C5: Infectious and Inflamm. Diseases Flashcards
1
Q
most common clinical presentation of infection that is common to all patients
A
fever
pain
leukocytosis
2
Q
what kind of testing is important for FUO
what to look for on US in general
A
lab tests and Hx, tells you where the infectious process might be located
organomegaly - common in acute infections
3
Q
describe an abscess
common symptom
A
localized collection of pus that is a complication of infection
localized tenderness
4
Q
patients at risk for an abscess
A
diabetics, immunocompromised, cancer patients
patients w/ hematomas or post-op
5
Q
Us appearance of abscess in the liver
A
fluid filled area w/ posterior enhancement
thick irregular walls w/ debris, maybe gas (dirty shadow)
6
Q
describe hepatitis
signs and symptoms
A
inflammation of the liver due to virus or toxins (cleaning solutions, Tylenol, etc)
fever, chills, N&V, maybe jaundice
7
Q
how many types of hepatitis
A
6
8
Q
primary mode of spread for Hep A
A
fecal oral
A for anal
9
Q
primary mode of spread for Hep B
A
blood & body fluid
theres a B in Hep B, Blood and Body fluids
10
Q
primary mode of spread for Hep C
A
transfusions
11
Q
primary mode of spread for Hep D
which demographic is this common in
A
depends of Hep B… must already be infected
common in IV drug users
12
Q
which type of Hep has a carrier state
A
B
13
Q
clinical recovery time for acute Hep
which type of hep is usually acute
A
4 months
Hep A (99%)
14
Q
causes of subfulminant/fulminant hepatitis
what does this type lead to
A
Hep B or drug toxicity
hepatic necrosis (patient dies if >40% liver function lost)
15
Q
criteria for chronic Hep
A
biochemical markers are abnormal for > 6 months
16
Q
US appearance of acute hepatitis
A
OFTEN LIVER LOOKS NORMAL
hepatomegaly
decreased liver echogenicity w/ prominent portal vein walls due to peri-portal fibrosis (starry sky appearance)
GB wall thickening
17
Q
US appearance of chronic hepatitis
A
coarse liver
increased echogenicity
portal hypertension and cirrhosis
18
Q
chronic hepatitis increases the patients risk for which type of carcinoma
A
HCC
19
Q
altered lab values w/ Hep
A
ALT, AST, bilirubin
20
Q
4 routes of spread by pyogenic bacteria to the liver
A
biliary tract (cholecystitis, cholangiocystitis)
portal venous sys (appendicitis)
HA (endocarditis)
trauma (blunt or penetrating trauma)
21
Q
clinical presentation of pyogenic bacterial infection of the liver
A
fever
RUQ pain
malaise -general feeling of un-wellness
anorexia - loss of appetite w/ weight loss and muscle wasting
22
Q
US appearance of pyogenic bacterial infection of the liver
A
an abscess…. :
simple to complex cyst
shaggy wall w/ internal septations
echogenic focus w/ post. reverb (gas)
23
Q
describe candida
A
a fungal, yeast infection that typically effect immunocompromised patients
24
Q
US appearance of candida in the liver
which organs are effected
A
uniformly hypoechoic liver (most common)
bulls eye appearance
wheel w/in a wheel
liver, kidney, spleen
25
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)
26
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
27
US appearance of pneumocystis Carinii
diffuse, small non-shadowing echogenic foci and progress to shadowing clumps of calcification
28
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
29
which lobe is more commonly affected by amebiasis
Rt lobe, maybe due to gravity
30
US appearance of amebiasis in the liver
abscess
31
most common clinical presentation of amebiasis
pain, +/- diarrhea
32
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
33
another name for hydatid disease
echinococcal disease
34
who is the definitive host for hydatid disease
what does that mean
dogs
host in which the parasite matures
35
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
36
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
37
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
38
US appearance of the embryo w/ hydatid disease
hydatid sand (low level echos)
simple cyst
daughter cysts
calcified walls
THICK, DOUBLE LAYERED CYST
39
signs and symptoms of hydatid disease
```
DEPENDS ON STAGE
pain/discomfort
jaundice
vascular thrombus/infarction
anaphylactic shock from cyst rupture
```
40
treatment for hydatid disease
why this treatment
surgery
the cyst is not aspirated because anaphylactic shock can occur if the cyst ruptures
41
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
42
which organs does schistosomiasis affect
liver, spleen, bowel, bladder
43
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
44
Us appearance of schistosomiasis in the liver
spleen
increased echogenicity/thickness of peri-portal walls
hepatomegaly initially.... shrunken liver chronically w/ portal HTN
splenomegaly
45
Us appearance of schistosomiasis involving the bladder
thickened bladder wall
46
what appearance is used to describe peri-portal fibrosis
turtle back appearance
47
describe TB
opportunistic infection that starts in the lungs but can affect many organs
48
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
49
what can TB eventually lead to w/ the adrenals
atrophy and hypoadrenalism/adrenal insufficiency (Addison's)
50
describe peritonitis
inflammation of the peritoneum due to infectious or non-infectious factors
51
what infectious and non-infecious factors can cause peritonitis
I: bacteria, viruses, fungi, parasites
N-I: pancreatitis, foreign bodies (talcum powder)
52
patient presentation w/ peritonitis
US appearance
severe pain
exudative fluid, lymphadenopathy
53
what is tuberculosis peritonitis
disease affecting immunocompromised patients
54
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
55
acute cholecystitis affects which gender more
women
56
clinical presentation of acute cholecystitis
RUQ pain that radiates to the back
fever, leukocytosis
N&V
painful jaundice
57
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
```
58
altered lab values w/ acute cholecystitis
ALT, AST, ALP, serum bilirubin, WBCs ++
59
complications of acute cholecystitis
```
empyema
gangrenous cholecystitis
emphysematous cholecystitis
perforation
abscess
```
60
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
61
where does perforation of the GB typically occur
why
fundus
it has the poorest blood supply
62
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
63
technique to better appreciate GB wall perforation
try a linear probe to see the wall defect better
64
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
65
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
66
describe acalculous cholecystitis
who's most commonly affected
inflamed GB w/o stones.... affects critically ill patients
67
risk factors for acalculous cholecystitis
trauma
surgery
burns
hyperalimentation (IV nutrition)
68
US appearance of acalculous cholecystitis
symptoms?
similar to acute cholecystitis w/o the stones
maybe painless due to pain meds
69
most common form of symptomatic GB disease
chronic cholecystitis.... chronic is more common than acute so more commonly causes symptoms
70
clinical presentation of chronic cholecystitis
intolerance to fatty foods
belching/indigestion
postprandial RUQ pain
N&V
71
Us appearance of chronic cholecystitis
thick, hetero GB wall
contracted GB w/ stones
WES sign
72
when do patient w/ GB stones usually feel pain
only if stones cause cholecystitis
73
what commonly happens to the GB wall w/ cirrhosis
thickens
74
altered lab values w/ chronic cholecystitis
ALT, AST, ALP, bilirubin
75
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
76
chronic cholecystitis is associated w/ which carcinoma
GB carcinoma
77
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
78
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
79
symptoms of Mirizzi's syndrome
fever, pain, obstructive jaundice (important)
80
Us appearance of Mirizzi's syndrome
dilated bile ducts above level of obstruction
| norm CBD
81
describe xanthogranulomatous cholecystitis
US appearance
rare form of chronic inflammation
hypo nodules/bands that represents fatty granulomatous nodules
thick GB wall
82
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)
83
porcelain GB is associated w/ what conditions
stones
| Highly associate w/GB carcinoma
84
Us appearance of porcelain GB
calcified GB wall
85
see notes for definitions
/
86
describe cholangitis
5 types
a rare, inflammatory and fibrosing disorder of the biliary tree
```
acute (bacterial)
recurrent pyogenic
AIDS
biliary ascariasis
primary sclerosing
```
87
Cause of acute (bacterial) cholangitis
clinical presentation
obstruction (chloedocholithiasis)
fever
RUQ pain
jaundice
88
US appearance of acute (bacterial) cholangitis
dilated biliary tree (BT) w/ thickened walls
may have BT stones
liver abscess
89
increased lab values w/ acute (bacterial) cholangitis
WBC, ALP, bilirubin
90
describe recurrent pyogenic cholangitis
cause
most common in SE and east Asia and most often affects the lateral Lt lobe of liver
unknown
91
possible complications of chronic recurrent pyogenic cholangitis
stasis and stone formation
biliary cirrhosis (hardening or bile ducts)
choleangiocarcinoma
92
US appearance of recurrent pyogenic cholangitis
dilated ducts w/ stones and sludge in one segment of the liver
93
describe cholangitis due to AIDS
US appearance
opportunist infection that occurs in the later stages of AIDS
thickened bile ducts and GB wall
focal strictures and intra + extra hepatic duct dilation
CBD dilated
94
increased lab value w/ cholangitis due to AIDS
which value is normal
ALP
bilirubin
95
cause of biliary ascariasis cholangitis
US appearance
roundworm infestation
echogenic, non-shadowing parallel lines/tubes in the ducts and GB
look for movement
96
w/ biliary ascariasis cholangitis what do the echogenic, parallel lines/tubes represent
the roundworm
97
how does the roundworm enter the bile ducts and GB
starts in the intestinal tract and moves retrogradely through the ampulla or vater into the GB and bile ducts
98
describe primary sclerosis cholangitis
cause?
what can it lead to
chronic inflammatory process where the bile ducts fibrose and inflame... unknown cause
biliar cirrhosis, portal HTN and liver failure
99
in which gender is primary sclerosis cholangitis more common
men
100
symptoms for primary sclerosis cholangitis
most are asymp, until it leads to other complications
101
80% of patients w/ primary sclerosis cholangitis have what other condition
ulcerative colitis, an autoimmune disorder
102
describe pancreatitis
inflammation of the panc, can be acute or chronic, range in severity and be diffuse or focal
103
how is acute pancreatitis diagnosed
clinical presentation
lab findings
lab or clinical findings
severe, constant and intense pain radiating to the back
N&V, maybe fever
increase amylase, and lipase
104
role of US w/ acute pancreatitis
find stone in the GB or duct
detect fluid collections
monitor inflammatory process
105
ethology of acute pancreatitis
alcohol abuse
| biliary stones
106
US appearance of diffuse acute pancreatitis
normal
hypo and hetero, enlarged/edematous
possible fluid collections
107
US appearance of focal acute pancreatitis
focal hypo areas commonly in the panc head
108
focal acute pancreatitis can mimic which other pathology
neoplasm... need lab test and HX to differentiate
109
which type of acute pancreatitis is most common in alcohol abusers
focal
110
complications of acute pancreatitis
```
fluid accumulations
pseudocysts (more common in chronic) and phlegmons
hemorrhage
necrosis
peritonitis
abscess
```
111
what are pseudocysts and phlegmons
pseudo: walled of collection of inflammatory debris
phle: inflammatory fat
112
describe chronic pancreatitis
most common cause
progressive, irreversible destruction and fibrotic scarring of the panc
alcoholism
113
US appearance of chronic pancreatitis
hallmark appearance
hetero
irregular contour
atrophy
dilated panc duct and calcifications
114
complications of chronic pancreatitis
lab findings
pseudocysts (more common in chronic)
porto-splenic vein thrombosis due to inflammation of PV and SV walls
norm amylase, increased lipase
115
most common method to assess inflammatory bowel diseases
barium studies and endoscopy
116
describe crohn's disease
cause
chronic inflammation most commonly affecting the terminal ileum and colon.... affects all layers of the bowl
unknown
117
signs and symptoms of crohn's disease
intermitten diarrhea
fever
crampy RLQ/LLQ pain
118
US appearance of crohn's disease
marked thickened, concentric, hypo walls (most common)
narrowed lumen
rigidity and lack of peristalsis in affected segment
creeping fat/edematous mesentary (echogenic halo)
hyperemia and mesenteric lymphadenopathy
119
complications of crohn's disease
abscess
fistula to the skin, bladder or other bowl loops - bands of variable echogenicity
inflamed fat (phlegmon) - poorly defined hypo areas
appendicitis
120
describe ulcerative colitis
ulceration of the colon and rectum that leads to the inflammation of ONLY mucosal and submucosal layer of the colon
121
ulcerative colitis is associated w/ what type of cancer
colon
122
clinical presentation of ulcerative colitis
rectal bleeding and abscesses
123
US appearance of ulcerative colitis
possibly normal or hypo, thick bowel wall
124
can we differentiate b/w crohns and ulcerative colitis on US
no
125
describe pseudomembranous colitis
necrotizing inflammation due to infection w/ C. diff
126
what drugs make a patient more susceptible to infection
why
oral antibiotics which wipe out the normal intestinal flora
127
clinical presentation of pseudomembranous colitis
diarrhea
fever
pain
128
US markers for pseudomembranous colitis
massive edema
| thick, hypo bowel wall w/ prominent austral markings
129
describe pneumatosis intestinalis
symptoms
rare disorder associated w/ underlying conditions like COPD or traumatic endoscopy
asymp
130
US appearance of pneumatosis intestinalis
- thick, hypo wall w/ echogenic areas in the wall w/ ring down artifact and dirty shadowing due to intramural pockets of gas
- air in the portal venous system (will move w/ patient position)
131
describe acute appendicitis
which age group is most often affected
most common cause of acute abdominal pain... young adults
132
causes of acute appendicitis and chain of events
obstruction of the appendiceal lumen compromises venous return and leads to bacteria overgrowth and inflammation
133
signs and symp of acute appendicitis
most important symp
starts w/ crampy peri-umbilical pain, N&V...
gaurding over McBurney's point (2/3 from umbilicus and 1/ from iliac crest)
classic presentation: RLQ pain, tenderness, leukocytosis
peritoneal irritation w/ rebound tenderness
134
which gender can have an atypical presentation for acute appendicitis
females, especially if appendix is low in the pelvis, can mimic pelvis pain
135
when do you use Us for appendicitis
slim adults and children
symptoms < 48 hrs in duration (acute)
differentiating gyne abnormalities
136
when do you use CT for appendicitis
normal or obese body habitus
chronic appendicitis
complications to the appendix
uncertain/equivocal US
137
landmarks for appendix
ascending colon, cecum/cecel lip, terminal ileum
iliopsoas
external iliac vessels
138
US appearance of appendicitis
```
blind-ended, non-peristalsing tube
non-compressible
>6 mm in AP diameter or single wall > 3mm
hyperemia
fat around the cecum
perforation
```
139
if the appendix is < 6mm AP how could we still diagnose appendicitis
if theres something obstructing the appendix (fecalith)
140
name for appendix w/ fecalith
appendicolith
141
complications of appendicitis
rupture
abscess
diffuse peritonitis
142
mesenteric adenitis symptoms
US appearance
symptoms mimic appendicitis...
RLQ lymphadenopathy w/ thick waled ileum but w/o appendicitis
143
describe a mucocele
which gender is affected more often
rare, distension of the appendix w/ mucous
can be benign or malignant...
females
144
causes of a benign mucocele
malignant?
fecaliths, inflammatory scarring, polyps
primary mucous cystadenoma/cystadenocarcinoma
145
symptoms of mucocele
asymp
146
US appearance of mucocele
large cyst/hypo mass in the RLQ
enhancement
wall calcifications
rupture of the malignant for can cause pseudomyoxoma peritonei (startburst appearance)
147
define diverticula
outpoutching of the bowel wall
148
define diverticulosis
multiple diverticula
149
what can diverticulitis lead to
inflammation
150
clinical presentation of diverticular bowel disease
classic triad:
fever
leukocytosis
pain
151
describe RLQ diverticulitis of the bowel
more common in which demographic
congenital and solitary... affects the cecum or AC and involves all layers of the gut wall
women, asian, young adults
152
Us appearance of RLQ diverticulitis of the bowel
```
sac like protrusion from wall
hyperemia
fecalith
inflammed fat
focal wall thickening
```
153
describe LLQ diverticulitis of the bowel
a defect in the muscular layer that causes multiple saccular out-pouchings of the mucosal layer.... inflammation occurs if fecal material gets trapped
usually effects the sigmoid and Lt colon... increased incidence w/ age and low bulk diet
154
most common form of diverticular bowel disease
LLQ diverticulitis
155
US appearance of LLQ diverticulitis of the bowel
hypo, concentric thickening of the bowel wall
enchogenic foci w/ post. shadowing or ring down
abcess
mesenteric thickening
156
describe a bladder diverticula
out-pouching of the bladder wall that can be congenital or acquired, usually lateral wall is affected
157
describe a congenital bladder diverticula
involves all 3 layers and located near the ureteral orifice
158
describe an acquired bladder diverticula
involves inner 2 layers only
| high occurrence w/ neurogenic bladder
159
will you see bladder diverticula post void
may disappear
160
complications of bladder diverticula
urinary stasis which can lead to infection or stone
161
describe a mechanical bowel obstruction (MBO)
US appearance
physical obstruction (GI mass or external impingement)
dilated bowel loops prox to the site of obstruction
hyperperistalsis in earlier stage
no peristalsis in late stage
162
why is there no peristalsis in the late stage of MBO
necrosis can start to occur
163
signs and symptoms of MBO
abdo pain and distention
| vomiting and diarrhea
164
describe intussusception
invagination/telescoping of bowel segments into the next distal segment
most common cause of sm bowel obstruction in children
165
signs and symptoms of intussusception
pain
vomiting
currant jelly stool (mix of stool, blood and mucous)
166
US appearance of intussusception
multiple concentric rings or the donut sign (the telescope)
| target appearance or pseudokidney
167
describe volvulus
close looped bowel obstruction
appears as a dilated U or C shaped loop of bowel... not diagnosed w/ US
168
what is paralytic ileus
US appearance
bowel obstruction related to lack of function and paralyzed muscle walls
++++ gas and not peristalsis
169
describe UTIs
higher incidences in which demographics
infection of the urinary sys that travels from the bladder to the kidneys
women, immunocompromised and diabetics
170
signs and symptoms of UTIs
flank pain and fever
| frequency and urgency
171
altered lab tests for UTIs
increased WBCs
pyuria
bacteremia
microscopic hematuria
172
describe acute pyelonephritis
affects which gender more, what age
refers to inflamed renal tubules caused by E. coli, can be focal or diffuse
young women (15-35)
173
how is acute pyelonephritis diagnosed
when is imaging done
clinically and w/ lab work
when symptoms or lab work abnormalities persist despite treatment
174
Us appearance of acute pyelonephritis
```
usually normal.... (important)
loss of CMJ
renal enlargement
compression of sinus
altered echo texture
focal masses (abscess)
+/- gas
```
175
describe chronic pyelonephritis
when does it start
which gender is more commonly affected
interstitial nephritis/intercellular c-tissue inflammation cause by vesicoureteric reflux
young age
women
176
US appearance of chronic pyelonephritis
cortical scarring
asymmetric changes b/w the R and L kidney
atrophy
dilated, blunted calyces
177
possible complication of pyelonephritis
initial and following up screening methods for this complication
abscess... can rupture into the collecting sys or perinephric space
CT initially
US follow up
178
describe pyonephrosis
associations in young and old adults
pus is the collecting sys
young: UPJ obstruction/stones
old: malignant obstruction (like TCC)
179
US appearance of pyonephrosis
complex hydro
180
2 rare forms of pyelonephritis
emphysematous
| xanthogranulomatous
181
describe emphysematous pyelonephritis
what demographic is most often affected
when gas forms in the parenchyma
older diabetic women (important)
182
US appearance of emphysematous pyelonephritis
preferred DI modality
linear echogenic areas w/ dirty shadowing
CT
183
describe xanthogranulomatous pyelonephritis
what can it cause
chronic, pus forming... usually unilateral and can be focal or diffuse
staghorn calculi (important - calcifications filling the collecting sys)
184
US appearance of xanthogranulomatous pyelonephritis
```
destruction of the parenchyma
loss of CMJ
dilated calyces
inflammatory mass
dirty shadow
```
185
can we tell xanthogranulomatous pyelonephritis from an abcess on US
no
186
describe glomerulonephritis
autoimmune rxn that causes inflammation at the level of the glomerulus
presents as medical renal disease
187
what are fungal infections of the urinary tact associated w/
what demographic is most often affected
associated w/ indwelling catheters
diabetics and immunocompromised patients
188
most common fungal infection of the urinary tact
candida albicans
189
US appearance of fungal infections of the urinary tact
hypo parenchymal masses (abscesses)
| fungal balls - echogenic, non-shadowing, mobile mass
190
DDX for fungal balls
blood clot
tumor
poly
191
2 parasitic infections of the urinary tract
schistosomiasis
| hydatid disease
192
what is cystitis
inflammation of the bladder
193
describe infectious cystitis
causes in men and women
how do patients present
infection that leads to mucosal edema and decreased bladder capacity (due to thickened bladder wall)
M: prostatitis or bladder outlet obstruction
W: E. coli
hematuria
194
US appearance of infectious cystitis
thick bladder wall
195
describe chronic cystitis
what gender is most often affected
chronic inflammation of the bladder
middle aged women
196
signs and symptoms of chronic cystitis
frequency, urgency, hematuria
197
US appearance of chronic cystitis
thick bladder wall
| possible TCC appearance
198
describe interstitial cystitis
associated w/ what type of conditions
US appearance
chronic bladder inflammation from an unknown cause
associated w/ systemic disease
can mimic bladder cancer
199
what is a neurogenic bladder
US appearance
loss of voluntary control of voiding
trebeculations
debris or stones in the bladder
hydro
200
describe retroperitoneal fibrosis
cause
when sheets of fibrous tissue form in the retroperitoneum and drape over the great vessel and surround the ureters
unknown etiology
201
DI modality of choice for retroperitoneal fibrosis
CT
202
US appearance of retroperitoneal fibrosis
hypo and homogenous masses
| envelope and obstruction of retro peri. strucutres
203
retroperitoneal fibrosis shouldnt be mistaken for which other pathology
inflammatory aneurysm
204
what is BPH
benign enlargement of the prostate in older men (>50)... transitional zone becomes enlarged and nodular
205
does size of the prostate correlate w/ symp
not always
206
upper limit of norm for prostate size
40 g/cc
207
signs and symptoms of BPH
nocturia (important)
| difficulty voiding due to prostate compressing ureter
208
US appearance of BPH
```
hypo enlargement of inner gland
calcifications
degenerative cysts
nodules
hetero
```
209
what is TURP
describe the process
transurethral resection of the prostate
an endoscope is inserted into the penile urethra and part of the prostate is resected.... uses a laser and electrocautery is used to control hemorrhage
210
purpose of TURP
relieve symptoms of BPH
211
Us appearance of TURP
key hole formed by the bladder and the part of the prostate that was removed
212
describe prostatitis
inflammation of the prostate and SVs due to an infection in the urethra that invades the ducts in the peripheral zone
-can be acute or chronic
213
signs and symptoms of prostatitis
dysuria (important), lower back pain, perineal pressure
214
altered lab values w/ prostatitis
increase PSA
215
cause of acute prostatitis
role of TRUS in acute prostatitis
what age group is most often affected
E. coli
limited
younger
216
clinical presentation of acute prostatitis
US appearance
+++++ pain
hypo areas
hyperemia
maybe abscess
217
cause of chronic prostatitis
US appearance
E. coli
focal mass w/ variable appearance
calcifications
periurethral gland irregularity
dilated SV
218
describe a pleural effusion
where is it located
fluid in the thoracic cavity, can be transudate or exudate
b/w the visceral and parietal pleura
219
describe transudate pleural effusion
anechoic fluid.... seen w/ CHF and cirrhosis (non inflammatory)
220
describe exudate pleural effusion
echogenic fluid w/ septations and pleural thickening... seen w/ infections and neoplasms (inflammatory and malignant)
221
most frequency cause of LUQ mass
splenomegaly
222
symptoms of splenomegaly
when is it often seen
LUQ fullness
pain
palpable spleen
infectious or inflammatory processes
223
causes of splenomegaly
```
infection (mono, TB, malaria)
inflammation (sarcoidosis)
hematologic disorders
neoplasms
congestion (PV thrombosis, P-HTN)
infiltration
```
224
more common causes of mild-mod splenomegaly
P-HTN
infection
AIDS
225
more common causes of marked splenomegaly
leukaemia
| lymphoma
226
sizes for mild-marked splenomegaly
mild-mod: 12-18 cm
| marked: > 18 cm
227
complications of splenomegaly
rupture... can be will minimal trauma (coughing)
228
describe acquired immune deficiency syndrome (AIDS)
syndrome of opportunistic infections, the final stage of infection by HIV
229
common diseases/abnormalities experienced by those w/ AIDS
```
Moderate splenomegaly
candida infections
pneumocystis carinii infections
kaposi's sarcoma
lymphoma
cholangitis (increased risk for GI neoplasms)
acute typhlitis
adrenal insufficiency
```
230
describe kaposi's sarcoma
cancer that hard to identify on US... hyper liver nodules and non-specific solid mass in adrenal gland
231
describe acute typhlitis
hypo, uniform thickening of the colon (cecum and AC)
