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URR Portal System Flashcards

1
Q

SMV and splenic vein are how to the panc?

A

posterior to the panc neck

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2
Q

what joins the splenic vein prior to splenic confluence with SMV?

A

IMV

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3
Q

the portal system enters the liver carrying blood from where?

A

digestive system

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4
Q

the portal vein is different how to the hepatic?

A

thicker and more echogenic, decrease in size

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5
Q

the main portal vein is how to the IVC?

A

anterior, arises from SV and SMV

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6
Q

the main portal vein drains what?

A

GI tract, and sends blood to liver for filtration

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7
Q

normal diameter of the portal vein?

A

13mm

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8
Q

flow toward the liver?

A

hepatopetal

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9
Q

normal velocity of MPV?

A

15-20 cm/sec

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10
Q

liver disease can cause what in the MPV?

A

increase in resistance to flow and or reversal

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11
Q

the splenic vein courses how to the panc?

A

posterior

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12
Q

the splenic vein drains what?

A

stomach, spleen, and panc

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13
Q

how is flow in the splenic vein?

A

flow toward the liver and away from the spleen

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14
Q

the SMV joins what posterior to the panc neck?

A

splenic vein

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15
Q

the SMV drains what?

A

small intestine and colon

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16
Q

how is flow in the SMV?

A

toward the liver and away from the mesentary

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17
Q

the IMV arises from what?

A

colon

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18
Q

the IMV ascends how to the IMA?

A

left

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19
Q

the IMV joins the splenic vein posterior to what?

A

panc body

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20
Q

the IMV drains what?

A

distal colon

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21
Q

cirrhosis causes what to the liver and spleen?

A

reduction in liver size, and increase in spleen size

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22
Q

budd chiari cases what to liver and spleen?

A

causes hepatomegaly during acute phase and reduction in liver size with an increase in spleen size with chronic obstruction

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23
Q

normal portal pressure is what?

A

5-10 mmHg

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24
Q

elevated pressure in the portal system due to flow obstruction can lead to what?

A

flow reversal in the portal system

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25
portal hypertension is most commonly cause by what?
cirrhosis
26
common sign of portal hypertension?
esophageal varices
27
associated with portal HTN, connected to left portal vein, extending towards umbilicus and flow is hepatofugal
recanalized umbilical vein
28
branch of portal vein near liver hilum, hepatofugal flow, normal drains into splenic vein near the portal confluence
coronary vein
29
tortuous vessels around the umbilicus?
caput medusa
30
extrahepatic presinusoidal HTN
PV thrombosis
31
intrahepatic presinusoidal HTN
schistosomiasis
32
intrahepatic postsinusoidal HTN
most common type, cirrhosis
33
intrahepatic postsinusoidal HTN
hepatic vein obstruction, budd chiari syndrome
34
measurements for splenomegaly?
>13cm
35
dilated splenic vein
>10 mm
36
slowed or reversed flow in portal system
hepatofugal
37
SMV and splenic vein size with inspiration?
increase
38
formation of varices and collaterals?
cavernous transformation
39
hepatic artery and portal vein carry blood into liver and the doppler should be how on baseline?
above baseline
40
causes of PV thrombosis?
portal HTN, inflammatory process, trauma, complications, extrinsic compression -can lead to pain, fever, rigid abd, nausea, vomiting, increased LFTs, cavernous transformation, increase in diameter of SMV and splenic vein
41
acute PV thrombosis?
echogenic debris > 13 mm
42
chronic PV thrombosis?
more echogenic <13 mm
43
treatment for PV thrombosis?
portal caval shunts
44
metallic device used to decrease pressure and increase flow of portal veins?
portal caval shunt
45
portal caval shunt placement?
inserted into IJV and advanced into the liver to the portal system -placed in between the portal system -usually MPV and hepatic vein
46
how does blood flow in the portal caval shunt?
bypasses liver and goes from digestive system to IVC
47
PV connected to hepatic vein and IVC>
TIPS = transjugular intrahepatic portosystemic shunt -flow should be hepatopetal prox and hepatofugal distal shunt
48
what is the most common cause of acute stenosis/occlusion in TIPS?
thrombus
49
most common site of chronic occlusion in tips?
hepatic vein anastomosis
50
most common cause of chronic occlusion in portal shunt?
neointimal hperplasia
51
how does a shunt look?
very echogenic with linear echoes
52
normal flow in shunt is from portal system into the shunt then into where?
hepatic system
53
right and left portal veins will demonstrate what flow with shunt?
hepatofugal flow (flow toward shunt)
54
peak velocity with portal shunt should not fall below and exceed what velocity?
below: 50cm/s exceed: 200 cm/sec
55
hepatofugal flow in the MPV is?
abnormal
56
hepatopetal flow in the right and left portal vein is what?
abnormal
57
hepatopetal flow in the associated hepatic vein is?
abnormal
58
-autosomal dominant disorder -affects vasculature of multiple organs -characterized by multiple AVMs -recurrent episodes of bleeding -dilated HA -dilated HV
hereditary hemorrhagic telangiectasia (Osler Weber Rendu Disease)
59
-soft blue skin lesions -multiple bowel venous malformations that can cause lower GI bleeding
Bean Syndrome (Blue Rubber Bleb Nevus Syndrome)
60
how is the HA and PV during a liver transplant?
both connected to native vessels just prox to liver hilum
61
what is a piggyback anastamosis in a liver trasplant?
hepatic confluence of transplant liver attached to native IVC
62
What is interposition anastamosis in the liver transplant?
donor IVC segment of the native IVC
63
most common complication of liver transplant?
biliary stricture or leakage
64
HA PSV during liver transplant?
<200 cm/sec RI .5-.8

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