Quiz 7 Flashcards
Look at indications for abdominal doppler
on first slide show
what may a physician find in AAA?
patients may present with a pulsatile mass around the umbilical level
what is necessary to fully evaluate the AAA?
duplex and colour doppler
how can you rule out dissection
using 2D as well as duplex colour doppler
what measurment considered AAA?
over 3 cm
what is the caliper placement when measuring AAA?
outer wall to outer wall
what does hepatic artery aneurysm cause?
abdominal pain
bleeding into the GI tract
what is useful to determine turbuent arterial waveforms with aneurysms?
doppler US
what do people with hepatic artery aneurysm have done?
selective angiography of the CA and SMA
what are grafts?
Repair of aneurysmal vessels such as the abdominal aorta and iliac arteries involves grafts to restore flow to the pelvis and lower limbs
what is a good surveillance protocol for grafts?
doppler US
what is a complication for grafts?
- restenosis
- occlusion
- graft leaking
- pseudoaneurysm
percentage of SMA embolism in acute mesenteric ishemia
50%
percentage of SMA thrombosis in acute mesenteric ishemia
25%
percentage of non-occlusive mesenteric ishemia
20%
what is the percentage of mesenteric venous thrombosis
5%
when looking for mesenteric ischemia where do you look?
doppler of
- proximal SMA
- pre and post prandial
what is the SMA preprandial waveform?
high resistant with low diastolic flow
what is the post prandial waveform in the SMA?
lower resisitant with continuous and higher diastolic flow
what does the SMA show in the event of ischemia?
atherosclerosis-waveforms do not change if the stenosis is significant
who is chronic mesenteric ishemia usually seen in?
- younger women
- smokers
- 2/3 with other vascular disease
what is shown clinically with chronic mesenteric ischemia?
bruit
what are the classic symtoms of chronic mesenteric ischemia?
- post prandial pain
- weight loss
- food fear
- GI ulceration
slide 17 PWP 1
look at this slide
where is hypervasculatity seen?
- thyroid-graves disease
- epididymitis
- hyperemia of bowel wall-chrons
- inflammed lymph nodes
what is ultrasound useful in ruling out for trauma?
- artriovenous fistula (AVF)
- pseudoaneurysm
what are the most common organs to be infarcted?
spleen
kidney
what is infarct caused by?
- arterial embolus
- thrombus
- atherosclerotic plaque
- trauma
- extrinsic tumour compression
what is most helpful in ruling out infarct?
colour/power doppler
how does pseudocyst form?
results from a bout of pancreatitis
erosion of tissue outside the pancreas may involve what?
splenic artery wall
what are renal doppler indications?
- pre and post transplant
- renal artery stenosis
- fibromuscular dysplasia
what must your settings at to evaluate suspected renal artery stenosis?
- angle correct
- 60 degrees
- doppler measurments of the PSV prox, central, dist the the extrarenal main reanl arteries
what should be used for calculating the renal artery to aortic ratio (RAR)
PSV of suprarenal aorta
what should be used when measuring the resistive indices (RI)?
spectral doppler of intrarenal arteries
if tadus parvus waveform is shown, what does this suggest?
proximal stenosis
what are a good predictor of RA disease?
resistive indices
what is the gold standard for evaluating RAS?
CTA or MRI, however renal artery doppler is usually the first test performed
why is renal artery doppler the first test performed?
- non-invasive
- no radiation
- no contrast
what is done after transplanted kidneys?
doppler evaluations to document vascular patency and blood flow characteristics
what structures may be examined after a renal transplant?
- main renal artery and vein
- ateria and venous anastomoses
- illiac artery and vein
- intrarenal arteries
what occurs with fibromuscular dysplasia in young females?
sudden uncontrollable hypertension
what is fibromuscular dysplasia? (FMD)
abnormal cell growth in the walls of renal arteries (non-atherosclerotic)
what is usualy affected with FMD?
usually mis to distal RA’s affected
what does FMD cause?
narrowing within the artery and impairs the blood flow to the kidney
what could happen if FMD is left untreated?
dissection could occur
how is FMD shown on ultrasound?
doppler areas of aliasing and stenosis
how is FMD shown on angiogram?
areas of narrowng and widening
who is at risk for renal artery stenosis?
- atherosclerosis
- FMD
- HBP
- diabetics
- smokers
how many measuements are taken of the kidneys?
3 (sag should be 9-12cm)
what do we compare with echogenicity of the kidneys
- cortex to sinus
- adjacent liver/spleen
- right and left kidneys
- thickness of the kidneys
what must be obtained in renal artery doppler?
RAR
where do you meausre the PSV when obtaining RAR?
aorta
- prox
- mid
- distal at renal hilum
what must we demonstate in colour when doing RAR?
renal artery length in colour to observe any changes
what is the normal range for RAR?
under 3.5
what is the normal PSV range in the aorta?
50-100 cm/s
sample just prox to renal arteries
when do we not use angle correct?
sonographic index used to assess for renal artery disease but we do not use angle correct (intrarenal)
how is RI calculated?
measuring the PSV and EDV within the segmental branch or arcuate artery in the cortex
what is the formula for RI?
PSV-EDV/PSV
what is the normal RI measument?
0.4-0.7 (over this indicates renal artery disease)
what are sone signs of RA stenosis?
- tardus parvus waveform distal to stenosis
- increased main reanl artery (PSV over 180 cm/s)
- post stenotic turbulence distal to site of stenosis
what makes up the portal venous system?
- SV
- SMV
- IMV
- MPV
- PV
- HV
- IVC
what are the causes of portal hypertension?
- cirrhosis
- alcohol
- hepatitis
what causes portal vein blood clots?
- pancreatitis
- cancer
- portal hypertension
what do you access with if portal hypertension is present?
- determine if flow is hepatofugal or hepatopetal in direction of both intra and extrahepatic branches
- evaluate for varices, patent umbilical vein, caput medusae, cavernous transformation
- Evaluate TIPS and DSRS
what does TIPS stand for?
transjugular intrahepatic portosystemic shunt
what does DSRS stand for?
distal splenorenal shunt
what may happen with abnormal portal venous flow (hepatofugal)?
splenorenal shunt may be spontaneous or created
what is cavernous transformation?
multiple large tortous vessels occupying the portal vein bed
what are some signs of portal hypertension?
- cirrhotic liver
- splenomegaly
- increased MPV size (under 13mm is normal)
- GI varices
- ascities
- clot-SV or PV
why do we look at the IVC?
- evaluate vena cava filters (greenfilter)
- Rule out tumor or thrombus invasion from renal cell or adrenal carcinoma
- over dilation of HV and IVC due to right heart failure
what is useful to evaluate phasicity?
duplex
what is a sign of IVC occlusion?
bilateral leg swelling
what are causes if IVC occlusion?
- extrinsic compression-nodes
- RCC
- hepatocellular carcinoma
what usually results from penetrating abdominal injury?
vena cava pseudoaneurysm
what is Vena cava pseudoaneurysm assocated with?
arterial-venous fistula
what cn right heart failure lead to?
overdistension of IVC and Hepatic veins
what will happen with overdistension of IVC and Hepatic veins?
- These vessels will appear larger than normal due to backup of blood flow
- The normally phasic flow due to respiratory movements are absent
- The IVC will measure almost the same in AP during expiration and inspiration
Renal vein thrombosis
- Underlying disease
- Dehydration
- Hypercoagulability
- Tumors of the kidneys and adrenals may grow into veins
- Extrinsic compression-tumor, fibrosis, trauma
is hepatic artery aneurysm rare or common?
rare
what do hepatic artery aneurysms have a high rate of?
rupture and can be fatal
