Wk 5 Flashcards
Messenteric vessels
Celiac Hepatic Splenic SMA IMA
Celiac axis
First major branch off aorta.
1-2cm below diaphragm
Celiac axis supplies
Stomach Duodenum Pancreas Liver Spleen
Why is direction important for abdominal
Veins can be red, arteries can be blue. Meaning the vessel is away from transducer but towards the organ
SMA
1-2 cm below celiac axis
Runs anterior and parallel to aorta
SMA supplies
Small intestine
Duodenum
Colon-to splenic flexure
Pancreas
IMA
Located 1-3 cm above aortic bifurcation.
Comes off aorta about 1 o’clock in trans.
IMA supplies
Colon-from splenic flexure
Common variants of mesentterics
20% have variants. Most common: rt hepatic comes off artery other than celiac. Rt hepatic off SMA common hepatic from SMA Common hepatic from aorta Common origin of celiac and SMA
Mesenteric waveforms
Celiac-low resistance SMA-high (fasting) IMA-high (fasting) Renals-low Aorta-high
Indications for mesenteric ischemia
Abdominal pain/cramping when eating.
Abdominal bruit.
Post-prandial pain
Unintended weight loss
Patient prep
NPO-nothing after midnight
Food changes waves-document food intake
Supine
Slight reverse trend if needed
IAC protocol mesenteric
Aorta Celiac axis Common hepatic Splenic SMA origin Prox SMA IMA
IAC protocol in long
Walk sample through for highest PSV.
Patency of celiac and SMA
Any conditions of great vessels
Celiac artery protocol
Patency
Common hepatic flow direction
Flow disturbance
High velocity or disturbed flow in celiac, hepatic, splenic. Measure.
If stenotic in celiac axis have patient hold breath
SMA protocol
Patency
High velocities or disturbed flow
Measure PSV in stenotic area
IMA protocol
Patency
Locate IMA, best in trans
Measure PSV document stenosis
Diagnostic criteria
Flow resistance patterns
Norma IMA SMA= high resistance in fasting patients.
Low resistance in IMA or SMA=mesenteric ischemia
Celiac artery stenosis
PSV >200
Post stenotic turbulence
Celiac artery occlusion
Absence of flow
Reserved common hepatic flow
Criteria for celiac
<125 =normal=low resistance
>200 =70% stenosis
No flow, reversed hepatic=occlusion
SMA criteria
<125 =normal=high resistance
>275 =70% stenosis
No flow, life IMA =occlusion
Criteria IMA
No velocity criteria
Waves depend on celiac and SMA
Assess for post stenotic turbulence
High velocities can indicate compensatory flow
Compensatory flow
Gut develops compensatory collateral flow.
May be asymptotic
Symptoms occur when 2/3 vessels occlude or stenos.
