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Intro to Vascular > Week 12: Abdominal Arterial Doppler > Flashcards

Week 12: Abdominal Arterial Doppler Flashcards

1
Q

What are the CHALLENGES ASSOCIATED WITH ABDOMINAL DOPPLER EXAMS? (4)

A
  1. the vessels are deeper than the ones in the neck/extremities
  2. adipose tissue (scatters the soundwaves) & bowel gas (reflect soundwaves) - need to apply more pressure
  3. hard to producea 60-degree Doppler beam angle
  4. patients’ respirationcause challenges - makes it difficult to acquire constant Doppler waveforms
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2
Q

Identify the vessel 1-6

A
  1. celiac trunk
  2. right/left renal artery
  3. SMA: superior mesenteric artery
  4. IMA: inferior mesenteric artery
  5. right common iliac artery
  6. left internal iliac artery
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3
Q

ABDOMINAL AORTA: abdominal aorta

  1. Begins at the ____ and extends distally to the bifurcation into the ____ arteries
  2. Lies slightly ____ of midline
  3. Supplies oxygenated blood to most of the body
A
  1. diaphragm, common iliac
  2. left
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4
Q

ABDOMINAL AORTA: celic trunk

1.____branch off the abdominal aorta
2. Branches off ____
3. Branches into the ____artery on the right and the ____ artery on the left
4. The____ artery branches off the celiac trunk, but not typically seen with ultrasound

A
  1. First
  2. anteriorly
  3. common hepatic, splenic
  4. left gastric
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5
Q

ABDOMINAL AORTA: celic trunk

1.____branch off the abdominal aorta
2. Branches off ____
3. Branches into the ____artery on the right and the ____ artery on the left
4. The____ artery branches off the celiac trunk, but not typically seen with ultrasound

A
  1. First
  2. anteriorly
  3. common hepatic, splenic
  4. left gastric
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6
Q

ABDOMINAL AORTA: SMA

  1. ____ branch off the abdominal aorta
  2. Branches off ____ just distal to the celiac axis -approx.____ cm below the celiac axis
  3. Normal variant can be present: celiac & SMA arising off the aorta ____
  4. SMA runs ____ and ____ to the aorta
  5. Has many small branches coming off to perfuse the ____
A
  1. Second
  2. anteriorly, 1
  3. together (normal variant)
  4. inferior, parallel
  5. intestine
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7
Q

ABDOMINAL AORTA: RENAL ARTERIES

  1. **Right **renal artery takes off the aorta slightly ____, ____ to the IVC and right renal vein
  2. The ____, on the right, makes a good acoustic window
  3. Left renal artery is slightly ____ making it more difficult to image. Locate ____ to the left renal vein
  4. ____% of people have duplicate renal arteries
  5. !!!____ renal artery is longer than the left renal artery
A
  1. anterolateral, Posterior
  2. liver
  3. posterolateral, Posterior
  4. 15%-25
  5. Right
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8
Q

ABDOMINAL AORTA: IMA

1.____ major aortic branch before the common iliac bifurcation
2.____ to the takeoff of the renal arteries
3.Comes off the aorta ____ towards the patient’s ____
4. feeds ____

A
  1. Last
  2. Inferior
  3. anterolaterally, left
  4. large bowel/large intestine
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9
Q

ABDOMINAL AORTA: Common Iliac Artery Bifurcation

  1. Just distal to the distal aorta
  2. Bifurcates into the right and left ____
A
  1. common iliac arteries
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10
Q

PATIENT POSITION:

Two patient positions for abdominal scanning
1. Supine aka: ____
2. Right or Left Decubitus aka: ____
* Can raise patient’s head

A
  1. ML (mid line) approach
  2. flank approach
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11
Q

SONOGRAPHER POSITION

  • Stay above your work
    -Stand
    -Have patient move close to you
  • Gently wrap fingers around probe

-Need for pressure when imaging
-NOT the baseball-bat grip!

A
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12
Q

PATIENT PREP for abdominal study

  1. Fasting ____ hours
  2. For renal study, you may want to have patient ____ to better assess the intrarenal vessels
A
  1. 8
  2. hydrate

!!!NPO & hydration

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13
Q

TRANSDUCER SELECTION

1.____ MHz will work for most patients
2. ____MHz for a large/difficult patient
3. ____ imaging- can help visualize deeper structures

A
  1. 3.5
  2. 2.5
  3. Harmonic
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14
Q

TRV Plane:

  1. Begin at the patient’s ____
  2. The ____ will appear as a curved echogenic structure in the far field of the image - this is a good landmark
  3. The aorta is slightly to the____ of midline
  4. The IVC is slightly to the ____ of midline
A
  1. midline
  2. spine
  3. left
  4. right
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15
Q

Identify the anatomy 1-3

A
  1. IVC
  2. vertebral body
  3. aorta
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16
Q

TRV Plane:: celiac trunk

  1. Find the takeoff of the celiac trunk
    -Can be tortuous or leaning to the right or left
  2. Try to obtain the “____” or “____” view
  3. The ____ & ____ arteries are seen at the top of the celiac
    -Adjust your probe to obtain this image
A
  1. seagull, whale tail
  2. common hepatic, splenic
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17
Q

Identify the anatomy 1-3

A
  1. hepatic artery
  2. splenic artery
  3. aorta
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18
Q

Identify the anatomy 1-4

A
  1. SMA
  2. AO
  3. IVC
  4. PV
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19
Q

TRV Plane:

  1. Slightly distal to the celiac origin you will see the round short-axis ____ origin, coming off the anterior aorta
  2. You will see the small circle above the aorta as you scan distally
A

SMA

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20
Q

Identify the anatomy 1-6

A
  1. SMA
  2. LT renal vein
  3. LT renal artery
  4. aorta
  5. IVC
  6. RT renal artery
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21
Q

TRV Plane:
1. Just distal you will be at the level of the origin of the renal arteries
2. In some patients, both renal arteries **do not **lie in the same TRV plane
3. Commonly image one and then the other
4. Can rotate the probe to attempt to get both in the same image

A
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22
Q

TRV Plane:

  1. Follow the aorta distal to the common iliac artery bifurcation
  2. ____ dives deep before the right
  3. Easy to obtain in TRV and then rotate the probe on the artery of interest to obtain a SAG view

*most common site for graft(?) anastamosis

A
  1. Left common iliac artery
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23
Q

SCANNING THE ABDOMINAL AORTA& BRANCHES

  1. Being midline just below the patient’s ____
  2. Angle slightly upward and angle to the left
  3. Aorta becomes more ____ as it courses distal
  4. Look for pulsatile vessel wall motion
A
  1. xyphoid process
  2. superficial
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24
Q

** SCANNING THE ABDOMINAL AORTA& BRANCHES**

Just distal to the proximal portion of the aorta, you should see two branches coming off the anterior aorta:
-Branch 1: ?
-Branch 2: ?

A
  1. celiac trunk
  2. SMA
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25
Q

** SCANNING THE ABDOMINAL AORTA& BRANCHES**

In some patients you can see short-axis of the renal arteries branching off the lateral sides of the aorta
-Angle slightly right for the right RA
-Angle slightly left for the left RA
Can use color Doppler to better visualize

26
Q

** SCANNING THE ABDOMINAL AORTA& BRANCHES**

Move distal keeping the aortic image clear
-Tiny adjustments of angle to keep the walls clear
-Tiny adjustments of rotation to keep the ends open

27
Q

SCANNING THE ABDOMINAL AORTA& BRANCHES

Obtain images of bilateral common iliac arteries

-If covered by gas midline, move the probe slightly RT or LT of
midline and angle medially

-This will allow visualization of both common iliac arteries branching off the distal aorta

28
Q

ABDOMINAL ARTERIAL DOPPLER

A

proximal aorta

29
Q

ABDOMINAL ARTERIAL DOPPLER

Proximal Aorta:

  1. This waveform and velocity measurement is commonly made at the level of the SMA origin
  2. Obtained in a SAG plane
  3. Doppler waveform: ____
  4. Above the renal arteries, which take ____% of the cardiac output, therefore contribute a ____ character to the distal vascular bed
  5. Measure just the ____ for all abdominal arteries
A
  1. sharp upstroke without reversal of flow
  2. 25%, large low-resistance character
  3. PSV
30
Q

ABDOMINAL ARTERIAL DOPPLER

location?

A

distal aorta

31
Q

ABDOMINAL ARTERIAL DOPPLE

Distal Aorta:

  1. Rock the probe to obtain a good angle
  2. Doppler waveform: ____
  3. Below the ____ & the distal vascular bed is higher in resistance
A
  1. sharp upstroke with reversal of flow
  2. renal arteries
32
Q

ABDOMINAL ARTERIAL DOPPLER

location?

A

common iliac arteries

33
Q

Common Iliac Arteries:

  1. Rock the probe to obtain a good angle
  2. Doppler waveform: ____
A

high resistive, sharp upstroke with reversal of flow, triphasic

34
Q

ABDOMINAL ARTERIAL DOPPLER

locastion?

A

Branch Arteries of the Abdomen

35
Q

Branch Arteries of the Abdomen:

  1. Waveforms are similar to an ICA rather than a LE artery
  2. They perfuse organs with ____
  3. PSV may be sharper than the ICA
  4. Lots of ____ (except for the SMA)
A
  1. low resistance
  2. diastolic flow
36
Q

ABDOMINAL ARTERIAL DOPPLER

location?

A

celiac trunk

37
Q

Celiac Trunk

  1. Can image in both the TRV and SAG planes
  2. Normal waveform:____, normal PSV <____
  3. If occluded, reversal of flow seen within the ____
A
  1. Low resistive, 200 cm/sec
  2. hepatic artery
38
Q

ABDOMINAL ARTERIAL DOPPLER

Superior Mesenteric Artery:

  1. Obtain in a SAG plane
  2. Does not always run directly above the aorta
  3. Can course to the right or left of the aorta
  4. Try different approaches (from rt or lt) to obtain image
  5. Has less diastolic flow in the ____ patient ( ____flow, similar to ECA)
  6. Has more diastolic flow in the ____ patient (____flow)
  7. Feeding the intestines = more blood needed when eating
  8. Can be up to ____ higher than preprandial
A
  1. preprandial/fasting, high resistance
  2. postprandial, low resistance
  3. 3X
39
Q

!!!ABDOMINAL ARTERIAL DOPPLER

location?

A

SMA

*Note the change in diastolic flow

40
Q

ABDOMINAL ARTERIAL DOPPLER

Inferior Mesenteric Artery:

  • No specific values for Doppler, however if a ____ is seen in conjunction with stenosis of either the celiac or SMA, it constitutes mesenteric ischemia
A

high velocity

41
Q

ABDOMINAL ARTERIAL DOPPLER

location?

A

renal artery

42
Q

**Renal Arteries:

  1. Obtained from a midline or flank approach
  2. Normal RA waveform = ____ with ____
  3. PW waveform obtained at the hilum differs slightly
  • Normal RA PSV = ____
  • NormalRA RI = ____
A
  1. low resistive, sharp systolic upstroke

<150cm/s, < 0.7

43
Q

**ABDOMINAL ARTERIAL DOPPLER **

Renal Arteries (Midline Approach):
1. Start in a TRV plane
2. Slightly distal to the SMA
3. Patient** supine**
4. Best to visualize the proximal and mid renal artery
5. Proximal RA is closest to the aorta (can also be referred to as the origin)
6. Be mindful of the proximity of the RA to the aorta when obtaining spectral Doppler (aorta will have ____, renal artery has ____)

A

little to no diastolic flow, lots of diastolic flow

44
Q

ABDOMINAL ARTERIAL DOPPLER

Renal Arteries (Midline Approach):

  1. Right renal artery branches off slightly _____ @ the 10 o’clock position
  2. Difficult to obtain a good Doppler angle
  3. Rock the probe to change the artery direction
  4. Slide the probe to move the desired spot somewhere else in the image
  5. Left renal artery branches off slightly ____ @ the 4 o’clock position
  6. ____ to obtain a good Doppler angle
  7. Ideally, we want to obtain PW Doppler at the proximal, mid, & distal RA bilaterally
A
  1. anterolaterally
  2. posterolateral
  3. Easier
45
Q

ABDOMINAL ARTERIAL DOPPLER

Renal Arteries:

  1. ____ approach is good to look directly at the kidney, the distal renal artery, and the smaller renal vasculature
  2. Patient can be in a ____, ____, or ____ position
A
  1. Flank approach
  2. RLD, LLD, seated upright
45
Q

**ABDOMINAL ARTERIAL DOPPLER **

Renal Arteries (Flank Approach): Renal Anatomy

  1. Renal arteries branch into (usually) ____ segmental arteries where they enter is called the ____
  2. Segmental arteries move within the kidney towards the ____, where they divide into the ____ that pass between the pyramids
  3. Interlobar arteries further divide into the ____ arching over the pyramids
  4. Arcuate arteries become the ____
A
  1. five, hilum
  2. renal pyramids, interlobar arteries
  3. arcuate arteries
  4. interlobular arteries
46
Q

Identify the anatomy 1-5

A
  1. arcuate artery
  2. segmental artery
  3. main renal artery
  4. interlobar artery
  5. interlobular artery
47
Q

ABDOMINAL ARTERIAL DOPPLER

Renal Arteries (Flank Approach): Renal Anatomy

Kidney echogenicity:

  1. Pelvis & calyces= ____
  2. Pyramids= ____
  3. Cortex= ____ (not as hypoechoic as the pyramids)
  4. Adult kidney length:
    - Normal= ____cm
    - ____cm is suggestive of renal failure
  5. Adult kidney cortical thickness: -Normal= _____cm
A
  1. fairly bright/echogenic
  2. hypoechoic
  3. hypoechoic !!not as hypoechoic as pyramids
  4. 9-12, < 9
  5. 1-2
48
Q

ABDOMINAL ARTERIAL DOPPLER

!!! Key points to optimize kidney imaging

Renal Arteries(Flank Approach):

  1. Begin posterolateral, anterolateral, or just lateral to start with a long axis image
  2. Kidneys lie somewhat oblique to the superior/inferior plane in the body
  3. Rotate the superior aspect of the beam a bit posterior to line up with the long axis
  4. Angle & rotate until you obtain the longest axis image
  5. Alter your approach to find the best window
  6. Have the patient take a deep breath in (pushes the kidney down)
  7. Have the patient move closer to you, do NOT reach across the patient
49
Q

ABDOMINAL ARTERIAL DOPPLER
Renal Arteries (Flank Approach):

What is the benefit of posterolateral approach?

A

Good for measuring (SAG plane)
(lays the kidney level across the screen)

50
Q

**ABDOMINAL ARTERIAL DOPPLER **
Renal Arteries: “ ____View”:

  1. Start with a slight anterolateral approach at the right flank, aiming medially
  2. Angle medial and laterally until you find the origins of both the right and left renal arteries
  3. The aorta will angle upward from left of the screen to right of the screen
  4. The ____ will be on top (closer to the probe)
  5. The ____ will be on the bottom
A

Banana Peel

  1. RRA
  2. LRA
51
Q

ABDOMINAL ARTERIAL DOPPLER
Renal Arteries (Flank Approach):

What is the benefit of anterolateral approach?

A
  1. Creates better Doppler angles for the upper and lower pole waveforms (SAG plane)
    (tilts the kidney across the screen)
  2. Better for Doppler at the** hilum**and distal renal arteries
52
Q

ABDOMINAL ARTERIAL DOPPLER

Renal Arteries (Flank Approach):

  • Helps produce Doppler waveforms at 3 levels:
    1. The ____
    2. The ____
    3. The _____
A
  1. distal RA
  2. hilum
  3. renal parenchyma
53
Q

ABDOMINAL ARTERIAL DOPPLER

The distal renal artery:

  1. Begin with Color Doppler with a ____ PRF/scale (____ velocities)
  2. Distal RA is ____cm from the renal hilum
  3. Best imaged in a ____ plane, but can be imaged in a SAG plane
A
  1. low, lower
  2. 1-2
  3. TRV
54
Q

What is the arrow pointing to?

55
Q

ABDOMINAL ARTERIAL DOPPLER

The hilum:

  1. The ____ point of the vessels into the kidney
  2. Best imaged in a ____ plane, but can be imaged in a SAG plane
56
Q

ABDOMINAL ARTERIAL DOPPLER

The hilum:

  1. Characteristics of hilar Doppler waveforms: -________ & ____
  2. To measure the acceleration time
    -Change the sweep speed ____ to ____mm/sec)
  3. spreads the waveform out ____ and allows for measurement of time on the x-axis
  4. Measure the time between the ____ and the ____
  5. If this exceeds ____m/sec, it may suggest proximal stenosis
A
  1. An early systolic peak, rapid acceleration time
  2. increase, 100
  3. horizontally
  4. end of diastole, early systolic peak
  5. 100
57
Q

ABDOMINAL ARTERIAL DOPPLER

The renal parenchyma:

  1. Intrarenal arteries (____, ____, ____, & ____ arteries)
  2. Best imaged in a ____ plane
  3. Have patient____ when performing spectral Doppler
  4. Normal waveform: _____, ____ & ____
A
  1. segmental, interlobar, arcuate, interlobular
  2. SAG
  3. suspend respiration
  4. very low resistance, lots of diastolic flow, & low velocity overall
58
Q

ABDOMINAL ARTERIAL DOPPLER

Resistive Index (RI) Measurement:

  1. Measurement for resistive character Calculation: ____
  2. A comparison of diastolic to systolic velocity
    * Normal = ____
    * Abnormal = _____
  3. ____number is abnormal
    * High RI can indicate ____
    * US machines typically can calculate the RI
A
  1. (PSV-EDV) / PSV
  2. < 0.7, > 0.7
  3. High, renal failure
59
Q

ABDOMINAL ARTERIAL DOPPLER

Resistance Ratio:

*Another measurement of resistive character
-Calculation: ____
* Normal = ____
* Abnormal = ____
____ number is abnormal

A

EDV/PSV
> 0.2
<0.2
Low

measuring the same thing in a different way

Intro to Vascular (17 decks)

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