DMS 241 Final Review- Weekly Lectures

early stages of portal hypertension include:

Increased velocity

Dilated measurement

High pressure

mid stages of portal hypertension include:

Decreased velocity

late stages of portal hypertension include:

Decreased pressure, diameter, and velocity

Flow reversal

Collaterals

which three vessels are most likely to become dilated due to portal HTN?

splenic vein

SMV

IMV

Which collateral is associated with coughing up blood as a symptom?

gastroesophageal vein

which collateral is associated with the ligamentum teres of the left lobe of the liver recannulaizing?

umbilical vein

what is the main indicator of UV recanulization?

medusa belly

what is portal HTN?

elevated blood pressure in MPV due to increased resistance

list some risk factors/predisposing conditions for portal HTN:

portal or splenic thrombosis

cirrhosis

trauma

hx of thrombus

hepatic/IVC thrombosis

___________________ syndrome may be a risk factor for portal HTN

Budd-Chiari syndrome

what is Budd-Chiari syndrome?

HV or IVC obstructed by thrombus or congenital flap

how may Budd-Chiari syndrome cause portal HTN

it can back all the way up into the MPV

suprahepatic causes of portal HTN include:

heart pathology

HV thrombus

Intrahepatic causes of portal HTN include:

cirrhosis

tumor/malignancy

Infrahepatic causes of portal HTN include:

PV thrombus

SV thrombus

PV compression

A-V malformation of splenic vessels

list some S/S of portal HTN:

GI bleed

ascites

hepatomegaly

splenomegaly

varices

jaundice

list some examples of varices:

ligamentum teres

esophagus

spleen

subcapsular liver

hemorrhoids

normal hepatic venous flow:

hepatofugal

pulsatile

biphasic

normal portal venous flow:

hepatopetal

spontaneous

phasic

normal splenic venous and SMA flow:

continuous flow

the W appearance of the HV waveform is due to...

backflow of the RA contracting

what are varices?

small vessels becoming prominent

enlarged hepatic veins may be caused by __________________________ disease

congestive heart disease

if you can see the MPV but there us no flow within it then it most likely due to __________________

thrombus throughout entire vessel

if you can see the MPV but there us no flow within it then what other methods can be used to exhibit the absence of flow?

power doppler

spectral doppler

the _____________ will never have flow reversal

HA

the splenic vein is normally ___________ on color doppler

red

splenomegaly measurement is over _______cm

13-14

________________________ is most commonly found in the hilum of organs

adenopathy

list some treatment options for portal HTN:

mostly untreatable

lifestyle changes

lowering BP

TIPS shunt

DSRS shunt

what is the TIPS shunt?

connects the hepatic vein to portal vein to lower portal pressure

enlarged MPV measures over ______mm

13

new thrombus will appear as _______echoic while older thrombus will be _______echoic

hypo

hyper

what is normal flow velocity with the TIPS shunt

90-190cm/s

list some indications for TIPS examination:

splenomegaly

ascites

elevated LFTs

GI bleed

normal portal venous flow with a TIPS shunt includes _______________________ flow in the MPV and ___________________ flow in both LPV and RPV

hepatopetal

hepatofugal

proximal TIPS is closer to the _________________

PV

distal TIPS is closer to the _______________

HV/IVC

mesenteric doppler includes assessment of the...

CA, SMA, IMA

the CA branches into the...

left gastric artery

common hepatic artery

splenic artery

the SMA supplies the

small intestine

the IMA supplies the

large intestine

what is MALS?

median arcuate ligament presses too tightly on the celiac artery causing obstruction

stenosis criteria for SMA

PSV over 275cm/s

stenosis criteria for CA

PSV over 200cm/s

post-prandial PSV and EDV will increase in the _________________

SMA

loss of flow reversal post-prandial will occur in the ____________

SMA

clinical presentation of MALS

post-prandial abdominal pain

delayed gastric emptying

weight loss

epigastric bruit

hx of POTS

with MALS there will be an __________________ in PSV during expiration

increase

Replaced RHA

most common variant of the SMA; when RHA originates from SMA rather than CHA

Chronic mesenteric ischemia

compromise of at least two of the three mesenteric arteries

presentation of chronic mesenteric ischemia

abdominal pain after eating

weight loss

diarrhea

acute arterial occlusive disease

acute thrombosis of a mesenteric artery emergency intervention needed

mesenteric venoocclusive disease

absence of flow on SMV and splenic/portal vein associated with mesenteric edema

list some indication for a liver transplant exam:

hx of liver transplant

post-op eval

HA stenosis

elevated LFTs

jaundice

PHTN

fluid collection

liver transplant donor HA anastomosed to...

recipient HA

liver carrel patch

Another method of arterial anastomoses in liver transplant is when the donor CA and a small part of the AO are attached to the recipient HA

HA is usually anastomosed __________ to ___________

end to end

liver transplant donor IVC are anastomosed to...

recipient IVC

The IVC can be anastomosed _________ to ____________ OR ___________ to ______________

end to end

end to side (piggyback)

liver transplant donor PV is anastomosed to...

recipient PV

PV is usually anastomosed __________ to ___________

end to end

if there is chronic PV thrombosis/occlusion a _____________________ is used

jump graft

the jump graft bypasses any obstruction in the MPV

true

normal range of HA RI is

0.55 to 0.7 RI

list some causes of elevated HA RI:

cirrhosis

hepatic venous congestion

transplant rejection

list some causes of decreased HA RI:

transplant stenosis

atherosclerosis

arcuate ligament syndrome

PHTN

post trauma

iatrogenic

elevated HA RI may also be caused by __________________ or ___________________

postprandial state or advanced pt age

normal hepatic venous waveforms are _______________________ or _______________________

triphasic or tetraphasic

A wave

represent atrial contraction seen above the baseline

S wave

represents ventricular systole seen below the baseline at the first point of the W

the ___ wave is usually the highest peak velocity in hepatic venous waveforms

S

V wave

represents atrial filling and is a transitional phase between S and D may be above or below baseline

D wave

represents ventricular diastole seen below the baseline as the second point on the W

list some causes for pulsatile hepatic venous waveform:

tricuspid regurg

right sided CHF

list some causes of decreased hepatic venous phasicity:

cirrhosis

HV thrombosis (Budd-chiari syndrome)

hepatic veno-occlusive disease

hepatic venous outflow obstruction

normal PI of MPV is...

more than 0.5

list some causes for pulsatile PV flow:

tricuspid regurg

right sided CHF

cirrhosis

list some findings of PHTN:

low PV velocity (less than 16cm/s)

hepatofugal PV

portosystemic shunts

dilated portal vein

post-op eval of liver transplant should include:

liver parenchyma

perihepatic space

biliary system

vasculature

if liver parenchyma is coarse or heterogenous there may be concern for:

recurrent cirrhosis

infection

ischemia

necrosis

steatosis

neoplasm

if there are any focal lesions seen in the liver there may be concern for:

neoplasm

infarct

abscess

ductal abnormality

if there is increased RI within the liver there may be concern for:

extrinsic compression

advanced parenchymal disease

venous outflow obstruction

reperfusion injury

if there is decreased RI within the liver there may be concern for:

HA stenosis

atherosclerosis

median arcuate ligament compression

the HA is crucial for blood supply to the __________________________

bile ducts

caval anstomotic stenosis or kinking may cause ____________________ and ____________________

outflow obstruction and transplant dysfunction

you will look for tardus parvus within the ______________________ arteries

intraparenchymal

Pseudoaneurysm shows the _______________________ sign

yin yang

fluid collection from a liver transplant may be caused by:

seroma

hematoma

biloma

abscess

lymphocele

another complication of liver transplants is __________________

hepatic fibrosis

renal transplant exam includes eval of:

renal size and echogenicity

collecting system

ureter condition

fluid collection

color/spectral of renal and illiac vessels

cadaveric renal transplant

MRA harvested with portion of AO and attached to recipient EIA

live donor renal transplant

direct end-to-side renal arterial graft to EIA or end-to-end with IIA

urinary drainage of renal transplant:

donor ureter into recipient bladder

pediatric recipients of adult kidneys may be anastomosed to ______________

distal AO or IVC

in en bloc transplant donor IVC and AO are attached to recipient:

EIV and EIA

normal RI of intrarenal arteries

0.6-0.7

echogenic kidney may cause concern for

CKD

take RI of ___________________ arteries

interparenchymal

take PSV of _____________________ artery

main renal