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AB&SS2 > C5: Infectious and Inflamm. Diseases > Flashcards

C5: Infectious and Inflamm. Diseases Flashcards

1
Q

most common clinical presentation of infection that is common to all patients

A

fever
pain
leukocytosis

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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

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3
Q

describe an abscess

common symptom

A

localized collection of pus that is a complication of infection

localized tenderness

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4
Q

patients at risk for an abscess

A

diabetics, immunocompromised, cancer patients

patients w/ hematomas or post-op

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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)

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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

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7
Q

how many types of hepatitis

A

6

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8
Q

primary mode of spread for Hep A

A

fecal oral

A for anal

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9
Q

primary mode of spread for Hep B

A

blood & body fluid

theres a B in Hep B, Blood and Body fluids

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10
Q

primary mode of spread for Hep C

A

transfusions

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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

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12
Q

which type of Hep has a carrier state

A

B

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13
Q

clinical recovery time for acute Hep

which type of hep is usually acute

A

4 months

Hep A (99%)

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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)

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15
Q

criteria for chronic Hep

A

biochemical markers are abnormal for > 6 months

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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

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17
Q

US appearance of chronic hepatitis

A

coarse liver
increased echogenicity
portal hypertension and cirrhosis

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18
Q

chronic hepatitis increases the patients risk for which type of carcinoma

A

HCC

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19
Q

altered lab values w/ Hep

A

ALT, AST, bilirubin

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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)

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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

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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)

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23
Q

describe candida

A

a fungal, yeast infection that typically effect immunocompromised patients

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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

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25
Q

describe the bulls eye and wheel w/in a wheel appearance

A

bulls eye: Hypo rim w/ hyper center

wheel: hypo rim, w/ hyper center and hypo nidus (dot)

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26
Q

describe pneumocystis Carinii

which organs are effected, most common?

A

a fungal, opportunistic infection that typically effect immunocompromised patients (AIDS)

liver (most common) , spleen, renal cortex, pan, lymph nodes

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27
Q

US appearance of pneumocystis Carinii

A

diffuse, small non-shadowing echogenic foci and progress to shadowing clumps of calcification

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28
Q

what type of disease is amebiasis

how is it spread and where does it travel

A

a parasitic disease from an ameba

fecal oral route, from the colon through the portal veins to the liver

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29
Q

which lobe is more commonly affected by amebiasis

A

Rt lobe, maybe due to gravity

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30
Q

US appearance of amebiasis in the liver

A

abscess

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31
Q

most common clinical presentation of amebiasis

A

pain, +/- diarrhea

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32
Q

describe hydatid disease

which organs does it affect

A

a parasitic infection from a tapeworm that’s common in sheep/cattle raising countries

liver (most common), spleen, ureter, bladder, kidneys

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33
Q

another name for hydatid disease

A

echinococcal disease

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34
Q

who is the definitive host for hydatid disease

what does that mean

A

dogs

host in which the parasite matures

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35
Q

who is the intermediate host for hydatid disease

what does that mean

A

humans

host in which the parasite undergoes development but doesn’t reach maturity

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36
Q

how is hydatid disease typically spread

how does it enter the liver

A

fecal-oral route

via the portal venous sys…. Rt lobe more commonly affected

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37
Q

3 layers of the cyst (containing the embryo) w/ hydatid disease

A

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

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38
Q

US appearance of the embryo w/ hydatid disease

A

hydatid sand (low level echos)
simple cyst
daughter cysts
calcified walls

THICK, DOUBLE LAYERED CYST

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39
Q

signs and symptoms of hydatid disease

A 
DEPENDS ON STAGE
pain/discomfort
jaundice
vascular thrombus/infarction
anaphylactic shock from cyst rupture
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40
Q

treatment for hydatid disease

why this treatment

A

surgery

the cyst is not aspirated because anaphylactic shock can occur if the cyst ruptures

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41
Q

describe schistosomiasis

how does the worm enter the body

A

a parasitic infection

penetrate the skin and travel to the mesenteric veins via lymph and blood vessels

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42
Q

which organs does schistosomiasis affect

A

liver, spleen, bowel, bladder

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43
Q

how do the ova enter the liver w/ schistosomiasis

what does this lead to

A

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

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44
Q

Us appearance of schistosomiasis in the liver

spleen

A

increased echogenicity/thickness of peri-portal walls
hepatomegaly initially…. shrunken liver chronically w/ portal HTN

splenomegaly

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45
Q

Us appearance of schistosomiasis involving the bladder

A

thickened bladder wall

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46
Q

what appearance is used to describe peri-portal fibrosis

A

turtle back appearance

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47
Q

describe TB

A

opportunistic infection that starts in the lungs but can affect many organs

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48
Q

US appearance of TB for spleen and adrenals

A

spleen: sm echogenic foci w/ or w/o shadowing

adrenals:
acute - bilateral, diffuse enlargment
chronic - atrophied and calcified

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49
Q

what can TB eventually lead to w/ the adrenals

A

atrophy and hypoadrenalism/adrenal insufficiency (Addison’s)

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50
Q

describe peritonitis

A

inflammation of the peritoneum due to infectious or non-infectious factors

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51
Q

what infectious and non-infecious factors can cause peritonitis

A

I: bacteria, viruses, fungi, parasites

N-I: pancreatitis, foreign bodies (talcum powder)

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52
Q

patient presentation w/ peritonitis

US appearance

A

severe pain

exudative fluid, lymphadenopathy

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53
Q

what is tuberculosis peritonitis

A

disease affecting immunocompromised patients

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54
Q

describe acute cholecystitis (common cause)

what can it lead to

A

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

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55
Q

acute cholecystitis affects which gender more

A

women

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56
Q

clinical presentation of acute cholecystitis

A

RUQ pain that radiates to the back
fever, leukocytosis
N&V
painful jaundice

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57
Q

US appearance of acute cholecystitis

A 
GB wall >3mm
hyperemia
GB stones, possibly impacted @ the neck (narrowest part)
GB hydrops - dilated GB
pericholecystic fluid - fluid around GB
\+ murphy's
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58
Q

altered lab values w/ acute cholecystitis

A

ALT, AST, ALP, serum bilirubin, WBCs ++

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59
Q

complications of acute cholecystitis

A 
empyema
gangrenous cholecystitis
emphysematous cholecystitis
perforation
abscess
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60
Q

describe gangrenous cholecystitis

sympt. and US appearance

A

necrosis of the GB

no pain, nerves are dead

non-layer bands of echogenic tissue in the GB

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61
Q

where does perforation of the GB typically occur

why

A

fundus

it has the poorest blood supply

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62
Q

Us appearance of GB perforation

A

FF in peritoneal cavity
collection adjacent to the GB
ill-defined hypo mass around the GB
may see the perforation

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63
Q

technique to better appreciate GB wall perforation

A

try a linear probe to see the wall defect better

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64
Q

describe emphysematous cholecystitis

which demographic is affected more

A

rare type of cholecystitis that progresses rapidly and is caused by gas forming bacteria (will see a dirty shadow)

men and diabetics

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65
Q

how to remember the US appearance of “emphysematous” diseases

A

people w/ emphysema can’t get enough air… emphysematous diseases will always contain air/dirty shadow

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66
Q

describe acalculous cholecystitis

who’s most commonly affected

A

inflamed GB w/o stones…. affects critically ill patients

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67
Q

risk factors for acalculous cholecystitis

A

trauma
surgery
burns
hyperalimentation (IV nutrition)

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68
Q

US appearance of acalculous cholecystitis

symptoms?

A

similar to acute cholecystitis w/o the stones

maybe painless due to pain meds

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69
Q

most common form of symptomatic GB disease

A

chronic cholecystitis…. chronic is more common than acute so more commonly causes symptoms

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70
Q

clinical presentation of chronic cholecystitis

A

intolerance to fatty foods
belching/indigestion
postprandial RUQ pain
N&V

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71
Q

Us appearance of chronic cholecystitis

A

thick, hetero GB wall
contracted GB w/ stones
WES sign

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72
Q

when do patient w/ GB stones usually feel pain

A

only if stones cause cholecystitis

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73
Q

what commonly happens to the GB wall w/ cirrhosis

A

thickens

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74
Q

altered lab values w/ chronic cholecystitis

A

ALT, AST, ALP, bilirubin

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75
Q

complications of chronic cholecystitis

A

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

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76
Q

chronic cholecystitis is associated w/ which carcinoma

A

GB carcinoma

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77
Q

describe Mirizzi’s syndrome

A

a rare complication of chronic cholecystitis where there’s an impacted stone in the cystic duct, GB neck or hartmann’s pouch

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78
Q

how does Mirizzi’s syndrome affect the CHD

other complications

A

CHD is extrinsically compressed by the stone or inflammation which can lead to obstructive jaundice

fistula b/w cystic duct and CHD

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79
Q

symptoms of Mirizzi’s syndrome

A

fever, pain, obstructive jaundice (important)

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80
Q

Us appearance of Mirizzi’s syndrome

A

dilated bile ducts above level of obstruction

norm CBD

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81
Q

describe xanthogranulomatous cholecystitis

US appearance

A

rare form of chronic inflammation

hypo nodules/bands that represents fatty granulomatous nodules
thick GB wall

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82
Q

describe a porcelain GB

who’s most commonly affected

A

rare calcification of GB wall, maybe a type of chronic chole.
unknown cause

older females (60s)

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83
Q

porcelain GB is associated w/ what conditions

A

stones

Highly associate w/GB carcinoma

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84
Q

Us appearance of porcelain GB

A

calcified GB wall

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85
Q

see notes for definitions

A

/

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86
Q

describe cholangitis

5 types

A

a rare, inflammatory and fibrosing disorder of the biliary tree

acute (bacterial)
recurrent pyogenic
AIDS
biliary ascariasis
primary sclerosing
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87
Q

Cause of acute (bacterial) cholangitis

clinical presentation

A

obstruction (chloedocholithiasis)

fever
RUQ pain
jaundice

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88
Q

US appearance of acute (bacterial) cholangitis

A

dilated biliary tree (BT) w/ thickened walls
may have BT stones
liver abscess

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89
Q

increased lab values w/ acute (bacterial) cholangitis

A

WBC, ALP, bilirubin

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90
Q

describe recurrent pyogenic cholangitis

cause

A

most common in SE and east Asia and most often affects the lateral Lt lobe of liver

unknown

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91
Q

possible complications of chronic recurrent pyogenic cholangitis

A

stasis and stone formation
biliary cirrhosis (hardening or bile ducts)
choleangiocarcinoma

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92
Q

US appearance of recurrent pyogenic cholangitis

A

dilated ducts w/ stones and sludge in one segment of the liver

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93
Q

describe cholangitis due to AIDS

US appearance

A

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
Q

increased lab value w/ cholangitis due to AIDS

which value is normal

A

ALP

bilirubin

95
Q

cause of biliary ascariasis cholangitis

US appearance

A

roundworm infestation

echogenic, non-shadowing parallel lines/tubes in the ducts and GB
look for movement

96
Q

w/ biliary ascariasis cholangitis what do the echogenic, parallel lines/tubes represent

A

the roundworm

97
Q

how does the roundworm enter the bile ducts and GB

A

starts in the intestinal tract and moves retrogradely through the ampulla or vater into the GB and bile ducts

98
Q

describe primary sclerosis cholangitis

cause?
what can it lead to

A

chronic inflammatory process where the bile ducts fibrose and inflame… unknown cause

biliar cirrhosis, portal HTN and liver failure

99
Q

in which gender is primary sclerosis cholangitis more common

A

men

100
Q

symptoms for primary sclerosis cholangitis

A

most are asymp, until it leads to other complications

101
Q

80% of patients w/ primary sclerosis cholangitis have what other condition

A

ulcerative colitis, an autoimmune disorder

102
Q

describe pancreatitis

A

inflammation of the panc, can be acute or chronic, range in severity and be diffuse or focal

103
Q

how is acute pancreatitis diagnosed

clinical presentation

lab findings

A

lab or clinical findings

severe, constant and intense pain radiating to the back
N&V, maybe fever

increase amylase, and lipase

104
Q

role of US w/ acute pancreatitis

A

find stone in the GB or duct
detect fluid collections
monitor inflammatory process

105
Q

ethology of acute pancreatitis

A

alcohol abuse

biliary stones

106
Q

US appearance of diffuse acute pancreatitis

A

normal
hypo and hetero, enlarged/edematous
possible fluid collections

107
Q

US appearance of focal acute pancreatitis

A

focal hypo areas commonly in the panc head

108
Q

focal acute pancreatitis can mimic which other pathology

A

neoplasm… need lab test and HX to differentiate

109
Q

which type of acute pancreatitis is most common in alcohol abusers

A

focal

110
Q

complications of acute pancreatitis

A 
fluid accumulations
pseudocysts (more common in chronic) and phlegmons
hemorrhage
necrosis
peritonitis
abscess
111
Q

what are pseudocysts and phlegmons

A

pseudo: walled of collection of inflammatory debris
phle: inflammatory fat

112
Q

describe chronic pancreatitis

most common cause

A

progressive, irreversible destruction and fibrotic scarring of the panc

alcoholism

113
Q

US appearance of chronic pancreatitis

hallmark appearance

A

hetero
irregular contour
atrophy

dilated panc duct and calcifications

114
Q

complications of chronic pancreatitis

lab findings

A

pseudocysts (more common in chronic)
porto-splenic vein thrombosis due to inflammation of PV and SV walls

norm amylase, increased lipase

115
Q

most common method to assess inflammatory bowel diseases

A

barium studies and endoscopy

116
Q

describe crohn’s disease

cause

A

chronic inflammation most commonly affecting the terminal ileum and colon…. affects all layers of the bowl

unknown

117
Q

signs and symptoms of crohn’s disease

A

intermitten diarrhea
fever
crampy RLQ/LLQ pain

118
Q

US appearance of crohn’s disease

A

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
Q

complications of crohn’s disease

A

abscess

fistula to the skin, bladder or other bowl loops - bands of variable echogenicity

inflamed fat (phlegmon) - poorly defined hypo areas

appendicitis

120
Q

describe ulcerative colitis

A

ulceration of the colon and rectum that leads to the inflammation of ONLY mucosal and submucosal layer of the colon

121
Q

ulcerative colitis is associated w/ what type of cancer

A

colon

122
Q

clinical presentation of ulcerative colitis

A

rectal bleeding and abscesses

123
Q

US appearance of ulcerative colitis

A

possibly normal or hypo, thick bowel wall

124
Q

can we differentiate b/w crohns and ulcerative colitis on US

A

no

125
Q

describe pseudomembranous colitis

A

necrotizing inflammation due to infection w/ C. diff

126
Q

what drugs make a patient more susceptible to infection

why

A

oral antibiotics which wipe out the normal intestinal flora

127
Q

clinical presentation of pseudomembranous colitis

A

diarrhea
fever
pain

128
Q

US markers for pseudomembranous colitis

A

massive edema

thick, hypo bowel wall w/ prominent austral markings

129
Q

describe pneumatosis intestinalis

symptoms

A

rare disorder associated w/ underlying conditions like COPD or traumatic endoscopy

asymp

130
Q

US appearance of pneumatosis intestinalis

A
  • 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
Q

describe acute appendicitis

which age group is most often affected

A

most common cause of acute abdominal pain… young adults

132
Q

causes of acute appendicitis and chain of events

A

obstruction of the appendiceal lumen compromises venous return and leads to bacteria overgrowth and inflammation

133
Q

signs and symp of acute appendicitis

most important symp

A

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
Q

which gender can have an atypical presentation for acute appendicitis

A

females, especially if appendix is low in the pelvis, can mimic pelvis pain

135
Q

when do you use Us for appendicitis

A

slim adults and children
symptoms < 48 hrs in duration (acute)
differentiating gyne abnormalities

136
Q

when do you use CT for appendicitis

A

normal or obese body habitus
chronic appendicitis
complications to the appendix
uncertain/equivocal US

137
Q

landmarks for appendix

A

ascending colon, cecum/cecel lip, terminal ileum
iliopsoas
external iliac vessels

138
Q

US appearance of appendicitis

A 
blind-ended, non-peristalsing tube
non-compressible
>6 mm in AP diameter or single wall > 3mm
hyperemia
fat around the cecum
perforation
139
Q

if the appendix is < 6mm AP how could we still diagnose appendicitis

A

if theres something obstructing the appendix (fecalith)

140
Q

name for appendix w/ fecalith

A

appendicolith

141
Q

complications of appendicitis

A

rupture
abscess
diffuse peritonitis

142
Q

mesenteric adenitis symptoms

US appearance

A

symptoms mimic appendicitis…

RLQ lymphadenopathy w/ thick waled ileum but w/o appendicitis

143
Q

describe a mucocele

which gender is affected more often

A

rare, distension of the appendix w/ mucous
can be benign or malignant…

females

144
Q

causes of a benign mucocele

malignant?

A

fecaliths, inflammatory scarring, polyps

primary mucous cystadenoma/cystadenocarcinoma

145
Q

symptoms of mucocele

A

asymp

146
Q

US appearance of mucocele

A

large cyst/hypo mass in the RLQ
enhancement
wall calcifications
rupture of the malignant for can cause pseudomyoxoma peritonei (startburst appearance)

147
Q

define diverticula

A

outpoutching of the bowel wall

148
Q

define diverticulosis

A

multiple diverticula

149
Q

what can diverticulitis lead to

A

inflammation

150
Q

clinical presentation of diverticular bowel disease

A

classic triad:
fever
leukocytosis
pain

151
Q

describe RLQ diverticulitis of the bowel

more common in which demographic

A

congenital and solitary… affects the cecum or AC and involves all layers of the gut wall

women, asian, young adults

152
Q

Us appearance of RLQ diverticulitis of the bowel

A 
sac like protrusion from wall
hyperemia
fecalith
inflammed fat
focal wall thickening
153
Q

describe LLQ diverticulitis of the bowel

A

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
Q

most common form of diverticular bowel disease

A

LLQ diverticulitis

155
Q

US appearance of LLQ diverticulitis of the bowel

A

hypo, concentric thickening of the bowel wall
enchogenic foci w/ post. shadowing or ring down
abcess
mesenteric thickening

156
Q

describe a bladder diverticula

A

out-pouching of the bladder wall that can be congenital or acquired, usually lateral wall is affected

157
Q

describe a congenital bladder diverticula

A

involves all 3 layers and located near the ureteral orifice

158
Q

describe an acquired bladder diverticula

A

involves inner 2 layers only

high occurrence w/ neurogenic bladder

159
Q

will you see bladder diverticula post void

A

may disappear

160
Q

complications of bladder diverticula

A

urinary stasis which can lead to infection or stone

161
Q

describe a mechanical bowel obstruction (MBO)

US appearance

A

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
Q

why is there no peristalsis in the late stage of MBO

A

necrosis can start to occur

163
Q

signs and symptoms of MBO

A

abdo pain and distention

vomiting and diarrhea

164
Q

describe intussusception

A

invagination/telescoping of bowel segments into the next distal segment
most common cause of sm bowel obstruction in children

165
Q

signs and symptoms of intussusception

A

pain
vomiting
currant jelly stool (mix of stool, blood and mucous)

166
Q

US appearance of intussusception

A

multiple concentric rings or the donut sign (the telescope)

target appearance or pseudokidney

167
Q

describe volvulus

A

close looped bowel obstruction

appears as a dilated U or C shaped loop of bowel… not diagnosed w/ US

168
Q

what is paralytic ileus

US appearance

A

bowel obstruction related to lack of function and paralyzed muscle walls

++++ gas and not peristalsis

169
Q

describe UTIs

higher incidences in which demographics

A

infection of the urinary sys that travels from the bladder to the kidneys

women, immunocompromised and diabetics

170
Q

signs and symptoms of UTIs

A

flank pain and fever

frequency and urgency

171
Q

altered lab tests for UTIs

A

increased WBCs
pyuria
bacteremia
microscopic hematuria

172
Q

describe acute pyelonephritis

affects which gender more, what age

A

refers to inflamed renal tubules caused by E. coli, can be focal or diffuse

young women (15-35)

173
Q

how is acute pyelonephritis diagnosed

when is imaging done

A

clinically and w/ lab work

when symptoms or lab work abnormalities persist despite treatment

174
Q

Us appearance of acute pyelonephritis

A 
usually normal.... (important)
loss of CMJ
renal enlargement
compression of sinus
altered echo texture
focal masses (abscess)
\+/- gas
175
Q

describe chronic pyelonephritis

when does it start
which gender is more commonly affected

A

interstitial nephritis/intercellular c-tissue inflammation cause by vesicoureteric reflux

young age
women

176
Q

US appearance of chronic pyelonephritis

A

cortical scarring
asymmetric changes b/w the R and L kidney
atrophy
dilated, blunted calyces

177
Q

possible complication of pyelonephritis

initial and following up screening methods for this complication

A

abscess… can rupture into the collecting sys or perinephric space

CT initially
US follow up

178
Q

describe pyonephrosis

associations in young and old adults

A

pus is the collecting sys

young: UPJ obstruction/stones
old: malignant obstruction (like TCC)

179
Q

US appearance of pyonephrosis

A

complex hydro

180
Q

2 rare forms of pyelonephritis

A

emphysematous

xanthogranulomatous

181
Q

describe emphysematous pyelonephritis

what demographic is most often affected

A

when gas forms in the parenchyma

older diabetic women (important)

182
Q

US appearance of emphysematous pyelonephritis

preferred DI modality

A

linear echogenic areas w/ dirty shadowing

CT

183
Q

describe xanthogranulomatous pyelonephritis

what can it cause

A

chronic, pus forming… usually unilateral and can be focal or diffuse

staghorn calculi (important - calcifications filling the collecting sys)

184
Q

US appearance of xanthogranulomatous pyelonephritis

A 
destruction of the parenchyma
loss of CMJ
dilated calyces
inflammatory mass
dirty shadow
185
Q

can we tell xanthogranulomatous pyelonephritis from an abcess on US

A

no

186
Q

describe glomerulonephritis

A

autoimmune rxn that causes inflammation at the level of the glomerulus

presents as medical renal disease

187
Q

what are fungal infections of the urinary tact associated w/

what demographic is most often affected

A

associated w/ indwelling catheters

diabetics and immunocompromised patients

188
Q

most common fungal infection of the urinary tact

A

candida albicans

189
Q

US appearance of fungal infections of the urinary tact

A

hypo parenchymal masses (abscesses)

fungal balls - echogenic, non-shadowing, mobile mass

190
Q

DDX for fungal balls

A

blood clot
tumor
poly

191
Q

2 parasitic infections of the urinary tract

A

schistosomiasis

hydatid disease

192
Q

what is cystitis

A

inflammation of the bladder

193
Q

describe infectious cystitis

causes in men and women

how do patients present

A

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
Q

US appearance of infectious cystitis

A

thick bladder wall

195
Q

describe chronic cystitis

what gender is most often affected

A

chronic inflammation of the bladder

middle aged women

196
Q

signs and symptoms of chronic cystitis

A

frequency, urgency, hematuria

197
Q

US appearance of chronic cystitis

A

thick bladder wall

possible TCC appearance

198
Q

describe interstitial cystitis

associated w/ what type of conditions

US appearance

A

chronic bladder inflammation from an unknown cause

associated w/ systemic disease

can mimic bladder cancer

199
Q

what is a neurogenic bladder

US appearance

A

loss of voluntary control of voiding

trebeculations
debris or stones in the bladder
hydro

200
Q

describe retroperitoneal fibrosis

cause

A

when sheets of fibrous tissue form in the retroperitoneum and drape over the great vessel and surround the ureters

unknown etiology

201
Q

DI modality of choice for retroperitoneal fibrosis

A

CT

202
Q

US appearance of retroperitoneal fibrosis

A

hypo and homogenous masses

envelope and obstruction of retro peri. strucutres

203
Q

retroperitoneal fibrosis shouldnt be mistaken for which other pathology

A

inflammatory aneurysm

204
Q

what is BPH

A

benign enlargement of the prostate in older men (>50)… transitional zone becomes enlarged and nodular

205
Q

does size of the prostate correlate w/ symp

A

not always

206
Q

upper limit of norm for prostate size

A

40 g/cc

207
Q

signs and symptoms of BPH

A

nocturia (important)

difficulty voiding due to prostate compressing ureter

208
Q

US appearance of BPH

A 
hypo enlargement of inner gland
calcifications
degenerative cysts
nodules
hetero
209
Q

what is TURP

describe the process

A

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
Q

purpose of TURP

A

relieve symptoms of BPH

211
Q

Us appearance of TURP

A

key hole formed by the bladder and the part of the prostate that was removed

212
Q

describe prostatitis

A

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
Q

signs and symptoms of prostatitis

A

dysuria (important), lower back pain, perineal pressure

214
Q

altered lab values w/ prostatitis

A

increase PSA

215
Q

cause of acute prostatitis

role of TRUS in acute prostatitis

what age group is most often affected

A

E. coli

limited

younger

216
Q

clinical presentation of acute prostatitis

US appearance

A

+++++ pain

hypo areas
hyperemia
maybe abscess

217
Q

cause of chronic prostatitis

US appearance

A

E. coli

focal mass w/ variable appearance
calcifications
periurethral gland irregularity
dilated SV

218
Q

describe a pleural effusion

where is it located

A

fluid in the thoracic cavity, can be transudate or exudate

b/w the visceral and parietal pleura

219
Q

describe transudate pleural effusion

A

anechoic fluid…. seen w/ CHF and cirrhosis (non inflammatory)

220
Q

describe exudate pleural effusion

A

echogenic fluid w/ septations and pleural thickening… seen w/ infections and neoplasms (inflammatory and malignant)

221
Q

most frequency cause of LUQ mass

A

splenomegaly

222
Q

symptoms of splenomegaly

when is it often seen

A

LUQ fullness
pain
palpable spleen

infectious or inflammatory processes

223
Q

causes of splenomegaly

A 
infection (mono, TB, malaria)
inflammation (sarcoidosis)
hematologic disorders
neoplasms
congestion (PV thrombosis, P-HTN)
infiltration
224
Q

more common causes of mild-mod splenomegaly

A

P-HTN
infection
AIDS

225
Q

more common causes of marked splenomegaly

A

leukaemia

lymphoma

226
Q

sizes for mild-marked splenomegaly

A

mild-mod: 12-18 cm

marked: > 18 cm

227
Q

complications of splenomegaly

A

rupture… can be will minimal trauma (coughing)

228
Q

describe acquired immune deficiency syndrome (AIDS)

A

syndrome of opportunistic infections, the final stage of infection by HIV

229
Q

common diseases/abnormalities experienced by those w/ AIDS

A 
Moderate splenomegaly
candida infections
pneumocystis carinii infections
kaposi's sarcoma
lymphoma
cholangitis (increased risk for GI neoplasms)
acute typhlitis
adrenal insufficiency
230
Q

describe kaposi’s sarcoma

A

cancer that hard to identify on US… hyper liver nodules and non-specific solid mass in adrenal gland

231
Q

describe acute typhlitis

A

hypo, uniform thickening of the colon (cecum and AC)

AB&SS2 (9 decks)

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