Abdm Ultra: 100417: Ivc, Renal Veins, Hepatic Veins, Obstructions, Filters

Front 1

Arteries divide into ___1__, which divide into ___2___.

Back 1

1. arterioles
2. capillaries

Front 2

__1___ combine to form __2__, which combine to form veins.

Back 2

1. capillaries
2. venules

Front 3

What 2 factors cause blood to flow through the veins?

Back 3

1. Pressure differential
2. Muscle contractions (largely from muscles other than those in the vein walls)

Front 4

According to textbooks, a strict interpretation of medical terminology, and for the purposes of our tests, what part of the aorta is the proximal IVC adjacent to?

Back 4

The distal aorta (because technically, the "proximal" part of a structure is where it originates, and the IVC originates at the anastomosis of the right and left common iliac veins.)

Front 5

As used in common practice, what part of the aorta is the proximal IVC adjacent to?

Back 5

The proximal aorta (because, for consistency, the aortal directional terminology is applied to the IVC).

Front 6

What are the 2 sonographically significant tributaries of the IVC in the abdomen?

Back 6

1. Renal veins
2. Hepatic veins

Front 7

What are the names of the renal veins?

Back 7

1. Left renal vein
2. Right renal vein

Front 8

Which kidney is positioned more superiorly? Why?

Back 8

1. The left kidney is more superior than the right kidney.
2. Because the spleen (above the left kidney) is smaller than the liver (above the right kidney), so the left kidney is not displaced inferiorly as far.

Front 9

Which renal vein is longer? Why?

(This is a board question)

Back 9

The left renal vein is longer, because it must cross over the aorta to reach the IVC.

Front 10

How is the left renal vein positioned with respect to the aorta and the SMA?

Back 10

1. Anterior to the aorta
2. Posterior to the SMA

Front 11

How is the right renal artery positioned with respect to the IVC?

Back 11

Posteriorly

Front 12

Where do the hepatic veins
1. Originate?
2. Drain?

Back 12

1. The liver
2. The IVC

Front 13

What is a normal variant of where the hepatic veins drain?

Back 13

Into the right atrium

Front 14

What are the 3 hepatic veins called, and why?

Back 14

1. Right hepatic vein
2. Left hepatic vein
3. Middle hepatic vein

They are given these names to indicate the areas of the liver which each drains.

Front 15

What term means "a narrowing or stricture of a vessel or a canal"?

Back 15

vascular stenosis

Front 16

What are 2 possible causes of renal vein obstruction?

Back 16

1. Renal vein thrombosis (blood clotting)
2. Tumors (which press on the vein)

Front 17

Other than obstruction, what other type of problem can a vein have?

Back 17

Renal vein enlargement

Front 18

What can be done to address the problem of renal vein thrombosis?

Back 18

Installation of an IVC filter, a mesh netting which is meant to stop blood clots from getting to the heart

Front 19

What 5 conditions can lead to obstruction of the vena cava (not necessarily from the inside, but by pressing from the outside)?

Back 19

1. Right-sided heart failure
2. Enlarged liver
3. Para-aortic lymph node enlargement
4. Retroperitoneal masses
5. Pancreatic tumors

Front 20

In which 4 body quadrants would we most likely expect to find ascites, if it was present?

Back 20

1. Right upper
2. Left upper
3. Right lower
4. Left lower

Front 21

What characterizes those 4 particular quadrants, which would cause us to look there for ascites?

Back 21

Those quadrants contain the parcolic gutters.

Front 22

What are 4 clinical symptoms of vena caval obstruction?

Back 22

1. Abdominal pain
2. Ascites
3. Tender hepatomegaly
4. Lower extremity edema

Front 23

Can the sonographer compress the walls of the vena cava if there is a thrombus present?

Back 23

No

Front 24

What is the term for a filter inserted into the vena cava to restrict the flow of thrombus?

Back 24

Caval filter

Front 25

Are primary tumors of the IVC common or rare?

Back 25

Rare

Front 26

What demographic group is most likely to develop primary tumors of the vena cava?

Back 26

Women around 60 years old

Front 27

Where would a metastatic tumor of the vena cava most likely have originated?

Back 27

In the kidneys, since they drain to the IVC through the renal veins.

Front 28

What are the 2 elements of the sonographic appearance of a tumor of the IVC?

Back 28

1. Usually appear as echogenic foci
2. Can appear complex (heterogeneous with areas of necrosis)

Front 29

What are 3 things the sonographer should determine about any tumor which might be present in the vena cava?

Back 29

1. Its presence
2. Its extent
3. Whether it has invaded the wall of the IVC

Front 30

What diameter renal vein is considered "enlarged"?

Back 30

> 1.5 cm

Front 31

What are 2 other symptoms of renal vein enlargement (beyond diameter measurement)?

Back 31

1. Dilation of the renal vein at the insertion point into the IVC

2. Asymmetry in the caliber of the two renal veins

Front 32

Is the sonographic appearance of a clot in the renal veins echogenic or anechoic?

Back 32

It usually will be echogenic, but can be anechoic if new.

Front 33

What sonographic technique must be used to verify the existence of renal vein thrombosis?

Back 33

Doppler

Front 34

What medical technique is used to prevent a filter in the IVC from itself becoming a source of blockage?

Back 34

Anticoagulant therapy

Front 35

If a filter is being installed to stop a clot from the lower extremities, where in the vena cava will it usually be placed?

Back 35

Inferior to the renal veins