ARDMS - ABD - HHS

arterial blood vessel layers

tunica intima - inner

tunica media - middle (thickest)

tunica adventitia/externa - outer

bifurcation of common iliac artery

L3-L4 vertebra, umbilicus level

rt coronal

aorta as posterior vessel

lt coronal

ivc as posterior vessel

measurements of aorta

proximal 2.0-2.6cm

mid 1.6-2.4cm

distal 1.1-2.0cm

iliac 0.6-1.4cm

aorta doppler above renal

biphasic with low resistance

aorta doppler below renal

triphasic because lower ext high resistance

aortic ectasia

lack of tapering of distal aorta,

abdominal aortic aneurysm

most commonly caused by atherosclerotic disease (plaque)

saccular AAA

localized outpouching, small stalk

fusiform AAA

most common type, vessel wall stretches circumferential

berry AAA

tiny outpouching, usually found in cerebellum & splanchnic

mycotic AAA

infected aneurysm, seen with syphilis

below renal a

most common location of fusiform aneurysm

surgical intervention of AAA

>5.5 cm

blue toe syndrome

thrombus accumulation and embolization; cyanosis of distal tissue, ARTERIAL ONLY

aneurysms - splenic a

most common place of splanchnic a

aneurysms - hepatic a

2nd most common

endovascular aortic repair

stent/graft placement through groin for intrarenal AO aneurysm

endovascular aortic repair - type I

leak at graft attachment site

endovascular aortic repair - type II

retrograde flow into native sac from lumbar a or IMA

endovascular aortic repair - type III

defect in graft

endovascular aortic repair - type IV

graft is porous, allowing blood through fabric mesh

aortic rupture

> 7 cm diameter is increased risk

pseudoaneurysm

blood escapes artery into surrounded tissue and encapsulated within tissue, round sac of blood, connection through neck/stalk

pseudoaneurysm compressions

10 times at 1 minute intervals to reevaluate doppler, thrombin injection to clot the blood

pseudoaneurysm - sono

turbulent flow, yin-yang sign

dissection

most commonly occurs in AORTIC ARCH to shearing forces of blood as it rounds the curve of the aorta, thrombus in false lumen with flap in lumen

dissection Debakey classification - type II

involves asc aorta, associated with marfans, least common

marfans syndrome

genetic disorder affecting CT of heart, vessel, bones, AORTIC ROOT/ARCH MOST COMMONLY ATTACHED TO BLOOD VESSEL (TYPE II), mitral valve prolapse and valve insufficiency

aortic stenosis

most commonly caused by atherosclerotic change

retroperitoneal fibrosis (ormonds disease)

most commonly occurs at the level of bif and inferiorly in pelvis, overgrowth of tissue around aorta

retroperitoneal fibrosis (ormonds disease) - compress IVC

bilateral pedal edema

retroperitoneal fibrosis (ormonds disease) - compression gonadal

scrotal swelling

mesenteric ischemia

decreased or blocked flow to small/large intestine, occlusion of 2/3 mesenteric a

mesenteric ischemia - post-prandial

SMA high resistance

acute - clot

chronic - plaque

CA PSV >200 cm/sec

SMA PSV >280 cm/sec

IMA PSV >difficult to visualize

only anterior tributary for IVC

anterior tributary

dilated IVC

most common variation of IVC anatomy

IVC dilation

most common cause is Rt heart failure

IVC tumor invasion

renal cell carcinoma most common malignancy to invade IVC

venous aneurysms

portal vein aneurysm msot common type of visceral

may-thurner syn (iliac compression syn)

left leg DVT, RT CIA compress LT CIV

hepatoportal venous sys

confluence of SMV and splenic v, drains GI tract, continuous flow

portal HTN

most commonly caused by cirrhosis; increased pressure 12mmHg

extrahepatic portal venous thrombus

portal thrombosis - presinusoidal HTN

intrahepatic portal venous thrombus

schistosomiasis - presinusoidal HTN

intrahepatic HTN

most common type - cirrhosis

post-hepatic (post sinusoidal)

budd-chiari

portal triad within hilum

MPV,PHA,CHD

portal triad extrahepatic

MPV,PHA,CBD

medial lt lobe can also be called

quadrate lobe

caudate lobe

btwn IVC and medial lt lobe, enlarged with cirrhosis and budd chiari bc IVC compression

ligamentum teres "round ligament"

remnant of umbilical v recanalized with portal HTN

ligamentum venosum

remnant of ductus venosus from fetal circulation, thin echogenic line anterior to caudate lobe

intersegmental fissures

hepatic veins

intrasegmental fissures

portal vein, CBD, hepatic a

couinaud includes how many

8 segments

common hepatic artery (CHA)

supplies 20-25% of blood into liver, 95% of O2 saturation, branches include PHA after GDA,

portal venous system

portal confluence - SMV and SV, about 75-80% of blood, <13mm

hepatic venous system

largest IVC tributaries, INTERSEGMENTAL,

most common variation of hepatic vein anatomy

accessory RHV

functional unit of hepatocytes

lobules

liver function tests (LFT)

increased ALT and AST changes in ALT = liver specific

aspartate aminotransferase (AST)

increased with acute hepatitis, cirrhosis, mets, reye, mild increased with fatty change

alanine aminotransferase (ALT)

necessary for energy production, released through blood with liver cell damage, used to eval jaundice, monitory hepatitis and cirrhosis

alkaline phosphatase (ALP)

increased with biliary obstruction

gamma glutamyl transpeptidase (GGTP)

found in liver cells and biliary epithelium, SENSITIVE INDICATOR FOR ALCHOLISM,

increased GGTP + ALP = biliary

increased GGTP + ALP = HCC

lactic dehydrogenase (LDH)

non specific, increased with liver damage (cancer)

prothrombin time (PT)

used to detect clotting time, increased PT = increased hemorrhage risk, decreased vitamin K (if increased then HCC v. cholestasis)

alpha-feto protein (AFP)

elevated with cancer, most significant increase with HCC

human chorionic gonadotropin (HCG)

increased with testicular cancer

direct bilirubin

conjugated by liver for digestive use, increased with biliary tract obstruction, hepatitis, cirrhosis

indirect bilirubin

not conjugated by liver for use, increased with liver cell damage/disease, anemia

albumin

assoc. with ascites, protein produced in liver to control h2o distribution, increased with dehydration, decreased with CHF, chronic liver disease, inflammation , decreased albumin/globulin ratio with cirrhosis

obstructive jaundice

caused by biliary obstruction

pre-hepatic jaundice

HCC, hepatocyte destruction

hepatic jaundice

hemolytic disease, abn liver cell function, unable to conjugate bilirubin

post-hepatic jaundice

mechanical obstruction of biliary tree

echogenicity of organs (hyper to hypo)

renal sinus, pancreas, liver, spleen, renal parenchyma

caroli disease "communicating cavernous ectasia of biliary tree"

numerous cyst in biliary tree, causes biliary stasis/impairs function, assoc. w medullary sponge kidney & hepatic fibrosis

central dot sign

echogenic dots with color flow within cystic lesion

polycystic liver disease

autosomal dominant, 30-40, multiple noncommunicative cysts, normal LFT

biliary hamartoma "von meyenburg complex"

focal developmental liver lesion, group of dilated intrahepatic duct within dense stroma

fatty infiltration "steatosis"

triglyceride accumulation in liver cells, reversible, fatty deposits, increased LFT, malignant tumor formation will demo washout in contrast

focal fatty sparing

entire liver involved expect localized areas, adjacent to portal structures

focal fatty replacement

only small portion of liver is affected

glycogen storage disease

autosomal recessive, affects skeletal muscles, STARRY SKY, PROMINENT PORTAL VEINS

glycogen storage disease - type I

von gierke disease , most common type

wilson disease

autosomal recessive, DEPOSITION OF COPPER METABOLISM IN LIVER, RUSY BROWN COLORED RINGS (KAYSER-FLEISCHER), fetal if untreated, DECREASED ALBUMIN

cirrhosis

cause: alcoholism and hep c most common

micronodular <1cm - alcohol

macronodular 1-5cm - chronic viral

cirrhosis lab

increased AST, ALP, ALT, indirect bilirubin, GGTP, LDH

decreased albumin, albumin/globulin ratio

cirrhosis - later stage

varices with cavernous transformation

dilated coronary v. w/patent umbilical v

narrowed hepatic v - monophasic antegrade flow

decreased portal v flow = hepatic a atrophy

hepatitis

most common cause of intrahepatic cholestasis, IV DRUG USE = MOST COMMON SPREAD, prolonged prothrombin time

acute hepatitis

increased size, decreased echogenicity from fluid accumulation, increased reflection PERIPORTAL CUFFING,

STARRY NIGHT, ascites present

chronic hepatitis

atrophy and decreased echogenicity portal vein wall, multiple GRANULOMAS PUNCTATE CALIFICATION, HYPERECHOIC LIVER PARENCHYMA WITH FIBROSIS

echinococcal cyst "hydatid disease"

found in feces of infected animals, raw pork, prevalent in sheep hoarding countries, CYST FOUND IN TAPEWORMS, , RUPTURED HYDATID CYST = ANAPHYLACTIC SHOCK

casoni skin test

small amt of sterilized hydatid cells, red bumps 20-30 mins if affected

schistosomiasis "fluke parasite"

POLLUTED WATER, INFESTED SHELLFISH/SNAILS, WORM THROUGH PORTAL VEIN, narrowing = periportal fibrosis, most common infection in humans, cause of hepatic fibrosis, affects urinary tract

pneumocystis jirovecci "pneumocystis carinii"

YEAST FUNGUS, AIDS/IMMUNOCOMPROMISED pts, diffuse echogenic foci w/o shadowing, HONEYCOMB, "DAUGHTER CYST", WATERLILY, rt lobe liver

granulomatous infection

systemic fungal respiratory disease by BIRD/BAT DROPPINGS, HISTOPLASMOSIS/TURBUCLULOSIS