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A_arterial duplex and indirect > abdomen duplex > Flashcards

abdomen duplex Flashcards

1
Q

What anatomy is interrogated by abd doppler

A 
Ao - Iliac vessels 
renal artery
kidney 
mesenteric arteries  
liver
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2
Q

What anatomy is interrogated by abd doppler

A 
Ao - Iliac vessels 
renal artery
kidney 
mesenteric arteries  
liver
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3
Q

Ao iliac Doppler purpose

A

stenosis
bypass graft f/u
aneurysms

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4
Q

Renal artery

Kidney

A

> 60% diameter reduction
presence of disease (nephrosclerotic)
patient renal vessels in Tx

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5
Q

Mesenteric arteries

A

stenosis

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6
Q

liver

A

r/o portal HTN
patient liver vessels s/p liver Tx
pre op for liver transplant

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7
Q

Limitation

A

the usual obvious reasons + SOB and rapid respiration

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8
Q

parameter for

a. Ao-Iliac artery stenosis
b. aneurysm

A

a. 2:1 velocity increase (same as LE)
b. > 3 in aorta

*note that parameter for iliac is x 1.5 cm size increase from adjacent segment -
just like any other vessel outside of the Ao

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9
Q

most AAA are caused by what and occur mostly where

A

atherosclerotic disease

infrarenal

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10
Q

what is the most common type of aneurysm

A

true

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11
Q

what types of true aneurysm is most common

A

fusiform , saccular

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12
Q

what is the most frequent complication of aortic aneurysm?

peripheral aneurysm ?

A

Rupture for Aortic aneurysm

embolization from peripheral aneurysm

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13
Q

what 3 conditions can cause renovascular HTN

A

atherosclerosis
Fibromuscular dysplasia
occlusion

anything that would result in decreased profusion to kidney paranchyma

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14
Q

what is the mechanism for hypertension

A

Renin (when kidney parenchyma perfusion is suboptimal- renin production is increased
Renin stimulates angiotensinogen to be converted into angiotensin which causes increase in systemic HTN

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15
Q

what is the landmark for identifying the left renal artery

A

left renal vein

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16
Q

Describe the teq for RA interpretation

A

celiac artery and SMA velocity data

obtain aorta PSV near SMA level

turn trans- find renal arteries

image the kids and measure them + survey for cortex thinning and abnormal findings

Obtain PSV and EDV bilaterally @
renal artery :P, M, D

Upper/ Lower pole of the kidney in segmental arteries

OBSERVE FOR SECONDARY RENAL ARTERIES

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17
Q

what abdominal arteries should show low resistance on Doppler

A

renal
celiac
hepatic
splenic

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18
Q

what abdominal organs are typically high resistant

A

fasting SMA & IMA

Aorta

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19
Q

what is being referred to as splanchnic circulation ?

A

celiac trunk, SMA , IMA

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20
Q

what is RAR

A

highest RA PSV
////////////////////////////////////////
highest Ao PSV

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21
Q

what two conditions render the RAR insignificant

A

AAA
abnormal Ao PSV :
>90 cm/s
<40 cm/s

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22
Q

with abnormal aortic PSV what criteria is used instead of RAR

A

renal artery PSV of
> 180-200 cm/s

+ post stenotic turbulence

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23
Q

RAR parameters

A

normal <3.5

abnormal > 3.5 = greater than 60% diameter reduction

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24
Q

normal pole to pole length of a kidney

A

10-12 cm

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25
Q

what ratio’s are used to interpret renal artery study

A

EDR end diastolic ratio
(parenchymal reisitance ratio)
&
Resistivity Index

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26
Q

what is the resistivity index formula

A

PSV - EDV
//////////////
PSV

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27
Q

Normal velocity for RI of renal artery or parenchymal vessels

A
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28
Q

what is parenchymal resistance ratio

A

EDV
/////////////////////////
PSV

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29
Q

what is normal parenchymal resistance ratio value

A

> .2 anything below that is abnormal

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30
Q

what is considered abnormal AT time for renal waveform indicating >60% stenosis somewhere along the vessel

A

> 100 m/sec

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31
Q

what is normal value of renal doppler AT time ?

A

70 m/sec

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32
Q

mesenteric artery patient history

A

dull achy or crampy abdominal pain 15-30 minutes after meals

mesenteric angina

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33
Q

explain technique for mesenteric study

A 
Obtain PSV and EDV on following areas 
celiac artery 
SMA : P,M, D
IMA
AORTA
34
Q

what is the “food challenge test”

A

Pt ingest high caloric meal (document how much was consumed)

exam is repeated 20-30 minutes after or sooner with symptoms (document when sx started or duration of time between ingestion and beginning the exam)

PSV and EDV measurements obtained at areas of fasting test

(hyperemic response begins after about 10 -30min after eatin

35
Q

Doppler characteristics and velocities:

SMA

A 
High resistance  (pre-prandial)  
converts to lower resistance post prandal

normal 110-177 cm/sec

abnormal PSV >275 = >70% stenosis

36
Q

Doppler characteristics and velocities:

CA

A

unaffected by eating
can be taken in TRV

Normal velocities 50-160 cm/sec

> 70% stenosis = PSV >200cm/sec

37
Q

what predicts distal mesenteric disease?

A

high resistant waveform persists after eating

38
Q

name the two collaterals that exist between the sma and the ima

A

marginal artery of drummond

arc of riolan

39
Q

what is criteria for chronic mesenteric ischemia

A

2-3 mesenteric vessels have problems

40
Q

what is celiac band syndrome

A

extrinsic compression via the median arcuate ligament of the diaphragm

reversible CA stenosis
expiration- breath out = stenosis
inhilation-breath in = normal flow

41
Q

what is clinical indication for celiac band syndrome

A

bruie

or can be asymptomatic

42
Q

what might indicate acute rejection of renal transplant regarding doppler ?

A

increased arterial resistance

43
Q

Ao iliac Doppler purpose

A

stenosis
bypass graft f/u
aneurysms

44
Q

Renal artery

Kidney

A

> 60% diameter reduction
presence of disease (nephrosclerotic)
patient renal vessels in Tx

45
Q

Mesenteric arteries

A

stenosis

46
Q

liver

A

r/o portal HTN
patient liver vessels s/p liver Tx
pre op for liver transplant

47
Q

Limitation

A

the usual obvious reasons + SOB and rapid respiration

48
Q

parameter for

a. Ao-Iliac artery stenosis
b. aneurysm

A

a. 2:1 velocity increase (same as LE)
b. > 3 in aorta

*note that parameter for iliac is x 1.5 cm size increase from adjacent segment -
just like any other vessel outside of the Ao

49
Q

most AAA are caused by what and occur mostly where

A

atherosclerotic disease

infrarenal

50
Q

what is the most common type of aneurysm

A

true

51
Q

what types of true aneurysm is most common

A

fusiform , saccular

52
Q

what is the most frequent complication of aortic aneurysm?

peripheral aneurysm ?

A

Rupture for Aortic aneurysm

embolization from peripheral aneurysm

53
Q

what 3 conditions can cause renovascular HTN

A

atherosclerosis
Fibromuscular dysplasia
occlusion

anything that would result in decreased profusion to kidney paranchyma

54
Q

what is the mechanism for hypertension

A

Renin (when kidney parenchyma perfusion is suboptimal- renin production is increased
Renin stimulates angiotensinogen to be converted into angiotensin which causes increase in systemic HTN

55
Q

what is the landmark for identifying the left renal artery

A

left renal vein

56
Q

Describe the teq for RA interpretation

A

celiac artery and SMA velocity data

obtain aorta PSV near SMA level

turn trans- find renal arteries

image the kids and measure them + survey for cortex thinning and abnormal findings

Obtain PSV and EDV bilaterally @
renal artery :P, M, D

Upper/ Lower pole of the kidney in segmental arteries

OBSERVE FOR SECONDARY RENAL ARTERIES

57
Q

what abdominal arteries should show low resistance on Doppler

A

renal
celiac
hepatic
splenic

58
Q

what abdominal organs are typically high resistant

A

fasting SMA & IMA

Aorta

59
Q

what is being referred to as splanchnic circulation ?

A

celiac trunk, SMA , IMA

60
Q

what is RAR

A

highest RA PSV
////////////////////////////////////////
highest Ao PSV

61
Q

what two conditions render the RAR insignificant

A

AAA
abnormal Ao PSV :
>90 cm/s
<40 cm/s

62
Q

with abnormal aortic PSV what criteria is used instead of RAR

A

renal artery PSV of
> 180-200 cm/s

+ post stenotic turbulence

63
Q

RAR parameters

A

normal <3.5

abnormal > 3.5 = greater than 60% diameter reduction

64
Q

normal pole to pole length of a kidney

A

10-12 cm

65
Q

what ratio’s are used to interpret renal artery study

A

EDR end diastolic ratio
(parenchymal reisitance ratio)
&
Resistivity Index

66
Q

what is the resistivity index formula

A

PSV - EDV
//////////////
PSV

67
Q

Normal velocity for RI of renal artery or parenchymal vessels

A
68
Q

what is parenchymal resistance ratio

A

EDV
/////////////////////////
PSV

69
Q

what is normal parenchymal resistance ratio value

A

> .2 anything below that is abnormal

70
Q

what is considered abnormal AT time for renal waveform indicating >60% stenosis somewhere along the vessel

A

> 100 m/sec

71
Q

what is normal value of renal doppler AT time ?

A

70 m/sec

72
Q

mesenteric artery patient history

A

dull achy or crampy abdominal pain 15-30 minutes after meals

mesenteric angina

73
Q

explain technique for mesenteric study

A 
Obtain PSV and EDV on following areas 
celiac artery 
SMA : P,M, D
IMA
AORTA
74
Q

what is the “food challenge test”

A

Pt ingest high caloric meal (document how much was consumed)

exam is repeated 20-30 minutes after or sooner with symptoms (document when sx started or duration of time between ingestion and beginning the exam)

PSV and EDV measurements obtained at areas of fasting test

(hyperemic response begins after about 10 -30min after eatin

75
Q

Doppler characteristics and velocities:

SMA

A 
High resistance  (pre-prandial)  
converts to lower resistance post prandal

normal 110-177 cm/sec

abnormal PSV >275 = >70% stenosis

76
Q

Doppler characteristics and velocities:

CA

A

unaffected by eating
can be taken in TRV

Normal velocities 50-160 cm/sec

> 70% stenosis = PSV >200cm/sec

77
Q

what predicts distal mesenteric disease?

A

high resistant waveform persists after eating

78
Q

name the two collaterals that exist between the sma and the ima

A

marginal artery of drummond

arc of riolan

79
Q

what is criteria for chronic mesenteric ischemia

A

2-3 mesenteric vessels have problems

80
Q

what is celiac band syndrome

A

extrinsic compression via the median arcuate ligament of the diaphragm

reversible CA stenosis
expiration- breath out = stenosis
inhilation-breath in = normal flow

81
Q

what is clinical indication for celiac band syndrome

A

bruie

or can be asymptomatic

82
Q

what might indicate acute rejection of renal transplant regarding doppler ?

A

increased arterial resistance

A_arterial duplex and indirect (13 decks)

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