Spleen & portal venous

Question 1

t/f if spleen enlarges so does its splenule

Answer 1

true

Question 2

with splenic rupture, what do you expect to see? (4)

Answer 2

fluid LUQ
decreased hematocrit
morisons pouch and pelvis
intraperitoneal hematoma

Question 3

what do you expect to see with a hematoma?

Answer 3

anechoic initially, then echogenicity resembles normal spleen after 24-28 hr

Question 4

what MIMICS splenomegaly?

Answer 4

hematoma

Question 5

what do you suspect if you see a wedge-shaped mass in the periphery?

Answer 5

splenic infarction

Question 6

splenomegaly considered

Answer 6

> 18cm

Question 7

indications for splenomegaly (8)

Answer 7

mononucleosis (infectious reason)
congestion (portal hypertension, portal/spelenic thrombosis)
inflammatory/rheumatologic (sarcoidosis)
neoplasia (hemangioma/met)
infiltrative (lymphoma, gaucher’s disease)
hematologic (leukemia, lymphoma)
Gaucher’s disease

NOT HEMATOMA (mimics)

Question 8

focal abnormality sizes

Answer 8

<1 cm - micronodular
1-3 cm - nodular
>3 cm - focal

Question 9

non-hodgkins sono app

Answer 9

hypoechoic, hypovascular

Question 10

what is the most common primary malignant nonlymphoid tumour of the spleen

Answer 10

hemangiosarcoma

Question 11

most common cancer that metastises to spleen

Answer 11

melanoma

Question 12

most common primary benign neoplasm

Answer 12

hemangioma

Question 13

hemangioma sono app

Answer 13

well defined, focal, solid, echogenic

Question 14

true splenic cysts (3)

Answer 14

congenital
hydatid
peliosis

Question 15

not true splenic cysts (3)

Answer 15

abscesses
hematoma
pseudocyst

Question 16

MPV should be less than

Answer 16

<13mm

Question 17

left PV size and location

Answer 17

longer/smaller

medial/lateral

Question 18

right PV size and location

Answer 18

shorter/wider

anterior/posterior

Question 19

normal flow is

Answer 19

hepatopedal flow

Question 20

if hepatofugal flow is seen, what is most likely?

Answer 20

portal hypertension (prob cirrhosis)

Question 21

complications of liver failure (2)

Answer 21

hepatic encephalpathy

impaired protein synthesis

Question 22

most important portosystemic anastomoses are (2)

Answer 22

gastroesophageal collaterals

esophagel varices

Question 23

main cause of collaterals

Answer 23

high portal pressure

Question 24

portal vein hypertension associated with (2)

Answer 24

ascites and varices

Question 25

recanalized umbilical vein occures in the presence of (2)

Answer 25

cirrhosis | portal hypertension

Question 26

what condition is associated with recanalized umbilical vein?

Answer 26

caput medusae

Question 27

what ligament is recanalized umbilical vein assoc with

Answer 27

round/lig teres

Question 28

splenomegaly is considered (and severe)

Answer 28

>13 cm, 18cm is severe

Question 29

what does portal vein thrombosis lead to

Answer 29

cavernous transformation

Question 30

complications of portal vein thrombosis (3)

Answer 30

GI bleed Ascites Encephalopathy

Question 31

what does transgular intrahepatic portosystemic shuunt (TIPS connect

Answer 31

portal vein with hepatic vein | relieves pressure on abnormal veins

Question 32

what does distal splenorenal shunt connect (DSRS)

Answer 32

splenic vein to lt. kidney vein

Question 33

elevation of erythrocytes associated with (2)

Answer 33

polycythemia vera | severe diarrhea

Question 34

decrease in erythrocyte associated with (4)

Answer 34

internal bleed hemolytic anemia hodgkin's disease hemangiosarcomas

Question 35

low hemoglobin assoc with (4)

Answer 35

cancer lymphoma cirrhosis internal bleed

Question 36

leukocytes elevation assoc with (4)

Answer 36

Hemmorrhage Infection Malignancy Leukemia

Question 37

leukocytes decrease assoc with (5)

Answer 37

``` viral infection Hypersplenia Diabetes mellitus Leukemia Lymphoma ```

Question 38

complications splenomegaly (2)

Answer 38

hypersplenism | spontaneous rupture

Question 39

gaucher's disease (5)

Answer 39

rare inherited disorder causes splenomegaly multiple splenic nodules, fibrosis/infarction

Question 40

SMV runs ____ to SMA and IMV

Answer 40

Rt lateral

Question 41

which vessel is blue on US

Answer 41

posterior right portal vein because away from transducer

Question 42

sonographic applications for portal system (3)

Answer 42

portal vein hypertension detect tumour invasion detect thrombosis

Question 43

what is the usual cause of portal hypertension

Answer 43

cirrhosis

Question 44

portal pressure above what causes complications (what complications? what is the main complication)

Answer 44

>12 mmHg, varices and ascites (esophageal varices)

Question 45

arterialization of hepatic blood supply

Answer 45

with PH, the hepatic arteries will enlarge and become tortuous - aliasing as portal venous flow to liver decreases, arterial flow increases

Question 46

t/f most causes of portal hypertension cannot be treated

Answer 46

true - treatment focuses on preventing/managing complications