Abdo Vascular

Question 1

What waveform is expected to be seen in a normal study for the mesenteric arteries in a fasting patient?

Answer 1

High resistance
(SMA and IMA high resistance in the fasting patient)

Question 2

What vessel does the SMV join?

Answer 2

Splenic

Question 3

Which vessel courses posterior to the IVC?

Answer 3

Left renal artery

Question 4

Vessels to evaluate for Budd-Chiari syndrome?

Answer 4

All 3 hepatic veins, IVC, and portal vein

Question 5

What is the anatomic course of the gastroduodenal artery?

Answer 5

The GDA has a caudal course, anterior to the panc head

Question 6

What vein does not drain directly into the inferior vena cava?

Answer 6

The splenic vein - it joins the SMV to form the portal vein and does not empty into the IVC

Question 7

What is the greatest angle of incidence to get aan accurate velocity measurement?
60 degrees

Question 8

When scanning a patient with Marfan’s syndrome,. you see a linear band throughout the length of the abdominal aorta that is mobile in relation to the cardiac cycle - what pathology is this?

Answer 8

Aortic dissection

Dissection is related to: Marfan’s syndrome, trauma, pregnancy, bicuspid aortic valve, aortic stenosis, and hypertension

Question 9

What vessels will you study in a patient who has been referred for a Doppler study with symptoms of chronic mesenteric ischemia?

Answer 9

Celiac trunk, superior mesenteric, and inferior mesenteric arteries

*At least two of these vessels must be compromised to attribute symptoms to chronic mesenteric ischemia

Question 10

What’s the normal flow pattern in hepatic veins?

Answer 10

Triphasic

Question 11

What symptoms will show for a patient who has been referred for a Doppler study with symptoms of chronic mesenteric ischemia?

Answer 11

Postprandial abdominal pain and weight loss

*The abdominal pain is due to a lack of bloodflow that is able to get through after eating a meal

Question 12

What defines an aortic aneurysm?

Answer 12

A dilatation of the aorta exceeding 3cm in any dimension

Question 13

What describes the condition of cavernous transformation of the portal vein?

Answer 13

Network of vessels replacing obliterated portal vein

Question 14

While performing a Doppler evaluation of the abdominal vessels, you detect a stenosis in the right renal artery; what is NOT a sign of stenosis with spectral analysis?

Answer 14

Increased peak diastolic velocity proximal to the stenosis

Proximal to the stenosis, flow is typically dampened with decreased diastolic flow, diastolic flow is increased (with systolic flow) at the point of maximum stenosis

Question 15

Hepatic veins drain into which vessel?

Answer 15

IVC

Question 16

A patient has a mass in the pancreatic head - to ensure you’re scanning the entire pancreatic head, what vessel lies immediately posterior to the pancreatic head?

Answer 16

IVC

Question 17

What vessels form the portal vein?

Answer 17

Superior mesenteric vein and splenic vein

Question 18

While imaging the pancreas, you detect a vessel posteriorly that is coursing between the superior mesenteric artery and the aorta. What vessel is this?

Answer 18

Left renal vein

Question 19

Suspecting median arcuate ligament syndrome, how can you rule out this syndrome?

Answer 19

Obtain doppler readings during both inspiration and expiration and in both supine and upright positions

Question 20

Are multiple renal arteries rare?

Answer 20

No, it can occur in 30% of the population

Question 21

TIPS is used to connect what two vessels?

Answer 21

Portal vein and hepatic vein

Question 22

What describes the waveform seen in a portal vein in a normal study?

Answer 22

Mildly undulating

Flow is low-velocity

Question 23

What is the typical waveform in the neck of a pseudoaneurysm?

Answer 23

High velocity, bidirectional

Question 24

The abdominal aorta normally tapers in diameter from cranial to caudal - true or false?

Answer 24

True

Question 25

What is the proximity relationship of the splenic vein to the pancreas?

Answer 25

Posterior and inferior

Question 26

A patient has median arcuate ligament syndrome - what vessel should you be studying?

Answer 26

Celiac trunk

*the ligament lies anterior to the abdo aorta just proximal to the origin of the celiac trunk

Question 27

What is the most significant clinical consequence of portal hypertension?

Answer 27

Variceal hemorrhage

Question 28

‘Replaced’ hepatic artery has the right hepatic artery originating from which artery?

Answer 28

Superior Mesenteric Artery

Question 29

What vessel is anterior to the uncinate process and posterior to the neck of the pancreas?

Answer 29

Confluence of portal and splenic vein

Question 30

Most common location for AAA?

Answer 30

Infrarenal

Question 31

A patient has a history of chronic pancreatitis and abdominal bruit - what vascular abnormality is associated with this history?

Answer 31

Pseudoaneurysm of the hepatic or splenic artery

Question 32

Which visceral artery is most commonly involved with aneurysmal formation?

Answer 32

Splenic artery

Question 33

A 57-year-old woman has been referred for abdominal ultrasound with a history of abdominal bruit. What pathology are you looking for?

Answer 33

Vascular compromise involving the aorta or its branches

Question 34

Within the liver, the IVC lies along the posterior surface of what lobe?

Answer 34

Caudate lobe

Question 35

What are the branches of the celiac trunk?

Answer 35

Splenic, left gastric, and common hepatic

Question 36

You are performing a Doppler study of the portal vein and detect that the flow direction in the main portal vein is the same as a hepatic artery? What does that indicate?

Answer 36

A normal flow direction in the portal vein

Question 37

What is the normal direction of flow for the portal vein?

Answer 37

Hepatopetal (towards)

Question 38

The common hepatic artery splits into two branches: what are the two branches?

Answer 38

Proper hepatic artery & gastroduodenal artery

Question 39

What 3 structures compose the portal triad?

Answer 39

Hepatic artery, portal vein, and bile duct

Question 40

What vessel below provides the greatest amount of oxygenated flow to the liver?

Answer 40

Portal vein

Hepatic artery provides the remainder.