2. Role of color Doppler inevaluation of portal
hypertensionByDr. HATEM EL-AZIZIASS. PROF. OF RADIODIAGNOSISCAIRO
UNIVERSTIY 3. What is portal hypertension 4. Portal hypertension
Defined as elevation of pressure above 10 mmHg Difference in
pressure between PV & IVCmore than 5 mmHg Complication of
portal hypertensionoccurs above 12mmHg 5. Portal
hypertensionDefinition 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. 6. Portal hypertension causes pre hepatic Hepatic
Post hepatic 7. ? what to examin 8. Portal hypertension Portal vein
Hepatic vines IVC Splenic vein Hepatic artery Splenic artery
Superior mesenteric artery 9. !! Search & analysis 10. Portal
hypertension Flow pattern velocity Doppler indices waveform 11.
Flow pattern 12. Portal hypertension Flow pattern Normal
Hepatopedal Abnormal hepatopedal Hepatofugal Bidirectional Static
13. Basics of Doppler 14. Basics of DopplerThe sound frequency from
an approaching source is higher than from one receding 15. Basics
of Doppler 16. Basics of Doppler 17. Basics of Doppler 18. Basics
of Doppler 19. Basics of Doppler 20. Basics of Doppler 21. Basics
of Doppler 22. Basics of Doppler 23. Basics of Doppler Re dBloo
dCellsNo rm al Red Blo o dCellsCe Ab llulnoarrm stru ctual Rreed of
rBl o ed odbloReod C ells d cel blo l odc ellas vi 24. Basics of
DopplerRed Blood CellsNormal Red Blood Cells AbCellular structure
of red blood cell 25. Basics of Doppler Re dBloo dC ellsNo rm al
Red Blo odC ellsCe llula r stru ctu reof redb looRedc d bl ell 26.
Basics of DopplerRed Blood CellsNormal Red Blood Cells AbCellular
structure of red blood cell 27. Basics of DopplerRed Blood
CellsNormal Red Blood Cells AbCellular structure of red blood cell
28. Basics of DopplerRedB loodCe lls Norm Re al RdBed Blo loo odCdC
ells ellsNorm Ce al R lluledarstru Blo ctu od reCe of r
llsedbloReod dbcello o l dcellCeas llulviear we stru d frctu om re
the of r s id ed eb loRe od db cell l 29. Basics of DopplerRedB
loodCe lls Norm Re al RdBed Blo loo odCdC ells ellsNorm Ce al R
lluledarstru Blo ctu od reCe of r llsedbloReod dbcello o l
dcellCeas llulviear we stru d frctu om re the of r s id ed eb loRe
od db cell l 30. Basics of DopplerRedB loodCe lls Norm Re al RdBed
Blo loo odCdC ells ellsNorm Ce al R lluledarstru Blo ctu od reCe of
r llsedbloReod dbcello o l dcellCeas llulviear we stru d frctu om
re the of r s id ed eb loRe od db cell l 31. Basics of DopplerRedB
loodCe lls Norm Re al RdBed Blo loo odCdC ells ellsNorm Ce al R
lluledarstru Blo ctu od reCe of r llsedbloReod dbcello o l
dcellCeas llulviear we stru d frctu om re the of r s id ed eb loRe
od db cell l 32. Basics of Doppler 33. Basics of Doppler 34. Basics
of Doppler 35. Basics of Doppler 36. Basics of Doppler 37. Basics
of Doppler 38. Portal hypertension Flow pattern Normal Hepatopedal
Abnormal hepatopedal Hepatofugal Bidirectional Static 39. Portal
hypertension 40. Portal hypertension 41. Portal hypertension 42.
Portal hypertension 43. Portal hypertension 44. Portal hypertension
45. Doppler indices 46. Portal hypertension Portal vein velocity
Normal 20.2 -33.3 cm/sec Cirrhosis 11.0 cm/sec Portal hypertension
15.9 cm/sec 47. Portal hypertension Congestion index ratio between
cross section area andflow velocity Increase in PH Normal 0.06
Oesophageal varices 0.145 Cirrhosis 0.11 48. Portal hypertension
Splenic arterial RI 0.60 measured at splenic hilum Increased in PH
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 PH17.2+4.3 50. Waveform analysis 51. Portal
vein Continuous low velocity phasic signal;phasic means that the
velocityincreases and decreases withrespirations giving the signal
asmooth wavelike appearance Normal flow is termed
hepatopedal(toward the liver( Reversed flow ishepatofugal. 52.
Portal vein 53. Portal vein 54. Portal vein 55. Portal vein 56.
Portal vein 57. Portal vein 58. Portal vein 59. Portal vein 60.
Portal vein 61. Portal vein 62. Portal vein 63. Portal vein 64.
Portal vein 65. Portal vein 66. Portal vein 67. Portal vein 68.
Portal vein 69. Hepatic Artery Low resistance waveform; forwardflow
in diastole above baseline NOTE: The hepatic artery and portalvein
flow should be in the samedirection as the hepatic artery
runsparallel with the portal vein. 70. Hepatic Artery 71. Hepatic
Artery 72. Hepatic Venous System Multi-phasic pulsatile flow
patternsecondary to proximity of the right atriumwith flow above
and below the baseline Right sided heart failure may cause
thehepatic veins to become pulsatile anddilated. Increased
intrahepatic pressure or venousobstruction demonstrates a
morecontinuous or monophonic signal 73. Hepatic Venous System 74.
Hepatic Venous System 75. Hepatic Venous System 76. Hepatic Venous
System 77. Hepatic Venous System 78. Hepatic Venous System 79.
Inferior Vena Cava Continuous waveform with respiratoryvariations;
become more pulsatile asit empties into the right atrium. Best
imaged with a slight cranial-caudal sweep in the longitudinal
planewith the patient in deep inspiration Thrombosis can cause the
IVCwaveform to appear monophasic withhigh velocities. 80. Thank
You
