C5: Infectious and Inflamm. Diseases Flashcards
most common clinical presentation of infection that is common to all patients
fever
pain
leukocytosis
what kind of testing is important for FUO
what to look for on US in general
lab tests and Hx, tells you where the infectious process might be located
organomegaly - common in acute infections
describe an abscess
common symptom
localized collection of pus that is a complication of infection
localized tenderness
patients at risk for an abscess
diabetics, immunocompromised, cancer patients
patients w/ hematomas or post-op
Us appearance of abscess in the liver
fluid filled area w/ posterior enhancement
thick irregular walls w/ debris, maybe gas (dirty shadow)
describe hepatitis
signs and symptoms
inflammation of the liver due to virus or toxins (cleaning solutions, Tylenol, etc)
fever, chills, N&V, maybe jaundice
how many types of hepatitis
6
primary mode of spread for Hep A
fecal oral
A for anal
primary mode of spread for Hep B
blood & body fluid
theres a B in Hep B, Blood and Body fluids
primary mode of spread for Hep C
transfusions
primary mode of spread for Hep D
which demographic is this common in
depends of Hep B… must already be infected
common in IV drug users
which type of Hep has a carrier state
B
clinical recovery time for acute Hep
which type of hep is usually acute
4 months
Hep A (99%)
causes of subfulminant/fulminant hepatitis
what does this type lead to
Hep B or drug toxicity
hepatic necrosis (patient dies if >40% liver function lost)
criteria for chronic Hep
biochemical markers are abnormal for > 6 months
US appearance of acute hepatitis
OFTEN LIVER LOOKS NORMAL
hepatomegaly
decreased liver echogenicity w/ prominent portal vein walls due to peri-portal fibrosis (starry sky appearance)
GB wall thickening
US appearance of chronic hepatitis
coarse liver
increased echogenicity
portal hypertension and cirrhosis
chronic hepatitis increases the patients risk for which type of carcinoma
HCC
altered lab values w/ Hep
ALT, AST, bilirubin
4 routes of spread by pyogenic bacteria to the liver
biliary tract (cholecystitis, cholangiocystitis)
portal venous sys (appendicitis)
HA (endocarditis)
trauma (blunt or penetrating trauma)
clinical presentation of pyogenic bacterial infection of the liver
fever
RUQ pain
malaise -general feeling of un-wellness
anorexia - loss of appetite w/ weight loss and muscle wasting
US appearance of pyogenic bacterial infection of the liver
an abscess…. :
simple to complex cyst
shaggy wall w/ internal septations
echogenic focus w/ post. reverb (gas)
describe candida
a fungal, yeast infection that typically effect immunocompromised patients
US appearance of candida in the liver
which organs are effected
uniformly hypoechoic liver (most common)
bulls eye appearance
wheel w/in a wheel
liver, kidney, spleen
describe the bulls eye and wheel w/in a wheel appearance
bulls eye: Hypo rim w/ hyper center
wheel: hypo rim, w/ hyper center and hypo nidus (dot)
describe pneumocystis Carinii
which organs are effected, most common?
a fungal, opportunistic infection that typically effect immunocompromised patients (AIDS)
liver (most common) , spleen, renal cortex, pan, lymph nodes
US appearance of pneumocystis Carinii
diffuse, small non-shadowing echogenic foci and progress to shadowing clumps of calcification
what type of disease is amebiasis
how is it spread and where does it travel
a parasitic disease from an ameba
fecal oral route, from the colon through the portal veins to the liver
which lobe is more commonly affected by amebiasis
Rt lobe, maybe due to gravity
US appearance of amebiasis in the liver
abscess
most common clinical presentation of amebiasis
pain, +/- diarrhea
describe hydatid disease
which organs does it affect
a parasitic infection from a tapeworm that’s common in sheep/cattle raising countries
liver (most common), spleen, ureter, bladder, kidneys
another name for hydatid disease
echinococcal disease
who is the definitive host for hydatid disease
what does that mean
dogs
host in which the parasite matures
who is the intermediate host for hydatid disease
what does that mean
humans
host in which the parasite undergoes development but doesn’t reach maturity
how is hydatid disease typically spread
how does it enter the liver
fecal-oral route
via the portal venous sys…. Rt lobe more commonly affected
3 layers of the cyst (containing the embryo) w/ hydatid disease
pericyst - dense c-tissue capsule around the cyst/ectocyst, this is the body attempt to protect itself
ectocyst - external membranes (~1mm)
endocyst - inner germinal layer where the embryo develops
US appearance of the embryo w/ hydatid disease
hydatid sand (low level echos)
simple cyst
daughter cysts
calcified walls
THICK, DOUBLE LAYERED CYST
signs and symptoms of hydatid disease
DEPENDS ON STAGE pain/discomfort jaundice vascular thrombus/infarction anaphylactic shock from cyst rupture
treatment for hydatid disease
why this treatment
surgery
the cyst is not aspirated because anaphylactic shock can occur if the cyst ruptures
describe schistosomiasis
how does the worm enter the body
a parasitic infection
penetrate the skin and travel to the mesenteric veins via lymph and blood vessels
which organs does schistosomiasis affect
liver, spleen, bowel, bladder
how do the ova enter the liver w/ schistosomiasis
what does this lead to
ova penetrate the portal vein walls… leads to a granulomatous rxn and perip-portal fibrosis…. then portal HTN and cirrhosis over time.
granulomatous rxn: inflammation of peri-portal walls
Us appearance of schistosomiasis in the liver
spleen
increased echogenicity/thickness of peri-portal walls
hepatomegaly initially…. shrunken liver chronically w/ portal HTN
splenomegaly
Us appearance of schistosomiasis involving the bladder
thickened bladder wall
what appearance is used to describe peri-portal fibrosis
turtle back appearance
describe TB
opportunistic infection that starts in the lungs but can affect many organs
US appearance of TB for spleen and adrenals
spleen: sm echogenic foci w/ or w/o shadowing
adrenals:
acute - bilateral, diffuse enlargment
chronic - atrophied and calcified
what can TB eventually lead to w/ the adrenals
atrophy and hypoadrenalism/adrenal insufficiency (Addison’s)
describe peritonitis
inflammation of the peritoneum due to infectious or non-infectious factors
what infectious and non-infecious factors can cause peritonitis
I: bacteria, viruses, fungi, parasites
N-I: pancreatitis, foreign bodies (talcum powder)
patient presentation w/ peritonitis
US appearance
severe pain
exudative fluid, lymphadenopathy
what is tuberculosis peritonitis
disease affecting immunocompromised patients
describe acute cholecystitis (common cause)
what can it lead to
inflammation of GB usually due to impacted stones
can lead to an inflammation( if the stone interferes w/ blood supply) and infection which is common w/ biliary colic
acute cholecystitis affects which gender more
women
clinical presentation of acute cholecystitis
RUQ pain that radiates to the back
fever, leukocytosis
N&V
painful jaundice
US appearance of acute cholecystitis
GB wall >3mm hyperemia GB stones, possibly impacted @ the neck (narrowest part) GB hydrops - dilated GB pericholecystic fluid - fluid around GB \+ murphy's
altered lab values w/ acute cholecystitis
ALT, AST, ALP, serum bilirubin, WBCs ++
complications of acute cholecystitis
empyema gangrenous cholecystitis emphysematous cholecystitis perforation abscess
describe gangrenous cholecystitis
sympt. and US appearance
necrosis of the GB
no pain, nerves are dead
non-layer bands of echogenic tissue in the GB
where does perforation of the GB typically occur
why
fundus
it has the poorest blood supply
Us appearance of GB perforation
FF in peritoneal cavity
collection adjacent to the GB
ill-defined hypo mass around the GB
may see the perforation
technique to better appreciate GB wall perforation
try a linear probe to see the wall defect better
describe emphysematous cholecystitis
which demographic is affected more
rare type of cholecystitis that progresses rapidly and is caused by gas forming bacteria (will see a dirty shadow)
men and diabetics
how to remember the US appearance of “emphysematous” diseases
people w/ emphysema can’t get enough air… emphysematous diseases will always contain air/dirty shadow
describe acalculous cholecystitis
who’s most commonly affected
inflamed GB w/o stones…. affects critically ill patients
risk factors for acalculous cholecystitis
trauma
surgery
burns
hyperalimentation (IV nutrition)
US appearance of acalculous cholecystitis
symptoms?
similar to acute cholecystitis w/o the stones
maybe painless due to pain meds
most common form of symptomatic GB disease
chronic cholecystitis…. chronic is more common than acute so more commonly causes symptoms
clinical presentation of chronic cholecystitis
intolerance to fatty foods
belching/indigestion
postprandial RUQ pain
N&V
Us appearance of chronic cholecystitis
thick, hetero GB wall
contracted GB w/ stones
WES sign
when do patient w/ GB stones usually feel pain
only if stones cause cholecystitis
what commonly happens to the GB wall w/ cirrhosis
thickens
altered lab values w/ chronic cholecystitis
ALT, AST, ALP, bilirubin
complications of chronic cholecystitis
Bouveret syndrome:
gastric outlet obstruction due to GB stone lodged in the duodenum, not allowing stomach contents to pass
gallstone ileus:
distal bowel obstruction due to GB stone lodged @ ileocecal valve
Mirizzi’s syndrome
chronic cholecystitis is associated w/ which carcinoma
GB carcinoma
describe Mirizzi’s syndrome
a rare complication of chronic cholecystitis where there’s an impacted stone in the cystic duct, GB neck or hartmann’s pouch
how does Mirizzi’s syndrome affect the CHD
other complications
CHD is extrinsically compressed by the stone or inflammation which can lead to obstructive jaundice
fistula b/w cystic duct and CHD
symptoms of Mirizzi’s syndrome
fever, pain, obstructive jaundice (important)
Us appearance of Mirizzi’s syndrome
dilated bile ducts above level of obstruction
norm CBD
describe xanthogranulomatous cholecystitis
US appearance
rare form of chronic inflammation
hypo nodules/bands that represents fatty granulomatous nodules
thick GB wall
describe a porcelain GB
who’s most commonly affected
rare calcification of GB wall, maybe a type of chronic chole.
unknown cause
older females (60s)
porcelain GB is associated w/ what conditions
stones
Highly associate w/GB carcinoma
Us appearance of porcelain GB
calcified GB wall
see notes for definitions
/
describe cholangitis
5 types
a rare, inflammatory and fibrosing disorder of the biliary tree
acute (bacterial) recurrent pyogenic AIDS biliary ascariasis primary sclerosing
Cause of acute (bacterial) cholangitis
clinical presentation
obstruction (chloedocholithiasis)
fever
RUQ pain
jaundice
US appearance of acute (bacterial) cholangitis
dilated biliary tree (BT) w/ thickened walls
may have BT stones
liver abscess
increased lab values w/ acute (bacterial) cholangitis
WBC, ALP, bilirubin
describe recurrent pyogenic cholangitis
cause
most common in SE and east Asia and most often affects the lateral Lt lobe of liver
unknown
possible complications of chronic recurrent pyogenic cholangitis
stasis and stone formation
biliary cirrhosis (hardening or bile ducts)
choleangiocarcinoma
US appearance of recurrent pyogenic cholangitis
dilated ducts w/ stones and sludge in one segment of the liver