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So here's some examples of a normal right upper quadrant exam with liver Doppler

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with normal waveforms. So when we do these exams, we start with a linear image to

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look for the surface nodularity, and we want to see it nice and smooth.

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We look through the other upper abdominal organs, so we look through the pancreas,

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and we see it really nicely in this case.

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It's this nice echogenic structure here.

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We start to lose a little bit due to bowel gas, but that's to be expected.

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We look for the splenic vein posterior to the pancreas at first, and so we can see

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starting here towards the transducer, so going antegrade back towards the liver,

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which is what we want.

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Then we start to evaluate the liver and the different structures.

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So we make sure that we look at grayscale evaluations of all of these,

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and then we take different images when we get to these regions.

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And so we start with the left portal vein.

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So you can see we have a nice, fairly normal portal venous waveform.

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We don't have any significant phasicity to this waveform.

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There's a gentle undulation, but that's to be expected, and that's normal.

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We then try to stay within the same ballpark. So we go to the left hepatic artery.

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That runs really close into that region, and so you can see our normal low

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resistance waveform here.

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We then look at the left hepatic vein.

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So in the left hepatic vein, you can see we have nice respiratory variability.

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We have areas above and below the baseline.

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It doesn't always exactly comply with the typical waves that we would see with

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hepatic venous waveforms with our respiratory change, but as long as you have the

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nice up and down undulation, that's usually a pretty good sign that you have good

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variability here.

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We move over to the middle hepatic vein.

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Again, we can see nice variability above and below the baseline.

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And then same with the right hepatic vein.

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You can see we have a nice, good waveform there.

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Looking through the remainder of the liver,

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we get nice views of other structures.

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We're taking our measurement in our mid-clavicular line.

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And then we look at the main portal vein.

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So the main portal vein, this is a normal diameter for it.

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We would like to see it below 1.5 centimeters to make sure that we don't have any

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evidence of portal hypertension, and we have a nice, clear forward flow towards the

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liver. So the liver's in the foreground, and we have the flow going towards it.

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Again, nice normal waveform, gentle undulations, no significant phasicity

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or pulsatility.

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Similar findings in the main hepatic artery, just like what we see in the left

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hepatic artery. And then finally, our right-sided structures.

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So our right portal vein, nice and good size here, going right towards the liver

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parenchyma, nice undulations again.

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And then finally, our right hepatic artery, where we have, again, nice normal low

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resistance waveform going towards the liver.

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Finally, we finish with the IVC. So ideally, we want to just confirm patency of the

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IVC, and we should, in most cases, see some respiratory variability as well because

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that's the one that's going to be closest to the heart, and that's where you'll

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start to see those changes reflected back.