Liver Vasculature Flashcards
(106 cards)
1
Q
Liver Vasculature includes evaluation of
A
Hepatic veins
Portal veins
Hepatic artery
IVC
Collaterals?
2
Q
3 disorders we look at
A
Portal hypertension
Shunts/stents
Transplants
3
Q
2 things causing portal hypertension
A
Portal vein thrombosis
Hepatic vein thrombosis
4
Q
___ HV and ___ HV typically join before the IVC
A
MHV
LHV
5
Q
___ HV is commonly duplicated
A
Left
6
Q
HV waveforms are ___ and ___
A
Respirophasic
Pulsatile
7
Q
Assess HV for ____ or ____
A
Patency
Distension
8
Q
HV are ___ segmental
A
Inter (between)
9
Q
PV drain blood from the (3)
A
Bowel spleen liver
10
Q
PV supply approximately ___ of blood to liver
A
75%
11
Q
MPV comprises of
A
SV
sMV
12
Q
MPV enters liver through the
A
Porta hepatis
13
Q
Hepatopetal
A
Towards the liver
14
Q
Hepatofugal
A
Away from the liver
15
Q
What means towards the liver
A
Hepatopetal
16
Q
What means away from the liver
A
Hepatofugal
17
Q
Portal veins have a ___ velocity normal (range for MPV is ____)
A
Low
16-40 cm/s
18
Q
Portal veins flow increases ____
A
Post-prandial
19
Q
Normal MpV diameter should be less than or equal to ___
A
13mm
20
Q
HA supplies ___ of blood to liver
A
25%
21
Q
Proximal HA seen at
A
Celiac axis
22
Q
Distal hepatic artery is ___ and seen at
A
Intercostal
MPV/RPV
23
Q
HA should be ___ resistance
A
Low
24
Q
Is there spectral broadening go in HA
A
Small amount due to small vessel
25
HA has variable velocities so ___ is used to assess for pathology
RI
26
Normal RI for HA
0.55-0.7
27
Post-prandial
After eating
28
Angle for MPV angle correct has to be ___
60 degrees or less
29
____ is tortuous
HA
30
RI
Resistive index
31
Greater than __ is considered dilated for the IVC
2.5cm
32
IVC spectral trace has a ____ waveform
Spontaneous
33
IVC spectral influenced by ___ and ____
Heart
Respiration
34
IVC is ___ proximally and ___ distally
Pulsatile
Phasic
35
Portal hypertension can be categorized as (3)
Pre-hepatic
Intrahepatic
Post-hepatic
36
What a the most common portal hypertension category
Intrahepatic
37
What is the leading causes of portal hypertension
Cirrhosis
38
What is the first and second leading cause of cirrhosis
Hepatitis C
Alcoholism
39
signs/symptoms of portal hypertension
jaundice
abnormal LFTs
ascites
splenomegaly
GI bleed (hematemesis, melena)
40
LFT
liver function test
41
hematemesis
vomiting blood
42
melena
dark tarry stools
43
caput medusae (what/seen with)
dilated abdominal wall veins sometimes seen with portal hypertension
44
hepatic encephalopathy
confusion due to poor liver function
45
4 reasons for pre-hepatic obstruction
portal/splenic vein thrombosis
portal/splenic vein invasion (tumor within)
extrinsic compression by a tumor
pancreatitis
46
pancreatitis
inflammation of the pancreas
47
in pre-hepatic obstruction the liver is ____ and the spleen is ____ (size)
typically normal
enlarged
48
5 causes for portal vein thrombosis
cirrhosis (20%)
malignancies (20%)
hypercoagulable states
intra-abdominal inflammation/infection
trauma (from surgery)
49
T/F chronic PHT always has symptoms
F
49
normal PV diameter
<13mm
50
can PV be enlarged with PV thrombosis
yes
51
T/F the lumen of PV may be any echogenicity with PV thrombosis
T
52
cavernous transformation
other V and PV dilated (looks like can of worms at porta hepatis)
53
can the HA be enlarged/have increased flow with a PV thrombosis
yes
54
does PVT tend to be permanent or not
permanent
55
what does permanent PVT commonly lead to
scarring
56
5 causes of PHT
cirrhosis
hepatitis
hepatic fibrosis
nonalcoholic steatohepatitis (NASH)
inflammation of normal liver tissue
57
PHT leads to _____ and _____
tissue death and fibrosis
58
with intrahepatic obstruction, it can damage what 3 things
liver
sinusoids
hepatocytes
59
with intrahepatic obstruction, there is an ______ resistance to blood flow at the ______ level
increased
sinusoid
60
with intrahepatic obstruction, there may be a shunting of blood to _____
collateral vessels
61
can varices develop with intrahepatic obstruction
yes
62
with intrahepatic obstruction, the liver with _____ in size in the end stage and the spleen will ____ in size
decrease
increase
63
3 causes of post-hepatic obstruction
chronic right-sided heart failure (CHF)
tricuspid regurgitation (TR)
Budd Chiari
64
what is Budd Chiari
thrombosis of the HV's or IVC
65
if post-hepatic obstruction is acute, the liver _____ in size, and the spleen ____ in size
increases
increases
66
with CHF or TR, the PV will appear ____ on spectral, the HV normal waveform will change as the ___ wave will ___, and there will be a ____ IVC
pulsatile
S
decrease
dilated
67
Budd Chiari is most commonly caused by ______ like _____
a hypercoagulable state
polycythemia
68
polycythemia
too many RBC
69
can oral contraception lead to post-hepatic obstruction
yes; thrombosis
70
with post-hepatic obstruction, _____ may form and the ____ may help drain the liver
collaterals
caudate lobe
71
4 things we look for when scanning liver vasculature
patency of MPV and branches
direction of flow
phasicity
MPV velocity
72
what is the normal range for MPV velocity
16-40cm/sec
73
the major 3 congenital shunts are
portocaval (PV to IVC)
mesocaval (SMV to IVC)
splenorenal (SV to Lt. RV)
74
left gastric vein AKA
coronary vein
75
what is the most prevalent portosystemic collateral
left gastric (coronary vein)
76
increased pressure in the coronary vein may cause _____ varices
esophageal
77
visualization of the coronary vein implies an increased risk for ____
hemorrhage
78
with PHT the remnant of the _____ recanalizes in the lig teres from ___ to ____. Flow is ____ (in comparison to liver)
umbilical vein
LPV
umbilicus
hepatofugal
79
surgical shunts can be placed ___ or with an ______ technique
surgically
endovascular technique
80
the most common way to place a shunt for PHT is
TIPS
81
TIPS
trans-jugular intrahepatic portosystemic shunt
82
TIPS shunts blood from ___ to ___
PV
HV
83
TIPS: catheter passed down ___ into HV, advancing through liver tissue into PV branch
IJV
84
technical success rate of TIPS is
nearly 100 percent
85
normal TIPS velocity range ____ with velocities increasing from the ___ end to the ___ end
90-190cm/s
portal
hepatic
86
normal PV velocity is at least after TIPS
30cm/s
87
TIPS: flow is ____ in the right and left portal
retrograde
88
TIPS: compensatory HA flow ____
increases
89
with early TIPS complication, we will see increased velocities in ____ and decreased velocities in ___
stenosis
MPV
90
late complication fo TIPS
neo-intimal hyperplasia invades stent
91
if stenosis is detected in TIPS what is done (2)
balloon angioplasty
thrombolysis
92
is transplant liver always whole
no
93
the post-opperative US is used to confirm patency, flow direction and size of what 4 things after liver transplant
HA
PV
IVC/HV
SV/mesenteric V
94
the PV can be larger in the transplant patient with normal size up to
15mm
95
pseudo aneurysm
where leak happens and body walls it off making it look like an aneurysm
96
hepatic infarction (what, usual shape/echogenicity)
death of tissue (usually wedge shaped/hypo)
97
air can act as an ____
embolism
98
AV fistulas
arterial-venous connection due to surgery
99
US is done ___ after transplant and at regular intervals afterwards
24hours
100
HA should have a ___ upstroke and an RI in the range of
rapid
0.5-0.8
101
AT time for HA
<80ms
102
if AT is high what does it mean
proximal stenosis
103
PSV of HA is variable and not reliable but should be less than
200cm/s
104
if PSV high this means
stenosis with jet
105
HV can have a ______ waveform immediately after surgery but will normalize over time
monophasic (never crosses baseline)
