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RVT Review > Abdominal > Flashcards

Abdominal Flashcards

(59 cards)

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1
Q

In 40% of people, the Hepatic artery arises from what artery rather than the Celiac?

A

Superior Mesenteric Artery (SMA)

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2
Q

Which artery can be identified by its surrounding triangle of fat: Celiac, SMA, or IMA?

A

SMA

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3
Q

Does the Right Renal Artery pass superficial or deep to the IVC?

A

Deep

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4
Q

Loss of the Early Systolic Peak is the first indication of disease in which arteries?

A

Renal Arteries

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5
Q

Which two veins join to form the Portal Vein?

A

Superior Mesenteric vein and Splenic vein.

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6
Q

What percentage of the blood is supplied to the liver by the Portal vein (versus the Hepatic artery)?

A

70-80% from the Portal vein.

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7
Q

List the segments of the Portal vein.

A

External Hepatic Portal Vein
Internal Hepatic Portal Vein
Right Portal Vein (Anterior and Posterior branches)
Left Portal Vein (Transverse and Umbilical branches)

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8
Q

The Doppler signature of the Portal venous system normally has these three attributes:

A

Low velocity
Subtle phasicity
Hepatopedal flow direction

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9
Q

Portal flow away from the liver is given this term:

A

Hepatofugal

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10
Q

The normal diameter of the Portal vein is:

A

< 13mm

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11
Q

Portal vein diameter larger than 13mm and diminished phasicity are signs of:

A

Portal Hypertension

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12
Q

What is the normal effect of deep inspiration on the Portal, Splenic, and Superior Mesenteric veins?

A

Increased diameter

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13
Q

Differentiate hepatic from portal veins in their orientation; where they converge; their change in diameter; and their margins.

A

Hepatic longitudinal, Portal transverse.
Hepatic to IVC, Portal to porta hepatis.
Hepatic larger to IVC, Portal larger to porta hepatis.
Hepatic no sheath, Portal echogenic fibrous sheath.

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14
Q

The normal diameter of the aorta is:

A

< 3 cm

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15
Q

The normal diameter of the iliac arteries is:

A

1.3 cm females, 1.5 cm males.

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16
Q

List three risk factors for abdominal aortic aneuryism:

A

Sex (male)
Age
Smoking

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17
Q

The renal arteries are probably not involved with a AAA if the proximal portion of the aneurysm is how far from the SMA?

A

2 cm

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18
Q

List four potential problems with endovascular grafts.

A

Endoleak (perigraft flow into aneurysm sack)
Endotension (sack diameter increases w/o leak)
Migration/Kinking
Disassociation (graft separates from native vessel)

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19
Q

What are the four types of Endoleaks?

A

Type 1: from anastomosis (1a: prox; 1b: distal)
Type 2: from Aorta branch
Type 3: From graft junctions or fabric tears
Type 4: From graft pores

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20
Q

What is meant by the “Two artery rule” regarding mesenteric ischemia?

A

Two of the three mesenteric (splanchnic) arteries need to be diseased in order to cause mesenteric ischemia.

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21
Q

Compression of the Celiac artery causing pain during exhalation is termed:

A

Median Arcuate Ligament Syndrome

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22
Q

During which phase of respiration does Median Arcuate Ligament Syndrome cause pain?

A

Exhalation

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23
Q

What is the normal fasting waveform of these three arteries: Celiac; SMA; IMA.

A

Celiac: Low resistance

SMA & IMA: High resistance

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24
Q

What is the criteria for an abnormal SMA PSV?

Study These Flashcards
A

≥ 275 cm/sec

25
What is the criteria for an abnormal Celiac PSV?
≥ 200 cm/sec
26
What does a low resistance signal in the SMA or IMA suggest while fasting?
Mesenteric ischemia, since the distal arterioles are dilated.
27
What is the criteria for abnormal portal vein diameter?
> 13mm where PV passes over IVC
28
What is the most common portosystemic shunt?
Coronary vein to gastroesophageal collaterals.
29
Endoleak Type I
From proximal or distal anastamosis.
30
Criteria for mesenteric ischemia (3)
2 of 3 splanchnic arteries stenosed or occluded Celiac > 200 cm/sec SMA > 275 cm/sec
31
Endoleak Type II
From branch of the aorta (eg. IMA, etc.)
32
Endoleak Type III
From junction between modular devices, or tears.
33
Endoleak Type IV
Graft porosity.
34
Causes of portal vein occlusion (4)
Thrombosis secondary to cirrhosis Tumor from liver or panceas Pancreatitis Schistosomiasis
35
Criteria for portal HTN (6)
``` Flow < 15 cm/sec PV diameter > 13mm Splenomegaly > 13cm Waveform to/fro or reversed Hepatofugal direction of flow Development of shunts ```
36
Budd-Chiari Syndrome symptoms:(hepatic vein obstruction)
``` hepatomegaly abdominal pain ascites jaundice hepatocellular dysfunction ```
37
Renal artery progression
``` Renal arteries >Anterior - 4 segmental arteries >Posterior - 1 segmental artery >Segmental arteries: in renal pelvis >Interlobar arteries (in parenchyma) >Arcuate arteries (curve around corticomedullary junction) >Cortical branches (in cortex) ```
38
Criteria for Renal Artery Stenosis (5)(RAS)
``` Renal/Aortic ratio > 3.5 PSV > 180 cm/sec Accel time > 0.1 sec Accel index < 300 cm/sec2 Loss of early systolic peak ```
39
Criteria for aneurysm (1)
Diameter ≥ 1.5 times normal
40
Types of aneurysms (4)
True: all layers stretched Pseudo: hole in atrial wall Dissecting: separation of intima and media Mycotic: infection destroys part of wall causing rupture
41
Renal artery doppler signature (2)
Low resistance | Early systolic peak
42
Forms of aneurysms (4)
Fusiform/Diffuse (gradual) Bulbous/Focal (sharp) Concentric: equal all around Saccular: off to one side
43
Indications of Renovascular HTN (3)
Hypertension, esp. in younger patients Decreased renal function Abdominal bruit
44
Hepatic vein Doppler signature
Phasic with pulsations from RA, often above and below baseline.
45
Most common location for AAA?
Distal to the renal arteries.
46
Symptoms of AAA?
Pain in abdomen, back, or legs.
47
What is the 2 cm rule?
If the proximal portion of AAA is ≥2 cm beyond SMA origin, the renal arteries are probably not involved.
48
3 objectives of aneurysm repair surveillance:
To determine if anastomoses feeding AAA. To check for fluid collection. To examine for hematoma, abcesses, pseudoaneurysms.
49
Describe Median Arcuate Ligament syndrome:
The median arcuate ligament compresses the celiac artery during exhalation, causing pain.
50
Describe the surgical anastomoses for renal allografts.
Renal artery: end-to-end for internal iliac artery, end-to-side for external iliac artery. Renal vein: end-to-side for external iliac vein. Ureter: to bladder with anti-reflux device.
51
Kidney transplant complications (3):
Renal artery stenosis: from intimal damage. Renal artery or Renal vein thrombosis: from surgical complications. Pseudoaneurysms or artery to vein fistula (AVF).
52
Portal vein HTN shunts (4):
Coronary-gastroesophageal Splenorenal Umbilical vein Hemorrhoidal
53
Criteria for renal parenchymal disease:
If Resistive Index > 80 then parenchymal disease, and fixing stenosis will not improve renal function.
54
Formula for Resistive Index
RI = (PSV - EDV) / PSV
55
Criteria for Aortic Aneurysm
>3 cm diameter
56
Criteria for Iliac Aneurysm
>1.5 cm diameter
57
Budd-Chiari Doppler signal
Changes from normal triphasic to monophasic, absent, reversed, or turbulant.
58
Portal Cavernoma duplex signs (3)
Extrahepatic portal vein not visualized (no flow) Multiple periport collaterals Phasic flow in periport collaterals
59
Thrombosis (Portal/IVC/Renal vein) duplex signs (3)
Visualization of thrombus Lack of Doppler signal Dilated vessel

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