week 2- renal & abdominal doppler Flashcards
hepatic ___ accompany course of portal veins
arteries
hepatic veins empty into
IVC
Liver receives dual blood supply from ___ & ___
Portal veins
Hepatic Arteries
source of oxygenated blood into the liver
hepatic arteries
Portal veins carry nutrient rich (de-oxygenated) blood to the liver from ___
GI tract
supplies 30% of incoming blood to liver
hepatic arteries
supplies 70% of incoming blood to liver
portal veins
Hepatopetal
blood flow torwards the liver
hepatofugal
blood flow away from the liver
Hepatopetal or Hepatofugal flow: Portal veins?
Hepatopetal
Hepatopetal or Hepatofugal flow: Hepatic veins?
Hepatofugal
Hepatopetal or Hepatofugal flow: hepatic arteries?
Hepatopetal
Hepatopetal or Hepatofugal flow: splenic vein?
Hepatopetal
phasicity in portal veins
monophasic
splenic vein shows as ___ on colour doppler because ___
blue
going away from transducer and towards liver
splenic artery shows as ___ on colour doppler because ___
red
going towards transducer (spleen)
renal arteries arise ___ to SMA
3cm distal
flow of blood from renal artery
renal A –> segmental A –> interlobar A–> arcuate A –> interlobular
renal veins follow ___ course as arteries
same
RRA passes ___ to IVC
posterior
what passes between AO and SMA
left renal vein
lots of flow during diastole indicates ___ resistance
low
renal arteries show ___ resistance
low
normal resistive index in renal vessels ___, and the upper limit is ___
- 6
0. 7
renal arteries show __ flow and __ resistance
high
low
if there is a stenosis, the velocity will go ___ at the stenosis and go ___ distal to the stenosis
UP
DOWN
velocity and pulatility ___ as arteries get progressively smaller from the hilum
decrease
colour scale in renal vessels should be set ___
low
wall filter in renal vessels should be set ___
low
colour gain in renal vessel should be set ___
high
High resistive index at the hilum of the kidney indicates what something is going wrong, where?
in the cortex (down the road from the hilum)
suprarenal abdominal aorta expected flow
moderate
only a portion of the kidney will be affected if there is a renal artery obstruction in the ____ artery
segmental
how much of the kidney will be affected if there is a renal artery obstruction in the main renal artery
all of it
Atheromatous affects the ___ of the renal artery
proximal 1/3
abnormal and reversible accumulation of material in the inner layer of an artery wall.
Atheromatous
Atheromatous stenosis leads to hypertension ___ renal failure
and
Dysplastic stenosis Leads to hypertension __ renal fa
without
Atheromatous relationship with angioplasty (balloon in vessel to open it)
resistant
-use stenting
Dysplastic stenosis relationship with angioplasty (balloon in vessel to open it)
responds well
Dysplastic stenosis affects what part of renal artery
mid to distal
“ring of pearls” in a renal vessel indicates
narrowing of vessels
–> fibromuscular dysplasia
Peak systolic velocity is ___ (high/low) at stenosis
HIGH
- trying to push through
The following indicate ___: Reduced pulsatility
Slower acceleration
Longer acceleration times
tardus parvus
treatment options for stenosis
- angioplasty
- stent placement
aneurysm
dilation of the artery
what does an aneurysm look like on US
- cystic mass
- arterial flow
AV Fistula
abnormal connection between 2 body parts
acquired fistula accounts for __% and congenital fistula accounts for __%
75
25
turbulent diastolic arterial flow with high flow velocity indicates
AV fistula
symptoms of acute & chronic renal vein thrombosis
acute -flank pain -hematuria chronic -asymptomatic
renal vein thrombosis shows flow ___ in diastole
reversal
Abnormal increase in portal venous pressure due to obstruction of blood flow through liver
portal hypertension
Portal veins characteristics:
- ___ pulsatility
- flow velocity ___ reach zero
- ___ reversal
- moderate
- does NOT
- No
mild portal hypertension has ___ -phasic flow
monophasic
moderate portal hypertension has ___-phasic flow
biphasic
severe portal hypertension has ___ flow
reversed
sonographic findings of portal hypertension
- ascites
- splenomegaly
- varices
- portal vain diameter >13mm
- increased hepatic flow
cause of portal hypertension
cirrhosis due to alcohol consumption or hepatitis
5 major sites of portosystemic venous collaterals
- GE junction
- paraumbilical vein
- splenorenal & gastrorenal
- intestinal
- hemorrhoidal
acronym for a portosystemic shunt used to treat portal hypertension, usually between right portal and right hepatic veins
TIPS
transjugular intrahepatic portosystemic shunt
thrombus within portal vein lumen appears as
echogenic
what is Cavernous transformation
numerous worm like vessels at the porta hepatis
when does Cavernous transformation occur
chronic thrombosis
Rare syndrome where there is occlusion of the lumen of the hepatic veins and/or the IVC
budd-chiari syndrome
clinical presentation of Budd-Chiari syndrome
- RUQ pain
- Ascites
- hepato & splenomegaly
sonographic appearance of Budd-Chiari syndrome
- thickened hepatic vein walls
- enlarged caudate lobe
- stenosis with prox dilation
- developed intrahepatic collaterals
doppler findings of Budd-Chiari syndrome
- flow in IVC/ hepatic veins changes from phasic to continuous, reversed, turbulent or absent
- PV flow slow or reversed
spectral broadening is seen in the ___ artery
splenic
tortous artery
splenic
portal veins ___ (should/ should not) exhibit pulsation
SHOULD NOT
With portal hypertension, the portal vein may ___ and phasic variation in the portal and splenic/superior mesenteric veins may be lost.
dilate
The hepatic veins and IVC demonstrate a pulsatile flow pattern with a ___ configuraion. Flow is predominately ____
- triphasic
- hepatofugal
Transmitted cardiac pulsations ___ (are/are not) evident in the renal veins near the IVC.
are
The size of the IVC varies markedly with respiration and throughout the cardiac cycle, but seldom exceeds __ cm in diameter
2.5
