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abdominal doppler Flashcards

(59 cards)

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1
Q

4 vascular anastomoses?

A
  1. Suprahepatic vena cava
  2. Infrahepatic vena cava
  3. Hepatic artery
  4. Portal vein

Also biliary duct anastomosis

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2
Q

sonogrpahers role in anastomoses?

A
  • each anastomosis must be assessed with ultrasound using a combination of grey scale and spectral doppler
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3
Q

Anastomotic regions have higher chance of developing?

A

a stenosis or occulsion

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4
Q

anastomosis sequelae of events?

A
  • necrosis- fibrosis- stenosis

- all branches of the portal vein should be interrogated

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5
Q

most significant vascular complication, high mortality rate?

A

Hepatic artery thrombosis

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6
Q

Hepatic artery stenosis occurs where?

A

11% of recipients-near anastomosis

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7
Q

Portal vein complications?

A

1-13%-narrowing of vessel lumen at anastomotic site

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8
Q

IVC complications?

A

stenosis is a rarity-recurrent HCC may cause tumor in Hepatic Veins/IVC

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9
Q

Vascular patency post transplant ensure what vessels are working? (4)

A

Hepatic artery
Portal vein
IVC
Hepatic veins

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10
Q

vasular patency?

A
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11
Q

vasular patency?

A
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12
Q

post transplant inspect for?

A

Narrowed diameter
Thrombus
Normal spectral waveform and direction

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13
Q
A

portal vein stenosis

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14
Q
A

portal vein stenosis

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15
Q

Renal transplant-vascular complications (4)?

A

Renal artery stenosis: months to years after
Renal artery occlusion: first few days
Primary renal vein thrombosis: originates RV
Secondary renal vein thrombosis: into Iliac V

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16
Q

sonographers role- all anastomoses must be assessed with doppler when?

A
  • iliac A&V prior to the anastomoses
  • RV and RV at the iliac anastomoses
  • colour image of both vessels long axis to show patency/aliasing
  • intrarental RI- arcuate or interlobar
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17
Q
A

Renal artery stenosis

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18
Q

Main right renal artery is prone to?

A

prone to stenosis at the ostium (takeoff from Aorta) due to its sharp angle superiorly and then inferiorly toward the right kidney

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19
Q

A ratio between the RA stenosis flow and proximal Ao flow is a good indicator of?

A

disease

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20
Q

Renal artery (native)?

A
  • Technically difficult due to overlying gas and patient body habitus
  • Decubitus position is helpful
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21
Q

How to obtain RA/AO ratio?

A
  • Angle correct must be used for both measurements
  • Measure the PSV in Aorta just proximal to RA takeoff
  • Measure the PSV within the RA stenosis (aliasing is a tipoff)
  • Open the gate size as it is a small vessel
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22
Q

RA PSV/AO PSV not condisered hemosynamically significant?

A

< 3.5 is not considered hemodynamically significant

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23
Q

Renal artery flow pattern? and PSV?

A
  • Low resistant flow pattern
  • Distal RA – usually no window is seen
  • PSV of up to 180 cm/s is considered normal
  • Low resistance waveforms demonstrate broad systolic peaks and forward flow throughout diastole
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24
Q

Resistant index also known as?

Study These Flashcards
A

pourcelot index

25
How to obtain the RI measurement?
- Index of pulsatility and opposition to flow - Angle correct is not used as it is angle independent - RI: PSV-EDV/PSV - Obtain a signal in the arcuate or segmental arteries at UP, mid and LP cortex - Measure the PSV and EDV-use the calculation package on the US unit
26
RI=
PSV-EDV/PSV
27
In the arcuate vessels, an RI ___ indicates resistance to flow due to main RA stenosis?
<0.7
28
High resistance waveforms demonstrate?
tall, narrow, sharp systolic peaks and reversed or absent diastolic flow
29
Other Examples of high resistant waveforms?
- Infrarenal aorta, iliacs and fasting SMA | - Due to many small branches encountered
30
Origin of SMA is prone to?
stenosis due to and angle of takeoff from the aorta
31
normally SMA has what type of flow pattern?
- high resistant flow pattern in fasting state - It attains a low resistant flow pattern post prandial due to the capillaries allowing for nutrients to pass into tissues (capillaries control resistance)
32
CA is prone to?
stenosis due to its short caliber and 3 immediate branches
33
Celiac Axis flow patteren?
- normally a low resistant flow pattern as its 3 branches supply the viscera - PSV and diastolic flow will also increase post prandially
34
MPV normal AP measurement should not exceed?
1. 3cm in an adult | - diameter will increase after a meal
35
MPV flow pattern?
- phasic low flow velocited toward the liver (hepatopetal)
36
MPV flow with inspiration?
Blood flow will decrease with inspiration and increase with expiration due to the increased and decreased abdominal pressure respectively
37
Splenic vein flow pattern?
Demonstrates spontaneous phasic flow away from the spleen and toward the liver
38
splenic vein normal adult size?
<10mm
39
splenic vein with increases with?
- inspiration | - portal hypertension
40
spenic vein drains? (3)
Drains spleen, pancreas and a portion of the stomach
41
Superior Mesenteric V flow pattern?
- Demonstrates spontaneous phasic flow toward the liver
42
SMV normal adult measurement?
<10mm
43
SMV increases caliber with?
- inspiration - following a meal - portal hypertension
44
SMV drains?
- small intestines - ascending - transverse colon
45
hepatic A demonstrates what waveform?
a low resistant waveform with continuous flow through diastole
46
hepatic artery increased flow velocity is associated with? (4)
- jaundice - cirrhosis - lymphoma - metastases
47
Normal hepatic arterial PSV and EDV in a fasting adult patient is approximately
PSV 30–40 cm/sec, and EDV is 10–15 cm/sec
48
HA aneurysm is?
- Rare | - fatal if ruptures
49
Splenic artery flow?
Demonstrates low resistant flow pattern with continuous flow through diastole
50
splenic artery gives rise to?
to gastroepiploic artery and branches to the pancreas and stomach
51
splenic artery route?
Very tortuous route to the spleen
52
splenic artery may have a pseudoaneurysm if?
- contained in a pseudocyst - Use color on collection to see turbulent blood flow within
53
IVC waveform proximal ?
- The waveform of the inferior vena cava varies according to the specific segment sampled - The flow in the proximal inferior vena cava is influenced by the activity of the right atrium - And shows back-pressure changes identical to those seen in hepatic venous flow
54
IVC waveform distal?
- Distally, the cardiac activity has a lesser effect on flow velocities - Variations in thoracic or abdominal pressure cause greater variability in forward flow
55
IVC Occlusion s/s? (4)
Bilateral leg swelling-sign Extrinsic compression-nodes Renal cell carcinoma Hepatocellular carcinoma
56
Right heart failure can lead to?
- overdistension of IVC and Hepatic veins | - These vessels will appear larger than normal due to backup of blood flow
57
HV flow pattern?
- The normally phasic flow due to respiratory movements are absent - The IVC will measure almost the same in AP during expiration and inspiration
58
Budd Chiari syndrome?
thrombus or hepatoma extension into hepatic veins
59
Renal vein thrombosis?
- Underlying disease usually - Dehydration - Hypercoagulability - Tumors of left kidney and adrenals grow into veins - Extrinsic compression-tumor, fibrosis, trauma - Large edematous kidney evident

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