Hepatoportal Abdominal Doppler

Question 1

spectral Doppler waveforms and velocity measurements of

Answer 1

Main, right and left portal vein
Right, middle and left hepatic veins
Splenic vein
Superior mesenteric vein
Inferior vena cava
Hepatic artery proper (angle-corrected velocity)

Question 2

normal findings of portal veins

Answer 2

Hepatopetal (toward liver)
Velocity typically of 15-18 cm/s
Varies with respiration and cardiac pulsation

Question 3

IVC and Hepatic veins

Answer 3

Phasic throughout respiratory and cardiac cycles

Increased diameter in patients with congestive heart failure

Question 4

Splenic Vein

Answer 4

Flow is toward liver

Monophasic with slight pulsatility, similar to portal veins

Question 5

Portal hypertension

Answer 5

Abnormal increase in portal venous pressure due to obstruction of blood flow through liver

Question 6

Portal vein flow portal hypertesnion-first

Answer 6

First becomes monophasic, no undulations

Question 7

Portal vein flow portal hypertesnion-second

Answer 7

As worsens, becomes biphasic (some reversal)

Question 8

In worst cases of portal hypertension

Answer 8

becomes hepatofugal (away from liver)

Question 9

what may also be seen in portal venous hypertension

Answer 9

May also see intrahepatic aterial-portal venous shunting

Question 10

what modalities are used in portal hypertension

Answer 10

Ultrasound Doppler is accurate in assessing anatomy and flow direction
MR angiography is superior to U/S in assessing patency of portal vein and surgical shunts, and detecting varices

Question 11

Sonographic signs of portal hypertension

Answer 11

Ascites
Splenomegaly
Varices
Portosystemic venous collaterals
Portal vein diameter >13mm
Increased hepatic artery flow (arterialization)

Question 12

causes of portal hypertension

Answer 12

Cirrhosis due to alcohol abuse or hepatitis are most common

Question 13

Complications of portal hypertension

Answer 13

Primary is gastrointestinal bleeding from ruptures esophogeal and gastric varices

Question 14

what are the five major sites of portosplenic venous collaterals

Answer 14

Gastroesophogeal junction
Paraumbilical vein
Splenorenal and gastrorenal
Intestinal
Hemorrhoidal

Question 15

TIPS

Answer 15

Transjugular intrahepatic portosystemic shunt

Question 16

what is TIPS used to treat

Answer 16

Used to treat portal hypertension that usually involves varices with gastrointestinal bleeding

Question 17

where do shunts usually run

Answer 17

Usually between right portal and right hepatic veins

Reroutes blood away from liver, from the portal vein, through the stent, into hepatic vein, back to the heart

Question 18

Normal post TIPS Doppler findings

Answer 18

High velocity, turbulent flow through stent
Hepatofugal flow in intrahepatic portal veins
Increased hepatic artery peak systolic velocity

Question 19

Complications of portosystemic shunts

Answer 19

Stent stenosis or occlusion

Hepatic vein stenosis

Question 20

Direct signs of portosystemic shunt complications

Answer 20

No flow
Abnormal peak shunt velocity
Low velocity in main portal vein
Reversal of hepatic vein flow
Hepatopedal intrahepatic portal vein flow

Question 21

Indirect signs of portosystemic shunt complications

Answer 21

Reaccumulation of ascites
Reappearance of collaterals
Recanalization of paraumbilical vein

Question 22

Causes of portal vein thrombosis Adults

Answer 22

Trauma
Sepsis
Malignancy (HCC, metastases, pancreatic carcinoma)
Splenomegaly / splenectomy
Chronic pancreatitis
Hypercoagulable states

Question 23

causes of portal vein thrombosis children

Answer 23

Umbilical vein catheterization
Omphalitis
Neonatal sepsis
Acute dehydration

Question 24

Budd Chiari

Answer 24

Rare syndrome where there is occlusion of the lumen of the hepatic veins and/or the IVC

Question 25

Budd Chiari Doppler Findings

Answer 25

Flow in IVC and/or hepatic veins changes from phasic continuous, reversed, turbulent or absent
Portal vein flow may be either slowed or reversed