Mesenteric, Hepatic and Renal Vascular Assessment

Details

Title

Mesenteric, Hepatic and Renal Vascular Assessment

Type

Stage Two

Module code

HPS184

Requirement

Compulsory

Module objective

By the end of this module, the Clinical Scientist in HSST will be able to apply their knowledge, skills and experience in the clinical setting to undertake mesenteric, hepatic and renal vascular assessment including mesenteric ischemia; renal artery disease (hypertension and renal failure) and hepatic-portal disease. They will also be able to recognise, deliver, report and interpret the appropriate physiological test/s to address the findings from initial clinical assessment and apply a detailed knowledge of management options available to the supervising clinician based on the investigative findings whilst critically evaluating their own response to both normal and complex situations using the professional attributes and insights required of a Consultant Clinical Vascular Scientist.

Knowledge and understanding

By the end of this module, Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to the assessment of a range of patients, including those with complex problems with respect to mesenteric, hepatic and renal assessment including:

 Anatomy, Physiology and Pathology

• identification of typical anatomy and common variants of the abdominal aorta and its major branches and the vena cava and its major tributaries.
• anatomy associated with transplanted kidney
• renal hypertension associated with renal artery stenosis or kidney disease
• mesenteric angina and ischaemia
• identification of the range and variety of pathology including;
  • mesenteric artery disease.
  • renal artery stenosis or occlusion, including renal transplants.
  • aneurysm.
  • portal venous hypertension portal vein thrombosis.
  • hepatic vein obstruction.
  • normal and pathophysiological haemodynamics.
    • superior mesenteric artery (SMA) flow related to pre and post prandial states.
    • definition of SMA aortic peak systolic velocity ratio.
    • renal artery aortic peak systolic velocity index.
    • pulsatility and resistance index related to renal artery blood flow.
    • spectral Doppler assessment of the renal interlobar arteries.

Clinical History, Examination and Management Options

• presenting signs and symptoms and identify possible alternative diagnoses.
• the range of medical, interventional and surgical management options including surveillance, best medical therapy, angioplasty, stenting and surgery.
• the complementary use of angiography, CT and MRA in the diagnosis and management.
• how to recognise the clinical sequelae of the diagnosis.
• recognition of how diagnosis affects management pathway.

Diagnostic Techniques

• diagnostic techniques used by clinical vascular scientists to assess the range of disorders.
• ultrasound appearance of common incidental findings.
• selection of the appropriate technique for each patient.

Technical and clinical skills

By the end of this module the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills:

• performance and interpretation of mesenteric duplex and spectral doppler investigations including superior and inferior mesenteric artery flow.
• performance and interpretation of renal duplex and spectral doppler investigations.
• performance and interpretation of hepatic-portal duplex and spectral doppler investigations.
• performance and interpretation post intervention scans i.e. angioplasty, stenting or bypass using duplex.
• performance and interpretation of duplex and spectral Doppler assessment in patients with a transplanted kidney.
• recognition of artefacts, potential sources of error and limitations of assessment and addressing appropriately.

By the end of this module, the Clinical Scientist in HSST will be expected to critically reflect and apply in practice, with respect to mesenteric, hepatic and renal assessment in a range of patients, clinical and communication skills to advise and communicate effectively with patients, relevant clinicians and other healthcare professionals and will:

• take a clinical history and perform clinical assessment of patient.
• choose and provide expert opinion on the most appropriate technique/test for the clinical presentation.
• perform the ultrasound imaging or physiological measurement diagnostic test
• identify normal anatomical variants and refer appropriately.
• analyse and interpret physiological images and measurements.
• formulate and organise data (clinical history, clinical assessment, scientific results) to accurately report cases and emphasise the key findings and diagnoses.
• compare all data to justify and validate the conclusion.
• communicate with the multi-disciplinary team and participate as an active member of multi-disciplinary teams.

Attitudes and behaviours

By the end of this module, the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations. They will also be expected to demonstrate the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:

• communicate appropriately with the patient placing the patient at the centre of care and prioritising the safety of the patient.
• consistently work to high standards of clinical practice applying knowledge and evidence, making decisions and evaluating the impact of those decisions.
• monitor, evaluate and maintain clinical practice standards.
• share data on clinical practice standards with service users and managers to encourage dialogue and debate.
• recognise the importance of the multidisciplinary clinical team and take responsibility for ensuring appropriate and effective decision-making processes are in place.
• support and contribute to the development of multidisciplinary clinical team working and work with the team to determine scientific service priorities.
• be committed to and support continuous improvement of vascular services, with particular reference to auditing practice, evidence based practice, innovation, new and improved technologies.