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Abdominal > Spleen/venous system (midterm) > Flashcards

Spleen/venous system (midterm) Flashcards

1
Q

is the spleen retro or intra?

A

intra

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2
Q

what is the functions of the spleen?

A
  • immune reaction
  • reservoir for blood
  • major destruction site of old red blood cells
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3
Q

how many branches does the splenic artery branch into when entering the spleen?

A

6

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4
Q

what may the splenic vein do in cases of portal hypertension?

A

splenic vein may shunt blood directly into the left renal vein

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5
Q

what is the flow direction in the splenic artery and vein?

A

hepatopedal

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6
Q

what is the patient positions for scanning spleen?

A

supine and right lateral decubitus

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7
Q

what should the spleen measure?

A

13cm or less

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8
Q

what is elevation of erythrocytes associated with?

A
  • polycythemia

- severe diarrhea

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9
Q

what is decreased erythrocytes associated with?

A
  • internal bleeding
  • hemolytic anemia
  • Hodgkin’s disease
  • hemangiosarcomas
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10
Q

what is the oxygen carrying pigment in RBC’s?

A

hemoglobin

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11
Q

what is hemoglobin recycled by the spleen into?

A

iron

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12
Q

what is low hemoglobin associated with?

A
  • cancer
  • lymphoma
  • cirrhosis
  • internal bleeding
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13
Q

what is the elevation of leukocytes associated with?

A
  • infection
  • leukemia
  • hemorrhage
  • malignancy
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14
Q

what is decreased leukocytes associated with?

A
  • lymphoma
  • leukemia
  • viral infection
  • hypersplenia
  • diabetes mellitus
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15
Q

hematocrit

A

percentage of RBCs in the blood

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16
Q

what is the elevation of hematocrit associated with?

A
  • dehydration
  • shock
  • polycythemia (disorder of bone marrow)
  • infection
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17
Q

what is decreased hematocrit was associated with?

A
  • hemorrhage
  • anemia
  • leukemia
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18
Q

what are indications for spleen exam?

A
  • chronic liver disease
  • infection
  • leukocytosis
  • palpable mass
  • abdominal pain
  • fatigue
  • trauma
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19
Q

where is accessory spleen normally located?

A

splenic hilum

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20
Q

with accessory spleen if the spleen enlarges what else does?

A

so does splenule

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21
Q

what is wandering spleen?

A

spleen is mobile and is located somewhere else

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22
Q

asplenia

A

congenital absence of spleen

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23
Q

what happens with asplenia?

A
  • impairment if immune response
  • sepsis
  • bacterial meningitis
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24
Q

polysplenia

A

more than one spleen

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25
Q

what is visceral heterotaxy?

A
  • reversed portion of IVC and aorta

- may be 2 left lungs or 2 right lungs

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26
Q

retrorenal spleen

A

inferior portion of the spleen is located behind the upper left kidney

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27
Q

what is the most frequently injured visceral organ?

A

spleen

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28
Q

what may be seen with splenic trauma?

A

free intraabdominal fluid

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29
Q

what is splenic trauma called when capsule remains intact?

A

intraparenchymal or subcapsular hematoma

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30
Q

what happens with capsular rupture?

A
  • demonstrate fluid in LUQ
  • decreased hematocrit
  • may spread through peritoneal cavity (morrisons pouch)
  • a focal or free intraperitoneal hematoma may occur
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31
Q

subphrenic abscess

A

hematoma becomes infected

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32
Q

splenic infarction

A

occlusion of the splenic vascular supply

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33
Q

what are complications of splenic infarction?

A

hemorrhage
rupture
abscess
pseudocyst

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34
Q

what does splenic infarction look like sonographically?

A

peripheral
wedge shaped
hypoechoic

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35
Q

what does an early infarction appear as?

A

anechoic or hypoechoic

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36
Q

what does late infarction (fibrosis) appear as?

A

hyperechoic

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37
Q

what is the measurement of splenomegaly?

A

over 18 cm

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38
Q

what are causes of splenomegaly?

A
  • hematologic
  • rheumatologic
  • infectious
  • congestive
  • infiltrative
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39
Q

what does the spleen look like in people with portal hypertension?

A
  • linear reflective channels in the parenchyma
  • dilation of intrasplenic venous sinuses with increased collagen in the walls
  • periarterial fibrosis
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40
Q

hypersplenism

A

over active spleen-removes blood cells to early/quickly

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41
Q

what is the most common infectious reason for ordering an ultrasound?

A

mononucleosis

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42
Q

Congestion

A

Portal hypertension, portal/ splenic thrombosis and CHF

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43
Q

Sarcoidosis

A

multisystem granulomatous disease-associated with splenomegaly

44
Q

Neoplasia

A

Hemangioma and metastases

45
Q

what kind of virus is mononucleosis?

A

epsin-bar virus

46
Q

what is sonography extremely helpful in finding?

A

focal splenic lesions

47
Q

what is Non-Hodgkins/Hodgkins Lymphoma?

A

cancer of lymphatic system
-if nodules are present in a patient with known disease such as lymphoma, sarcoidosis or TB these nodules most likely represent this

48
Q

what will happen to your spleen with lymphoma?

A

spleen enlargement

49
Q

hemangiosarcoma

A

most common malignant, primary, nonlymphoid tumor of the spleen

50
Q

what is metastases frequently seen in?

A

malignant melanoma

51
Q

what is a common focal solid splenic mass?

A

hemangioma (primary benign neoplasm)

52
Q

what does an hemangioma look like?

A

well defined echogenic appearance similar to liver hemangiomas

53
Q

what are not true cysts?

A

metastases
abscess
hematoma

54
Q

splenic pseudocyst

A
  • false cyst
  • complex
  • wall calcifications
  • internal echoes
55
Q

what is the most common cause of splenic cysts?

A

hydatid cyst (echinococcal) water lily sign

56
Q

what are most common causes of splenic abscess?

A
  • endocarditis
  • septicemia
  • trauma
57
Q

what may splenic abscess be caused by?

A

candidiasis (immunosuppressed)

58
Q

Granulomatous spleen

A

one to several small echogenic shadowing calcifications throughout splenic parenchyma

59
Q

what are risk factors for splenic artery aneurysm?

A
  • pregnancy
  • smoking
  • aneurysm
60
Q

sickle cell disease

A
  • inherited blood disorder (anemia)
  • affects red blood cells (hemoglobin)
  • almost always affects the spleen
61
Q

Gaucher’s disease

A

Causes too much
glucercerebroside to build up
in the spleen, liver,lungs,bones

62
Q

what ALWAYS causes splenomegaly?

A

Gaucher’s disease

63
Q

what does Gaucher’s disease look like sonographically?

A

multiple splenic nodules
variable echogenicity
fibrosis and infarction

64
Q

where is the portal venous blood filtered twice?

A
  • liver

- capillaries

65
Q

what does blood do once it gets to the liver?

A
  • detoxification

- metabolism

66
Q

80% liver blood supply=

A

1/2 oxygen

67
Q

is the main portal vein intra or extrahepatic?

A

both

68
Q

how big in diameter is the MPV?

A

under 13 mm

69
Q

what forms the MPV?

A

SMV

Splenic vein

70
Q

what is the direction of the MPV?

A

ascends to liver hilum, posterior to proper hepatic artery

71
Q

what accompany the portal veins in triads?

A

bile ducts

hepatic artery

72
Q

portal triads are enclosed by a shealth of connective tissue with a high collagen content, what is the appearance?

A

echogenic

73
Q

what do the SMV tributaries drain?

A
  • small and large intestine
  • stomach
  • pancreas
  • appendix
74
Q

where does the SMV run to the SMA?

A

right lateral

75
Q

what does the IMV drain?

A
  • large intestines
  • sigmoid colon
  • rectum
76
Q

what does the splenic vein drain?

A
  • splenn

- branches drain pancreas and stomach

77
Q

where does the splenic vein lie compared to the splenic artery?

A

inferoposterior

78
Q

which portal vein is longer and smaller?

A

left portal

79
Q

what does the left portal vein supply?

A

left lobe

caudate lobe

80
Q

what does the right portal vein supply?

A

right lobe

81
Q

what direction are the portal veins?

A

hepatopedal (even the blue right posterior branch)

82
Q

what are some other tributaries of the PV?

A 
SV
SMV
Cystic V
Pyloric V
LT and RT Gastric V
Pancreaticduodenal V
Gastroepiploic V
IMV
83
Q

what are some sonographic applications?

A
  • portal vein hypertension
  • detect tumor invasion
  • detect thrombosis
84
Q

what is normal direction of flow throughout the portal vein system?

A

hepatopedal (towards liver)

85
Q

what is the usual cause of hepatofugal (abdnormal everywhere)?

A

cirrhosis

86
Q

Hepatocellular dysfunction

A

coagulopathy

87
Q

what are complications of liver failure?

A
  • Hepatic encephalopathy

- Impaired protein synthesis(serum albumin and PTT

88
Q

what happens with portal hypertension?

A

varices and ascites

89
Q

what is the main complication of portal hypertension?

A

esophageal varices

90
Q

what does scar tissue do?

A
  • obstructs vessels
  • increases resistance
  • hypertension
91
Q

what happens to vessels surrounding the liver in portal hypertension?

A

subjected to HBP

92
Q

what is the response to increased pressure?

A

development of collateral circulation

93
Q

what are the most important portosystemic anastomoses?

A
  • gastroesophageal collaterals

- esophageal varices

94
Q

what does the umbilical vein become in the liver?

A

round (teres) ligament

95
Q

when may the round ligament open to allow passage of blood?

A

presence of cirrhosis and portal hypertension

96
Q

what is the to round ligament opening condition called?

A

caput medusae

97
Q

what is splenomegaly associated with?

A

any disease that involves abnormal red blood cells being destroyed

98
Q

what are important signs of portal hypertension?

A

enlarged spleen

caput medusae

99
Q

what are some causes of portal vein thrombosis?

A
  • pancreatitis
  • cirrhosis
  • diverticulitis
  • cholangiocarcinoma
100
Q

what happens to the arteries with portal hypertension?

A

hepatic arteries will enlarge and become tortuous showing aliasing

101
Q

what happens to arterial flow as portal venous flow to the liver decreases?

A

arterial flow increases

102
Q

can portal hypertension be treated?

A

no but it focusses on preventing or managing complications

103
Q

TIPS

A

transjugular intrahepatic portosystemic shunt

104
Q

what is TIPS

A

stent is placed in the liver connecting the hepatic and portal vein. Helps relieve pressure in abnormal veins

105
Q

DSRS

A

distal splenorenal shunt

106
Q

what is DSRS?

A

connects the vein from the spleen to the vein from the left kidney

Abdominal (11 decks)

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