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Vascular Boards > URR Portal System > Flashcards

URR Portal System Flashcards

1
Q

SMV and splenic vein are how to the panc?

A

posterior to the panc neck

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2
Q

what joins the splenic vein prior to splenic confluence with SMV?

A

IMV

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3
Q

the portal system enters the liver carrying blood from where?

A

digestive system

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4
Q

the portal vein is different how to the hepatic?

A

thicker and more echogenic, decrease in size

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5
Q

the main portal vein is how to the IVC?

A

anterior, arises from SV and SMV

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6
Q

the main portal vein drains what?

A

GI tract, and sends blood to liver for filtration

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7
Q

normal diameter of the portal vein?

A

13mm

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8
Q

flow toward the liver?

A

hepatopetal

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9
Q

normal velocity of MPV?

A

15-20 cm/sec

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10
Q

liver disease can cause what in the MPV?

A

increase in resistance to flow and or reversal

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11
Q

the splenic vein courses how to the panc?

A

posterior

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12
Q

the splenic vein drains what?

A

stomach, spleen, and panc

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13
Q

how is flow in the splenic vein?

A

flow toward the liver and away from the spleen

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14
Q

the SMV joins what posterior to the panc neck?

A

splenic vein

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15
Q

the SMV drains what?

A

small intestine and colon

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16
Q

how is flow in the SMV?

A

toward the liver and away from the mesentary

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17
Q

the IMV arises from what?

A

colon

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18
Q

the IMV ascends how to the IMA?

A

left

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19
Q

the IMV joins the splenic vein posterior to what?

A

panc body

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20
Q

the IMV drains what?

A

distal colon

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21
Q

cirrhosis causes what to the liver and spleen?

A

reduction in liver size, and increase in spleen size

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22
Q

budd chiari cases what to liver and spleen?

A

causes hepatomegaly during acute phase and reduction in liver size with an increase in spleen size with chronic obstruction

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23
Q

normal portal pressure is what?

A

5-10 mmHg

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24
Q

elevated pressure in the portal system due to flow obstruction can lead to what?

A

flow reversal in the portal system

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25
Q

portal hypertension is most commonly cause by what?

A

cirrhosis

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26
Q

common sign of portal hypertension?

A

esophageal varices

27
Q

associated with portal HTN, connected to left portal vein, extending towards umbilicus and flow is hepatofugal

A

recanalized umbilical vein

28
Q

branch of portal vein near liver hilum, hepatofugal flow, normal drains into splenic vein near the portal confluence

A

coronary vein

29
Q

tortuous vessels around the umbilicus?

A

caput medusa

30
Q

extrahepatic presinusoidal HTN

A

PV thrombosis

31
Q

intrahepatic presinusoidal HTN

A

schistosomiasis

32
Q

intrahepatic postsinusoidal HTN

A

most common type, cirrhosis

33
Q

intrahepatic postsinusoidal HTN

A

hepatic vein obstruction, budd chiari syndrome

34
Q

measurements for splenomegaly?

A

> 13cm

35
Q

dilated splenic vein

A

> 10 mm

36
Q

slowed or reversed flow in portal system

A

hepatofugal

37
Q

SMV and splenic vein size with inspiration?

A

increase

38
Q

formation of varices and collaterals?

A

cavernous transformation

39
Q

hepatic artery and portal vein carry blood into liver and the doppler should be how on baseline?

A

above baseline

40
Q

causes of PV thrombosis?

A

portal HTN, inflammatory process, trauma, complications, extrinsic compression
-can lead to pain, fever, rigid abd, nausea, vomiting, increased LFTs, cavernous transformation, increase in diameter of SMV and splenic vein

41
Q

acute PV thrombosis?

A

echogenic debris > 13 mm

42
Q

chronic PV thrombosis?

A

more echogenic <13 mm

43
Q

treatment for PV thrombosis?

A

portal caval shunts

44
Q

metallic device used to decrease pressure and increase flow of portal veins?

A

portal caval shunt

45
Q

portal caval shunt placement?

A

inserted into IJV and advanced into the liver to the portal system
-placed in between the portal system
-usually MPV and hepatic vein

46
Q

how does blood flow in the portal caval shunt?

A

bypasses liver and goes from digestive system to IVC

47
Q

PV connected to hepatic vein and IVC>

A

TIPS = transjugular intrahepatic portosystemic shunt
-flow should be hepatopetal prox and hepatofugal distal shunt

48
Q

what is the most common cause of acute stenosis/occlusion in TIPS?

A

thrombus

49
Q

most common site of chronic occlusion in tips?

A

hepatic vein anastomosis

50
Q

most common cause of chronic occlusion in portal shunt?

A

neointimal hperplasia

51
Q

how does a shunt look?

A

very echogenic with linear echoes

52
Q

normal flow in shunt is from portal system into the shunt then into where?

A

hepatic system

53
Q

right and left portal veins will demonstrate what flow with shunt?

A

hepatofugal flow (flow toward shunt)

54
Q

peak velocity with portal shunt should not fall below and exceed what velocity?

A

below: 50cm/s
exceed: 200 cm/sec

55
Q

hepatofugal flow in the MPV is?

A

abnormal

56
Q

hepatopetal flow in the right and left portal vein is what?

A

abnormal

57
Q

hepatopetal flow in the associated hepatic vein is?

A

abnormal

58
Q

-autosomal dominant disorder
-affects vasculature of multiple organs
-characterized by multiple AVMs
-recurrent episodes of bleeding
-dilated HA
-dilated HV

A

hereditary hemorrhagic telangiectasia (Osler Weber Rendu Disease)

59
Q

-soft blue skin lesions
-multiple bowel venous malformations that can cause lower GI bleeding

A

Bean Syndrome (Blue Rubber Bleb Nevus Syndrome)

60
Q

how is the HA and PV during a liver transplant?

A

both connected to native vessels just prox to liver hilum

61
Q

what is a piggyback anastamosis in a liver trasplant?

A

hepatic confluence of transplant liver attached to native IVC

62
Q

What is interposition anastamosis in the liver transplant?

A

donor IVC segment of the native IVC

63
Q

most common complication of liver transplant?

A

biliary stricture or leakage

64
Q

HA PSV during liver transplant?

A

<200 cm/sec
RI .5-.8

Vascular Boards (33 decks)

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