdomen
nasuea
vomiting
increased LFTS
portal vein thrombosis sono appearance ACUTE
echogenic thrombis
absence of flow
increased diameter
portal vein thrombosis sono appearance CHRONIC
more echogenic
numerous collaterals
decreased flow
tumor invasion of portal vein is associated w/
hepatocellular cancer
tumor in portal vein on sono
can show arterial flow within mass on doppler signal
TIPS or Caval shunt is used to
alleviate portal HTN and allow blood flow to bypass liver
TIPS is inserted into
the IJV and through the hepatic viens into the portal system
where is the shunt more commonly placed
the MPV into the right hepatic vein
sono eval of TIPS must include
flow velocity and direction in the MPV< SMV, confluence, and 3 hepatic veins
portal and hepatic anastomosis
flow in the TIPS shunt should be
HEPATOFUGAL
TIPS peak velocity should not be less than
50 cm/s
TIPS peak velocity should not be MORE than
200 cm/s
most common cause of shunt stenosis is
neointomal hyperplasia of the HEPATIC VEIN anastomosis
signs a TIPS shunt is failing
-absence of flow in shunt
-hepatopetal flow in INTRAhepatic portal branches
-hepatofugal flow in MPV
-reversal of flow in hepatic veins
portal anuerysm
at the junction of splenic vein and SMV most common
