Scan Lab Final 2024 Flashcards by Sonography ♡

What does “TIPS” stand for?

Transjugular intrahepatic portosystemic shunts

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What two vessels does the tips usually connect?

Right hepatic vein and right portal vein

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True/False
You only measure the velocity at the mid portion of the TIPS to determine if it is completely patent

False

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What is the most common reason a patient gets a TIPS?

Portal hypertension

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What is the most common complication in a TIPS?

Stenosis within the TIPS

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Which characteristics best describe flow in the main portal vein?

Low velocity and hepatopedal flow

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The flow in the left portal vein should be ______________ in a patient with a TIPS:

Hepatofugal

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A _______ velocity change from previous exams denotes possible malfunction within a TIPS. (in cm/s)

> 50cm/s

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In the setting of chronic cirrhosis, flow in the hepatic artery will be ______ resistance

Low resistance

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What does RAR stand for?

Renal Aortic velocity ratio

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When performing a renal artery stenosis exam, which two vessels do you use a sample gate with the angle correct on?

Renal artery and Aorta

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another name for a dominant follicle is a _________ follicle

Graafian follicle

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For ovarian Doppler, you should expect to decrease your ________ when evaluating for torsion

PRF

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With an LMP, you need to know the ______ day of the last menstrual cycle.

First

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Ovarian torsion causes the ovary to become edematous giving the ovarian a _________ echogenecity

HypOechoic

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What two vessels supply oxygenated blood to the ovaries?

Uterine artery and ovarian artery

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The left ovarian vein travels superiorly into what vessel?

Left renal vein

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Term for the surgical removal of the ovary:

Oophorectomy

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Color flow is a _____________ type of measurement.

Qualitative

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With a properly placed ________, you will get a more accurate evaluation

Sample gate

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To ensure accuracy, your angle correct should be set at _____ degrees or less.

60 degrees

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_________ ultrasound is a vital component in evaluating the female pelvis

Doppler

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Ovarian veins are known to _________ during pregnancy

Dilate

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Once ruptured, the follicle turns into a ___________________

Corpus luteum

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The ___________ sign represents the twisting of the ovaries, vascular pedicle

Whirlpool sign

Where does the ovarian artery originate?

Aorta

Normal parenchymal ovarian artery flow has ______ velocities

Low

List the vessels imaged for the mesenteric Doppler protocol:

Ao (prox, mid, distal) Celiac axis Hepatic artery Splenic artery SMA (prox, mid, distal) IMA

Celiac and hepatic artery will have _______ resistance

Low

SMA while fasting needs to be ______ (____ resistance) with a brief period of flow reversal, and little to no flow in diastole

Triphasic, high resistance

IMA is going to have ______ flow characteristic as the SMA

The same

After the patient consumes approximately 16 to 20 fluid ounces of ________, Then you wait ______ minutes to go back and reevaluate the same vessels with color and pulse wave.

-a high calorie drink (such as boost or ensure) -Wait 20 minutes

What we are looking for in the post prandial exam is a(n) _____ in the PSV and EDV in the _______

an INCREASE in PSV and EDV in the SMA

There are only guidelines per the PSV/EDV for the ______ and the ______

SMA and Celiac axis

Renal artery is slightly __________ to the renal vein

Sample gates on the Renal artery Doppler protocol must have the correct…

Size, placement, and angle correct (AO & renal artery only) in the direction of blood flow

Color Doppler can be fine tuned with _______

Scale (Sensitivity = good)

Purpose of Renal artery stenosis evaluation:

-To evaluate the kidneys when the patient presents with sudden onset hypertension and/or fluctuating blood pressures -To identify renal stenosis before renal failure occurs

What is the primary imaging modality for Renal artery stenosis in possible surgical and non-surgical situations?

-u/s if the first choice for typical evaluation of the kidney -CT is the first choice in cases of possible surgical situations

Most common reason for a renal artery stenosis examination?

Any uncontrolled or sudden blood pressure issues and/or hypertension

What type of flow occurs right before a stenosis in the renal artery

Laminar flow

Flow directly after stenosis in the renal artery is __________

Turbulent

Where in location of a stenosis in the renal artery do you check for blood flow?

Before, during, and after the stenosis.

Renal Doppler protocol:

• Full Kidney protocol • Doppler the arcuate arteries at upper, mid, & lower poles • Doppler the renal vein • Renal artery Doppler @ prox, mid, & dist *ANGLE CORRECT* • Gray scale, color, and pulse wave of the mid aorta *ANGLE CORRECT*

Why do you also evaluate the vein during a RAS exam?

To rule out thrombus (looks like slow flow in the vein)

* Formula for End Diastolic Ratio (EDR):

EDV / PSV = EDR

What is a normal EDR?

> 0.2

- Formula for acceleration time (AT):

What is a normal acceleration time (AT)?

<100 milliseconds

How is renal artery stenosis most often treated?

With angioplasty and/or stunting

Where are the calipers placed for acceleration time?

End diastolic pattern to early systolic peak

Renal Aortic Ratio (RAR) formula:

Highest Renal Artery PSV / Aorta PSV

Normal value for RAR:

<3.5

Formula for resistive index (RI):

(PSV - EDV) / PSV

Normal value for RI:

<0.8

When there is torsion in the ovaries, you will image it in….

B-mode (grayscale), color Doppler, and power Doppler.

Ovaries have what type of waveform?

Low resistance (10-35 cm/s)

Arterial spectral waveform for an ovarian Doppler has an alternating _____ uptake and systolic peak and has _____ diastolic flow.

Quick uptake Lower diastolic flow

Left ovarian vein drains into the…

Left renal vein

Right ovarian vein drains…

Directly into the IVC

Venous spectral waveform on an ovarian Doppler has what type of flow in diastole?

continuous, low resistance recurring flow

Venous spectral waveform on an ovarian doppler has what type of flow in systole?

Reduced flow signal

What is used to detect the presence of blood flow in a select area at a known depth with a given sample gate?

Pulsed wave Doppler

What is used along with PW doppler that allow for a more concise evaluation of a given vessel?

Sample gate

When the waveform is above the baseline, flow is traveling…

Toward the transducer

When the waveform is below the baseline, the flow is moving…

Away from the transducer

What information does color Doppler provide?

Directional information and relative velocity of flow

What is color Doppler dependent on?

Optimization of angles, the flow that is being interrogated, and the transducer

Higher/faster velocities appear ______ in color

Brighter

Slower velocities appear _______ in color

Darker

What type of Doppler is used when more sensitivity is needed for subtle flow and is not dependent on specific Doppler angles?

Power Doppler

What displays blood flow movement with no directional information

Power Doppler

Ovarian flow patterns vary depending on…

The degree of torsion and duration

While doing an ovarian Doppler examination, non-existent vascular flow is indicative of…

An oophorectomy

List the classic sonographic signs of ovarian torsion:

- Unilateral enlarged edematous with small peripheral follicles -Little to no vascular flow -Free fluid in the cul-de-sac

Clinical/Physical symptoms of ovarian torsion:

lower abdominal pain Fever Nausea/vomiting Peritoneal irritation

Important patient history to get prior to ovarian Doppler exam:

-LMP -G/P -Surgical history -Age

What is the purpose of ultrasound for a TIPS procedure?

To examine the abdomen and determine the presence and amount of ascites.

What is being assessed during a TIPs ultrasound examination?

-ascites -any hepatic hematoma, -biliary obstruction, -debris in the GB or CBD. -the shunt

What is the usual placement of the shunt for a TIPS procedure?

between the right portal and right hepatic veins.

(TIPS) What is the normal appearance of the stent via ultrasound?

The stent is echogenic and looks like two parallel curvilinear lines.

(TIPS) During a Doppler interrogation, what is being sampled?

Velocity, flow direction and waveforms patterns are sampled

(TIPS) Velocity, flow direction and waveform patterns are sampled at the:

MPV Portal vein end of shunt Mid shunt Hepatic vein end of shunt Left portal vein Hepatic artery

Flow in a normal TIPS progresses (blank) the transducer, then will appear to be (blank) for a short segment (d/t the flow being perpendicular to the beam).

Progresses towards the transducer then appears absent for a short segment

(TIPS) As the shunt curves away from the probe, the color is…

displayed in a different hue.

(TIPS) In the MPV, flow will be (blank) before the shunt

hepatopedal

(TIPS) Flow will be (blank) at the Hepatic vein

Hepatofugal

(TIPS) Once at the mid of the shunt, flow is…

Hepatofugal

After a TIPS placement, flow in the left portal vein is…

Hepatofugal

(TIPS) Velocities will vary widely throughout the shunt, usually increasing from the (blank) to the (blank)

portal venous end to the hepatic venous end

(TIPS) Velocities in the shunt range from…

50-190cm/sec.

(TIPS) What is the best means of documenting any changes within the shunt and will act as an early indicator of shunt compromise?

Serial evaluations

When / how often is a patient scanned for a TIPS procedure?

The patient is usually scanned pre procedure, post procedure, 3 months post procedure, and then every 6 months to a year. This should be done at the same clinic or records