WEEK 2- PORTAL HYPERTENSION

Question 1

walls of the portal veins are __ and ___ compared to the hepatics

Answer 1

thick & hyperechoic

Question 2

wall diameter of the portal veins is ___ compared to the hapatics

Answer 2

wider

Question 3

blood flow in the portal veins is

Answer 3

hepatopedal

Question 4

hepatopedal

Answer 4

blood flow TOWARDS the liver

Question 5

hepatofugal

Answer 5

blood flow AWAY from the liver

Question 6

location of the portal veins is __-segmental and in the ___ portion of the liver

Answer 6

INTRAsegmental

inferior

Question 7

flow in the portal veins is ALWAYS

Answer 7

antegrade (towards the transducer)

Question 8

flow velocity in the portal veins

Answer 8

relatively low (16-40)

Question 9

MPV spectral doppler

• ___ the base line
• ___ resistance
• ____-phasic
• ____ velocity

Answer 9

• below
• low
• mono
• continuous, low

Question 10

MPV feeds approx ___% of the oxygenated blood to the liver from the ___

Answer 10

70%

intestines

Question 11

an increase in portal venous pressure greater than 10mmHg or hepatic venous gradient greater than 5mmHg

Answer 11

portal hypertension

Question 12

portal hypertension results in ___ veins (large and swollen)

Answer 12

varicose

Question 13

varicose veins commonly form in these 4 areas

Answer 13

1. esophagus
2. stomach
3. rectum
4. umbilical area

Question 14

varices are very fragile and can ___ easily when the pressure becomes high

Answer 14

rupture

Question 15

increased resistance in portal hypertension causes ___ vessels to develop

Answer 15

collateral

Question 16

___ channels open for blood to flow away from the liver and through the collateral vessels

Answer 16

embryologic

Question 17

etiology of portal hypertension

Answer 17

result from pathologic condition that increases vascular resistance to portal blood flow

Question 18

primary cause of portal hypertension

Answer 18

cirrhosis

Question 19

portal hypertension can develop from an increase in ___ blood flow or an increased ___ to blood flow

Answer 19

portal

resistance

Question 20

PREhepatic causes of portal hypertension (obstruction to blood flow at level of the portal vein)

Answer 20

-thrombosis in portal or splenic vein

Question 21

INTRAhepatic causes of portal hypertension

Answer 21

• TB
• Cirrhosis, METS
• Obstruction

Question 22

POSThepatic causes of portal hypertension (obstruction of blood flow at level of the hepatic vein)

Answer 22

• Hepatic vein thrombosis (Budd-Chiari syndrome)
• IVC obstruction
• Cardiac diseases

Question 23

complications of portal hypertension

Answer 23

• Encephalopathy (confusion)
• Ascites (fluid in abdo)
• Splenomegaly
• Varices
• GI bleed

Question 24

diagnosis of portal hypertension is based on symptoms such as

Answer 24

-ascites & varices

Question 25

lab test results suggest increase liver enzymes, decreased platelets, decreased WBC suggest

Answer 25

portal hypertension

Question 26

portal vein diameter >__mm is associated with portal hypertension

Answer 26

13

Question 27

as shunts develop, portal vein diameter ____

Answer 27

decreases

Question 28

what is the best method to detect varices

Answer 28

endoscopy

Question 29

``` portal hypertension presents if: portal venous pressure >__mmHg Heptaic venous gradient >__mmHg Splenic vein pressure >___mmHg Portal vein pressure >__cm ```

Answer 29

- 10 - 5 - 15 - 30

Question 30

name 3 differential diagnosis for portal hypertension

Answer 30

- Budd Chiara syndrome - Occlusion of vessels - Cirrhosis - Sarcoidosis - Wilson Disease

Question 31

decompression procedure for portal hypertension

Answer 31

TIPS | transjugular intrahepatic portosystemic shunt

Question 32

metallic shunt is places in the liver

Answer 32

TIPS

Question 33

TIPS connect the ___ vein and ___ vein

Answer 33

portal & hepatic

Question 34

purpose of TIPS

Answer 34

decrease pressure in portal vein `

Question 35

ultrasound findings of portal hypertension

Answer 35

- PV dilation - reverse doppler flow in MPV (hepatofugal) - recanalized paraumbillical vein - Varices - Splenomegaly

Question 36

main points to remmeber about Portal hypertension: | PORTAL

Answer 36

- Pressure >10mmHg - Esophageal varices - Reverse (hepatofugal) flow - Tuberculosis (is a non cirrhosis cause) - AST & ALT are high - Low sodium diet is important treatment