Test 4

Question 0

The S.M.A is normally a high resistance artery. when does it change to low resistance?

Answer 0

After a person meal,muscles need to work so more blood is needed. Arteries dilate and the SMA becomes low resistance

Question 1

Which artery in the abdominal circulation is always low resistance?
Why?

Answer 1

Celiac trunk

Because 2 of its 3 branches go to soft organs liver and spleen

Question 2

What are the medical terms for “before eating a meal” and “after eating a meal”?

Answer 2

Pre-prandial (before)

Post-prandial (after)

Question 3

In the portal veins,how do we describe the Doppler waveform pattern? What causes this pattern?

Answer 3

Venous flow in general as Phasic but the Phase are caused by respiration, not heart rate.

Question 4

I the portal vein, flow is normally toward the liver ________ in the hepatic veins, flow is normally away from the liver or _________

Answer 4

Hepatic-petal

Hepatic-fugal

Question 5

Reversed flow in any of the portal veins could be evidence of what two conditions?

Answer 5

1. portal hypertension

2. cirrhosis

Question 6

What is the normal diameter of the main portal vein?

Answer 6

< 1.3cm or < 13mm

Question 7

Where is the most common area of the aorta for aneurysm?

Answer 7

Infrarenal segment of the abdominal aorta

Approx. 1.5-2.0cm distal to the branching of the renal Arteries

Question 8

What criteria do we use to diagnose an abdominal aortic aneurysm?

Answer 8

Any segment that is greater than 3.0cm in diameter or whose diameter is more than 50% greater than the proximal segment

Question 9

What is the most common treatment option for abdominal aortic aneurysm?

Answer 9

Angioplasty Sx with an internal graft

Question 10

In the abdominal aorta,a segment with a diameter of _______requires treatment and a segment with a diameter of ______or greater requires immediate emergency Sx

Answer 10

5. 0cm

6. 0cm

Question 11

Where is the most common area of the aorta for dissection?

Answer 11

Thoracic Aorta

Question 12

Is it possible for a patient to develop atherosclerosis in the abdominal aorta?if so how can we check for this?

Answer 12

Yes, we do 2-D (trans and Sag) imaging as well as PW Doppler analysis just as with any other

Question 13

What are the two main types of renal artery stenosis. Where typically do each of these occur in the renal arteries? Which is more common?

Answer 13

R.A stenosis due atherosclerosis (seen in prox RA) or to fibromuscular dysplasia

Atherosclerosis is more common

Question 14

Normal P.S.V of the R.A is around_______cm/s

A velocity than _______cm/s suggest significant R.A stenosis ____

Answer 14

190
180
>60%

Question 15

How can we get the R.A.R (renal aortic ratio)when looking for R.A stenosis?
How high should this number be to diagnose significant R.A stenosis? What percentage of area reduction does this suggest?

Answer 15

We measure the PSV of the RA at the area of stenosis (high velocity) and divide this by PSV of the Aorta and the origin of the RA

If the RAR is >3.5 we suspect significant RA stenosis

Question 16

Besides ischemia to the kidney, what is more global side effect of RA stenosis? Explain why it happens?

Answer 16

RA stenosis can cause systemic hypertension

Happens because the kidney release renin, substance which elevated blood pressure. Kidney contains a censor which regulates blood pressure and the ischemia causes the vendor to “think” the person. Has dangerously low blood pressure

Question 17

If the RA seems to be clear of any stenosis but still shows an abnormally high resistance waveform what could be causing this?

Answer 17

Renal disease or rejection of a kidney transplant

Question 18

What two calculations can be done to determine whether or not the resistance in a RA is abnormally high?

Answer 18

EDR=EDV
—–
PSV

RI=(PSV-EDV)
————
PSV

Question 19

What is considered a normal value for each?

Answer 19

EDC less than 0.2 is evidence of abnormally high resistance and so is an R.I more than 0.70

Question 20

When a patient receives a new (donor) kidney where is it placed? How is the blood flow “connected” to the new kidney?

Answer 20

Kidney is placed at the RT iliac region of the pelvis and connection are made to the RT iliac artery and vein

Question 21

What is normally done with the patient original kidney?

Answer 21

Normally left in place and will atrophy overtime

Question 22

What is another word for the mesenteric Arteries?

Which one is normally low resistance?

Answer 22

Splanchnic arteries

1. C.T (celiac trunk) and 3 branches
2. S.M.A
3. I.M.A

C.T is normally low resistance since two largest branded supply soft organs (liver and spleen)

Question 23

If a pt has mesenteric ischemia when will he complain of pain?
What is the pain called?

Answer 23

Complain after eating

Pain is post prandial abdominal angina

Question 24

Before pt feels abdominal pain, how severe should the stenosis be? How many arteries are normally involved? Why doesn't a milder case result in pain?

Answer 24

Stenosis of greater than 70% in at least 2 different mesenteric arteries before abdominal pain. Because collateral circulation normally develops allows intestines get enough blood.

Question 25

In the case of severe S.M.A stenosis or occlusion, what might we expect to see when we scan the I.M.A? Why?

Answer 25

We might see the I.M.A very enlarged because it is acting as a collateral pathway and taking on more volume than normal