Spleen/venous system (midterm) Flashcards
1
Q
is the spleen retro or intra?
A
intra
2
Q
what is the functions of the spleen?
A
- immune reaction
- reservoir for blood
- major destruction site of old red blood cells
3
Q
how many branches does the splenic artery branch into when entering the spleen?
A
6
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
5
Q
what is the flow direction in the splenic artery and vein?
A
hepatopedal
6
Q
what is the patient positions for scanning spleen?
A
supine and right lateral decubitus
7
Q
what should the spleen measure?
A
13cm or less
8
Q
what is elevation of erythrocytes associated with?
A
- polycythemia
- severe diarrhea
9
Q
what is decreased erythrocytes associated with?
A
- internal bleeding
- hemolytic anemia
- Hodgkin’s disease
- hemangiosarcomas
10
Q
what is the oxygen carrying pigment in RBC’s?
A
hemoglobin
11
Q
what is hemoglobin recycled by the spleen into?
A
iron
12
Q
what is low hemoglobin associated with?
A
- cancer
- lymphoma
- cirrhosis
- internal bleeding
13
Q
what is the elevation of leukocytes associated with?
A
- infection
- leukemia
- hemorrhage
- malignancy
14
Q
what is decreased leukocytes associated with?
A
- lymphoma
- leukemia
- viral infection
- hypersplenia
- diabetes mellitus
15
Q
hematocrit
A
percentage of RBCs in the blood
16
Q
what is the elevation of hematocrit associated with?
A
- dehydration
- shock
- polycythemia (disorder of bone marrow)
- infection
17
Q
what is decreased hematocrit was associated with?
A
- hemorrhage
- anemia
- leukemia
18
Q
what are indications for spleen exam?
A
- chronic liver disease
- infection
- leukocytosis
- palpable mass
- abdominal pain
- fatigue
- trauma
19
Q
where is accessory spleen normally located?
A
splenic hilum
20
Q
with accessory spleen if the spleen enlarges what else does?
A
so does splenule
21
Q
what is wandering spleen?
A
spleen is mobile and is located somewhere else
22
Q
asplenia
A
congenital absence of spleen
23
Q
what happens with asplenia?
A
- impairment if immune response
- sepsis
- bacterial meningitis
24
Q
polysplenia
A
more than one spleen
25
what is visceral heterotaxy?
- reversed portion of IVC and aorta
| - may be 2 left lungs or 2 right lungs
26
retrorenal spleen
inferior portion of the spleen is located behind the upper left kidney
27
what is the most frequently injured visceral organ?
spleen
28
what may be seen with splenic trauma?
free intraabdominal fluid
29
what is splenic trauma called when capsule remains intact?
intraparenchymal or subcapsular hematoma
30
what happens with capsular rupture?
- demonstrate fluid in LUQ
- decreased hematocrit
- may spread through peritoneal cavity (morrisons pouch)
- a focal or free intraperitoneal hematoma may occur
31
subphrenic abscess
hematoma becomes infected
32
splenic infarction
occlusion of the splenic vascular supply
33
what are complications of splenic infarction?
hemorrhage
rupture
abscess
pseudocyst
34
what does splenic infarction look like sonographically?
peripheral
wedge shaped
hypoechoic
35
what does an early infarction appear as?
anechoic or hypoechoic
36
what does late infarction (fibrosis) appear as?
hyperechoic
37
what is the measurement of splenomegaly?
over 18 cm
38
what are causes of splenomegaly?
- hematologic
- rheumatologic
- infectious
- congestive
- infiltrative
39
what does the spleen look like in people with portal hypertension?
- linear reflective channels in the parenchyma
- dilation of intrasplenic venous sinuses with increased collagen in the walls
- periarterial fibrosis
40
hypersplenism
over active spleen-removes blood cells to early/quickly
41
what is the most common infectious reason for ordering an ultrasound?
mononucleosis
42
Congestion
Portal hypertension, portal/ splenic thrombosis and CHF
43
Sarcoidosis
multisystem granulomatous disease-associated with splenomegaly
44
Neoplasia
Hemangioma and metastases
45
what kind of virus is mononucleosis?
epsin-bar virus
46
what is sonography extremely helpful in finding?
focal splenic lesions
47
what is Non-Hodgkins/Hodgkins Lymphoma?
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
what will happen to your spleen with lymphoma?
spleen enlargement
49
hemangiosarcoma
most common malignant, primary, nonlymphoid tumor of the spleen
50
what is metastases frequently seen in?
malignant melanoma
51
what is a common focal solid splenic mass?
hemangioma (primary benign neoplasm)
52
what does an hemangioma look like?
well defined echogenic appearance similar to liver hemangiomas
53
what are not true cysts?
metastases
abscess
hematoma
54
splenic pseudocyst
- false cyst
- complex
- wall calcifications
- internal echoes
55
what is the most common cause of splenic cysts?
hydatid cyst (echinococcal) water lily sign
56
what are most common causes of splenic abscess?
- endocarditis
- septicemia
- trauma
57
what may splenic abscess be caused by?
candidiasis (immunosuppressed)
58
Granulomatous spleen
one to several small echogenic shadowing calcifications throughout splenic parenchyma
59
what are risk factors for splenic artery aneurysm?
- pregnancy
- smoking
- aneurysm
60
sickle cell disease
- inherited blood disorder (anemia)
- affects red blood cells (hemoglobin)
- almost always affects the spleen
61
Gaucher’s disease
Causes too much
glucercerebroside to build up
in the spleen, liver,lungs,bones
62
what ALWAYS causes splenomegaly?
Gaucher's disease
63
what does Gaucher's disease look like sonographically?
multiple splenic nodules
variable echogenicity
fibrosis and infarction
64
where is the portal venous blood filtered twice?
- liver
| - capillaries
65
what does blood do once it gets to the liver?
- detoxification
| - metabolism
66
80% liver blood supply=
1/2 oxygen
67
is the main portal vein intra or extrahepatic?
both
68
how big in diameter is the MPV?
under 13 mm
69
what forms the MPV?
SMV
| Splenic vein
70
what is the direction of the MPV?
ascends to liver hilum, posterior to proper hepatic artery
71
what accompany the portal veins in triads?
bile ducts
| hepatic artery
72
portal triads are enclosed by a shealth of connective tissue with a high collagen content, what is the appearance?
echogenic
73
what do the SMV tributaries drain?
- small and large intestine
- stomach
- pancreas
- appendix
74
where does the SMV run to the SMA?
right lateral
75
what does the IMV drain?
- large intestines
- sigmoid colon
- rectum
76
what does the splenic vein drain?
- splenn
| - branches drain pancreas and stomach
77
where does the splenic vein lie compared to the splenic artery?
inferoposterior
78
which portal vein is longer and smaller?
left portal
79
what does the left portal vein supply?
left lobe
| caudate lobe
80
what does the right portal vein supply?
right lobe
81
what direction are the portal veins?
hepatopedal (even the blue right posterior branch)
82
what are some other tributaries of the PV?
```
SV
SMV
Cystic V
Pyloric V
LT and RT Gastric V
Pancreaticduodenal V
Gastroepiploic V
IMV
```
83
what are some sonographic applications?
- portal vein hypertension
- detect tumor invasion
- detect thrombosis
84
what is normal direction of flow throughout the portal vein system?
hepatopedal (towards liver)
85
what is the usual cause of hepatofugal (abdnormal everywhere)?
cirrhosis
86
Hepatocellular dysfunction
coagulopathy
87
what are complications of liver failure?
- Hepatic encephalopathy
| - Impaired protein synthesis(serum albumin and PTT
88
what happens with portal hypertension?
varices and ascites
89
what is the main complication of portal hypertension?
esophageal varices
90
what does scar tissue do?
- obstructs vessels
- increases resistance
- hypertension
91
what happens to vessels surrounding the liver in portal hypertension?
subjected to HBP
92
what is the response to increased pressure?
development of collateral circulation
93
what are the most important portosystemic anastomoses?
- gastroesophageal collaterals
| - esophageal varices
94
what does the umbilical vein become in the liver?
round (teres) ligament
95
when may the round ligament open to allow passage of blood?
presence of cirrhosis and portal hypertension
96
what is the to round ligament opening condition called?
caput medusae
97
what is splenomegaly associated with?
any disease that involves abnormal red blood cells being destroyed
98
what are important signs of portal hypertension?
enlarged spleen
| caput medusae
99
what are some causes of portal vein thrombosis?
- pancreatitis
- cirrhosis
- diverticulitis
- cholangiocarcinoma
100
what happens to the arteries with portal hypertension?
hepatic arteries will enlarge and become tortuous showing aliasing
101
what happens to arterial flow as portal venous flow to the liver decreases?
arterial flow increases
102
can portal hypertension be treated?
no but it focusses on preventing or managing complications
103
TIPS
transjugular intrahepatic portosystemic shunt
104
what is TIPS
stent is placed in the liver connecting the hepatic and portal vein. Helps relieve pressure in abnormal veins
105
DSRS
distal splenorenal shunt
106
what is DSRS?
connects the vein from the spleen to the vein from the left kidney
