4. Portal hypertension
Defined as
elevation of pressure above 10 mmHg
Difference in pressure between PV & IVC
more than 5 mmHg
Complication of portal hypertension
occurs above 12mmHg
5. Portal hypertension
Definition
Acute or chronic hepatocellular disease can block the
flow of blood throughout the liver, causing it to back
up into the hepatic portal circulation.
This causes the blood pressure in the hepatic
circulation to increase (portal hypertension).
In an effort to relieve the pressure, collateral veins
are formed that connect to the systemic veins.
This is known as varicose veins and occurs most
frequently in the area of the esophagus, stomach, and
rectum. Rupture of these veins may cause massive
bleeding that may result in death.
23. Basics of Doppler
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24. Basics of Doppler
Red Blood Cells
Normal Red Blood Cells Ab
Cellular structure of red blood cell
25. Basics of Doppler
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26. Basics of Doppler
Red Blood Cells
Normal Red Blood Cells Ab
Cellular structure of red blood cell
27. Basics of Doppler
Red Blood Cells
Normal Red Blood Cells Ab
Cellular structure of red blood cell
28. Basics of Doppler
Re
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29. Basics of Doppler
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Norm
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30. Basics of Doppler
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Norm
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31. Basics of Doppler
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47. Portal hypertension
Congestion index
ratio between cross section area and
flow velocity
Increase in PH
Normal
0.06
Oesophageal varices
0.145
Cirrhosis
0.11
49. Portal hypertension
Liver vascular index
Ratio between portal venous velocity &
hepatic artery PI
Cut-off of liver vascular index 12 cm/sec
Liver vascular index
Normal
8.7+2.1
Significantly higher in patient with PH
17.2+4.3
51. Portal vein
Continuous low velocity phasic signal;
phasic means that the velocity
increases and decreases with
respirations giving the signal a
smooth wavelike appearance
Normal flow is termed hepatopedal
(toward the liver( Reversed flow is
hepatofugal.
69. Hepatic Artery
Low resistance waveform; forward
flow in diastole above baseline
NOTE: The hepatic artery and portal
vein flow should be in the same
direction as the hepatic artery runs
parallel with the portal vein.
72. Hepatic Venous System
Multi-phasic pulsatile flow pattern
secondary to proximity of the right atrium
with flow above and below the baseline
Right sided heart failure may cause the
hepatic veins to become pulsatile and
dilated.
Increased intrahepatic pressure or venous
obstruction demonstrates a more
continuous or monophonic signal
79. Inferior Vena Cava
Continuous waveform with respiratory
variations; become more pulsatile as
it empties into the right atrium.
Best imaged with a slight cranial-
caudal sweep in the longitudinal plane
with the patient in deep inspiration
Thrombosis can cause the IVC
waveform to appear monophasic with
high velocities.