Abdominal Doppler

Front 1

Abdominal vasculature exams

Back 1

renal artery-vein/ mesenteric arteries/ portal venous system/ hepatic vasculature/ abdominal aorta for aneurysms-stenosis

Front 2

What can fixed hypertension be caused by?

Back 2

chronic renal disease/ renal artery disease/ true renovascular hypertension

Front 3

Renovascular hypertension etiology

Back 3

atherosclerosis (most common)/ fibromuscular dysplasia (FMD)/ dissection and/or extension of aortic dissection

Front 4

Indications for renal doppler exam

Back 4

uncontrolled hypertension, especially in younger pts/ decreasing renal function/ abdominal bruit

Front 5

Main renal arteries arise from ____ just distal to the ____.

Back 5

aorta/ sma

Front 6

Right renal artery courses ____ to the IVC.

Back 6

posterior

Front 7

Right renal artery is ____ than the left renal artery.

Back 7

longer

Front 8

Left renal vein lies ____ to the SMA and ____ to the aorta.

Back 8

posterior/ anterior

Front 9

Right renal vein is ____ than left.

Back 9

shorter

Front 10

Normal renal veins should demonstrate ____ flow and maybe pulsatile flow transmitted from ____.

Back 10

phasic/ right atrium

Front 11

______ renal arteries course through the hilum and are branches of the _____.

Back 11

Segmental/ main renal artery

Front 12

_____ arteries arise from segmentals and lie between the ______ and penetrate the _____.

Back 12

Interlobar/ renal medullary pyraminds/ renal parenchyma

Front 13

_____ arteries branch from the interlobars and turn at the cortico-medullary junction to course ____ to the cortex surface.

Back 13

arcuate/ parallel

Front 14

____ arteries extend into cortex.

Back 14

Interlobar (cortical branches)

Front 15

_____ renal arteries are common and may arise from ____, above or below the main renal arteries. On the right side, they may pass ____ to IVC. They may also arise from the ____ or _____.

Back 15

Accessory (polar arteries)/ aorta/ anterior/ SMA, iliac arteries

Front 16

Purpose of renal doppler exam

Back 16

identify vascular etiology of hypertension/ prevent renal failure due to permanent parenchymal changes/ evaluate renal transplants for artery twists, kinks, stenosis, rejection, and renal vein thrombosis

Front 17

Evaluates the entire renal artery, bilaterally, from the aorta to the renal parenchyma. Spectral waveforms obtained from the prox, mid, distal renal arteries and from segmental renal arteries. Limited by obesity, bowel gas, previous abdominal surgery, and prolonged exam time.

Back 17

Direct color duplex renal artery exam

Front 18

Examine only the segmental and/or interlobar arteries. Wavefrom characteristics within kidney are analyzed for abnormality associated with main renal artery stenosis or occlusion. Short exam time and high technical success rate, but limited to detecting severe stenoses.

Back 18

Indirect color duplex renal artery exam

Front 19

How to identify renal artery stenosis

Back 19

Look for regions of velocity increase and post stenotic turbulence, carefully map these regions with spectral doppler/ record the peak systolic velocity from the waveform demonstrating max velocity/ calcualte the renal-aortic peak systolic velocity ration (RAR) from the highest velocity obtained in the renal artery with the velocity from the aorta

Front 20

Normal Renal Artery characteristics

Back 20

High flow velocity (PSV 100 +/- 20 cm/s)/ low resistance (RI < .75)/ high diastolic flow (EDV 30 +/- 5 cm/s)

Front 21

Criteria for >60% Renal Artery Stenosis

Back 21

Renal-aortic ratio > 3.5
Peak systolic velocity (PSV) > 180 cm/s
Post-stenotic turbulence
Low flow in distal renal artery

Front 22

Renal Artery occlusion

Back 22

No flow detectable in a well visualized renal artery/ low amplitude color and spectral doppler signal from the parenchyma/ small kidney size (<9 cm)

Front 23

Renal parenchymal disease

Back 23

blood flow in the renal artery of a normal kidney is of low resistance/ in the presence of renal parenchymal disease velocity is reduced and resistance is high in the main renal artery and in the segmental and interlobar arteries

Front 24

Renal doppler physical limitations

Back 24

excessive depth of renal arteries/ motion of respiration/ intra-abdominal gas/ obesity/ previous abdominal surgery

Front 25

Technical limitations of Direct renal doppler

Back 25

high technical failure rate/ accessory renal arteries occur in some pts and are difficult, if not impossible/ to find/ poor doppler angles/ long exam time/ requires high skill

Front 26

Normal Indirect waveforms parameters

Back 26

presence of an ESP (early systolic)/ Acceleration Time less than .07 sec/ presence of diastolic flow

Front 27

Indirect criteria for > 60% stenosis

Back 27

increased acceleration time/ tardus-parvus waveform/ loss of early systolic peak/ flattened systolic upslope/ acceleration <3 m/s/ abnormality lower ipsilateral RI/ reduced color flow in kidney unilaterally

Front 28

Purpose of mesenteric doppler

Back 28

diagnose mesenteric ischemia

Front 29

very uncommon due to extensive collateral pathways/ usually caused by ather occlusive disease at vessel origins/ celiac, sma, and ima must all be involved for bowel ischemia to occur/ chronic or acute, usually caused by embolization

Back 29

mesenteric ischemia

Front 30

Mesenteric Ischemia symptoms

Back 30

abdominal cramps and pain after eating/ diarrhea, change in bowel habits/ weight loss/ fear of food syndrome

Front 31

Common hepatic artery branches

Back 31

hepatic artery, gastroduodenal artery, pancreaticoduodenal artery

Front 32

celiac axis branches

Back 32

lt. gastric artery, splenic artery, common hepatic artery

Front 33

supplies blood to the distal duodenum, small intestine, and colon

Back 33

sma

Front 34

arises from the aorta distal to renal arteries, supplies blood to the transverse descending, and sigmoid colong

Back 34

ima

Front 35

Celiac, hepatic, splenic arteries flow patterns

Back 35

low resistance

Front 36

sma & ima flow patterns

Back 36

high resistance when fasting, low resistance post prandium

Front 37

Criteria for >70% stenosis in mesenteric exam

Back 37

Celiac artery: PSV > 200 cm/s with post stenotic turbulence
SMA: PSV > 275 cm/s with post stenotic turbulence

Front 38

drains nutrient rich blood from the bowel and spleen into liver/ has capillary bed on each end of system, one it gut and other in parenchyma of liver

Back 38

portal venous system

Front 39

portal vein is formed by:

Back 39

smv and splenic vein

Front 40

portal vein course ____ in liver

Back 40

intra-segmentally

Front 41

Portal vein normal flow

Back 41

low velocity (20-40 cm/s), continuous flow/ no filling defects with color doppler/ hepatopetal direction/ no varices/ normal flow direction in potential collaterals

Front 42

elevated pressure in the portal venous system due to increased impedence of flow through the liver

Back 42

portal hypertension

Front 43

Causes of portal hypertension

Back 43

prehepatic obstruction: thrombosis of portal or splenic vein
intrahepatic: cirrhosis (most common cause), hepatic fibrosis, lymphoma
post hepatic: ivc obstruction, hepatic vein obstruction

Front 44

Most common cause of portal hypertension

Back 44

cirrhosis

Front 45

Portal hypertension can lead to:

Back 45

ascites/ splenomegaly/ GI-esophageal bleeding/ jaundince/ signs of hepatic failure

Front 46

Porto-systemic shunts

Back 46

lt. gastric vein (coronary vein), gastric varices, recanalized paraumblical vein with hepatofugal flow, spleno-renal shunt

Front 47

Gastic varices often occur:

Back 47

near stomach (epigastrum), under lt lobe of liver, near the spleen

Front 48

Spleno-renal vein

Back 48

splenic vein to left renal vein

Front 49

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

Back 49

stent placement in the liver parenchuma between the portal vein and hepatic vein/ purpose is decompression of the portal venous system/ does not address cause of portal hypertension

Front 50

drains right hepatic lobe

Back 50

right hepatic vein

Front 51

lies between left and right hepatic lobes

Back 51

middle hepatic vein

Front 52

courses between medial and lateral segments of left lobe

Back 52

left hepatic vein

Front 53

hepatic veins enlarge as they approach....

Back 53

the diaphragm

Front 54

How are hepatic veins best imaged?

Back 54

Trv, subcostally

Front 55

stenosis or obstruction of hepatic veins, may be caused by hepatomegaly, splenomegaly, ascites

Back 55

Budd-Chiari syndrome

Front 56

Normal hepatic veins flow

Back 56

respiratory variation, pulsatility