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Adv. Vas. Son.
Test 3 Abdominal Doppler Mesenteric
| Question | Answer |
|---|---|
| What does ICAVL/IAV stand for? | Intersocietal Commission for the Accreditation of Vascular Laboratories |
| What is the most common application of mesenteric duplex exams? | Chronic mesenteric ischemia |
| What is Chronic Mesenteric Ischemia? | Rare disorder w/ nonspecific SX, Mesenteric vessels have extensive collateral network, Typically 2 of 3 mesenteric vessels (Celiac, SMA & IMA) must be diseased before SX appear |
| Who does Chronic Mesenteric Ischemia occur more commonly in? | Women between ages of 40-70 years old |
| Celiac Artery facts: | 1st branch of abdominal aorta;~2-4 cm long, Arises on the anterior aspect;1-2 cm below diaphragm, Branches into common hepatic, splenic & left gastric As(LG typically not seen on US), |
| Superior Mesenteric Artery facts: | Also from anterior surface of aorta, Arises ~1-2 cm below celiac artery, Parallels aorta through abdomen |
| Inferior Mesenteric Artery facts: | Arises from anterior aspect of distal aorta, just above aortic bifurcation, Hard to see |
| Signs & SX of Chronic Mesenteric Ischemia: | Abdominal pain & cramping after eating (periumbilical pain starts ~ 30min after eating & lasts 1-2 hrs) Presence of abdominal bruit, Weight loss (typically due to food avoidance not malnutrition), Diarrhea |
| Why is it very important for the PT to fast for at least 6 hours prior to exam? | Diagnostic criteria for fasting vessels, SMA changes dramatically after eating (goes from High Res to Low Res), PT also no smoking or chewing gum |
| When will you not do the study? | If the PT is not fasting |
| What TD is used? | 2-5 MHz |
| Where is the celiac best viewed? | TRV plane |
| What is the celiac bifurcation called? | The seagull sign (wings are the common hepatic on the left, and the Splenic artery on the right) |
| Celiac, Common Hepatic, and Splenic arteries all demonstrate what flow resistance? | LOW resistance flow |
| Where is the SMA best viewed? | SAG plane |
| What should the fasting SMA demonstrate? | High res, Triphasic flow |
| What should postprandial (after eating) SMA demonstrate? | Low res, EDV should double |
| Where is the IMA most easily identified? | TRV plane, locate Ao bifurcation then scan prox 1-3 cm, Usually originates from anterior Ao, slightly to the left of midline (~1-2 o'clock), |
| What does the IMA doppler waveform resemble? | Fasting SMA (high res) (Does not change after eating) |
| SMA waveforms: | Fasting = High resistance, After Eating= Low resistance |
| What does a color bruit suggest? | Significant stenosis |
| What does the Celiac artery NORMAL waveform look like? | Sharp systolic upstroke, Low-resistance flow pattern, PSV<125 cm/s |
| What does the Celiac artery ABNORMAL waveform look like? | PSV≥ 200 cm/s consistent w/≥70% stenosis, EDV ≥55 cm/s consistent w/≥50% stenosis |
| What does the SMA NORMAL waveform look like? | Sharp systolic upstroke and clear systolic window, High-resistance flow pattern (fasting PT), PSV < 125 cm/s |
| What does the SMA ABNORMAL waveform look like? | PSV≥275 cm/s consistent w/ ≥70% stenosis, EDV ≥45 cm/s consistent w/≥50% stenosis |
| IMA NORMAL characteristics: | Sharp upstroke; High resistance, No specific criteria for disease if abnormal |
| Mesenteric system has an extensive ______ ________? | Collateral network |
| True stenosis usually demonstrates what? | Increased flow and post-stenotic turbulence/ spectral broadening |
| Compensatory flow has little what? | Spectral broadening and no stenotic profile (change before, in and after stenosis) |
| What does prominent IMA suggest? | SMA occlusion with collateralization through meandering mesenteric artery |
| Acute Mesenteric ischemia can result from? | Embolus to mesenteric arteries, Thrombosis of an artery w/ existing chronic disease |
| What do PTs experience with Acute Mesenteric Ischemia? | "Pain out of proportion to physical findings" |
| What can happen with Acute Mesenteric Ischemia? | Bowel necrosis happens rapidly w/ a high mortality rate, Duplex assessment is generally not useful and is discouraged, Embolus often occurs in distal SMA where ultrasound can't visualize |
| What is Median Arcuate Ligament Compression Syndrome | Transient compression of the celiac artery origin by the median arcuate ligament of diaphragm, Compression occurs during exhalation, Compression relieved by inhalation (diaphragm descends) |
| PSV in celiac artery increases with what? | Exhalation (or normal respiration) and decreases with inhalation |
Created by:
EmilyGriffin
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