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SONOCAN ABD Review > Infectious and inflamatory disease > Flashcards

Infectious and inflamatory disease Flashcards

1
Q

Most Common Clinical Presentation of Infection 3

A
  1. Fever
  2. Pain
  3. Leukocytosis
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2
Q

For fever of Unknown Origin (FUO) what are of great importance when diagnosing? What should we look for sonographically?

A
  1. History and lab tests are of great importance.
  2. Look for organomegaly. An infectious process can lead to abscess.
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3
Q

What does the word ‘itis’ indicate?

A

An inflammatory process.

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4
Q

What is an Abscess?

A

A localized collection of pus and a complication to an infection.

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5
Q

Patients at risk for Abscess 5

A
  1. Diabetics
  2. Immunosuppressed patients
  3. Cancer patients
  4. Patients with hematomas
  5. Post-operative patients.
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6
Q

Clinical presentation of Abscess

A

Patients often present with localized tenderness.

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7
Q

Sonographic appearance of Abscess

A
  1. Fluid filled area
  2. Posterior enhancement
  3. Thick irregular walls
  4. Debris
  5. Possible gas.
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8
Q

What is Hepatitis?

A

An inflammation of the liver that may be caused by viruses or toxins.

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9
Q

Signs and symptoms of Hepatitis 4

A
  1. Fever
  2. Chills,
  3. Nausea and vomiting
  4. Possibly jaundice.
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10
Q

Types of Viral Hepatitis

A

6 types.

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11
Q

Primary mode of spread for Hepatitis A

A

Fecal-oral route.

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12
Q

Primary mode of spread for Hepatitis B

A

Blood and body fluids. Has a carrier state.

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13
Q

Primary mode of spread for Hepatitis C

A

Transfusions.

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14
Q

Primary mode of spread for Hepatitis D

A

Dependent on hepatitis B. IV drug users.

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15
Q

Clinical recovery period of Acute Hepatitis? How many cases are acute?

A

Clinical recovery with 4 months. 99% of cases of Hepatitis A are acute.

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16
Q

Clinical presentation of Subfulminant/Fulminant Hepatitis? Death occurs if what happens to the liver?

A

Due to Hepatitis B or drug toxicity, hepatic necrosis. Death occurs if >40% of hepatic parenchyma is lost.

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17
Q

Clinical presentation of Chronic Hepatitis

A

Biochemical markers remain abnormal for >6 months.

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18
Q

Sonographic appearance of Acute Hepatitis? 5

A
  1. Hepatomegaly
  2. Decreased liver echogenicity
  3. Prominent portal vein walls
  4. Gallbladder wall thickening.
  5. Most often, the liver appears normal.
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19
Q

Sonographic appearance of Chronic Hepatitis? 4

A
  1. Coarse liver parenchyma
  2. Overall increase in echogenicity
  3. Portal hypertension
  4. Cirrhosis.
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20
Q

Lab values in Hepatitis. 3

A

ALT, AST, Bilirubin.

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21
Q

Routes of spread for Bacterial Liver Infections? 4

A
  1. Biliary tract
  2. Portal venous system
  3. Hepatic artery
  4. Trauma.
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22
Q

Clinical presentation of Bacterial Liver Infections. 4

A
  1. Fever
  2. RUQ pain
  3. Malaise
  4. Anorexia.
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23
Q

Sonographic appearance of Bacterial Liver Infections 4

A
  1. Simple to complex cyst
  2. Shaggy wall
  3. Internal septations
  4. Echogenic foci with posterior reverberation (gas).
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24
Q

What is Candidiasis?

A

A yeast infection that typically affects immunocompromised patients.

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25
Clinical presentation of Candidiasis
Persistent fever with WBC count returning to normal.
26
Sonographic presentation of Candidiasis
1. Uniformly hypoechoic 2. Hyperechoic 3. Bulls eye appearance 4. Wheel within a wheel appearance 5. Liver, kidney and spleen involvement.
27
What is Pneumocystis Carinii?
An opportunistic infection that affects immune compromised patients, such as those with AIDS.
28
Sonographic appearance of Pneumocystis Carinii
Tiny non-shadowing echogenic foci, progresses to shadowing clumps of calcification.
29
What is Amebiasis?
A fecal-oral route of spread to the liver, traveling from the colon through the portal vein.
30
Sonographic appearance of Amebiasis. 3
1. Round/oval abscess 2. Hypoechoic 3. Fine internal echoes.
31
Clinical presentation of Amebiasis
1. Pain 2. Possible diarrhea.
32
What is Hydatid Disease?
A parasitic infection (tapeworm) common in sheep and cattle raising countries.
33
Hosts in Hydatid Disease
Dogs are typically the definitive host; humans are an intermediate host.
34
Sonographic appearances of Hydatid Disease 4
1. Hydatid sand 2. Simple cyst 3. Daughter cysts 4. Calcified walls.
35
Signs and symptoms of Hydatid Disease 5
1. Dependent on stage 2. Pain/discomfort 3. Jaundice 4. Vascular thrombosis/infarction 5. Anaphylactic shock (rare – from cyst rupture).
36
What is Schistosomiasis?
A parasitic infection where worms penetrate the skin and travel to mesenteric veins.
37
Sonographic appearance of Schistosomiasis 4
1. Thickening/increased echogenicity of the periportal walls 2. Initially enlarged liver 3. Over time liver shrinks 4. Splenomegaly.
38
What is Tuberculosis (TB)?
An opportunistic infection that starts in the lungs but can affect many organs.
39
Sonographic appearance of TB in the spleen
Tiny echogenic foci with or without shadowing.
40
Sonographic appearance of TB in the adrenal glands 2
Acute: bilateral, diffuse enlargement; Chronic: atrophied and calcified.
41
What is Peritonitis?
Inflammation of the peritoneum caused by infectious or non-infectious factors.
42
Clinical presentation of Peritonitis
Patients present with severe pain.
43
What is Cholecystitis? Most often what is it caused by?
Inflammation of the gallbladder, most often due to impacted stones.
44
Clinical presentation of Acute Cholecystitis. 5
1. RUQ pain 2. Fever 3. Leukocytosis 4. Nausea and vomiting 5. Jaundice (25%).
45
Sonographic findings of Acute Cholecystitis 7
1. GB wall >3mm 2. Hyperemia 3. Gallstones 4. Impaction at neck 5. GB hydrops 6. Pericholecystic fluid 7. Positive Murphy’s sign.
46
Complications of Acute Cholecystitis
1. Empyema 2. Gangrenous cholecystitis 3. emphysematous cholecystitis 4. Perforation, abscess.
47
What is Gangrenous Cholecystitis?
Necrosis of the gallbladder, typically presents with no pain.
48
Sonographic appearance of Gangrenous Cholecystitis
Non-layering bands of echogenic tissue within the GB.
49
What is Perforation in Cholecystitis?
Typically occurs at the fundus, leading to free fluid in the peritoneal cavity.
50
Sonographic findings of Perforation
Low level collection adjacent to the GB, ill-defined hypoechoic mass surrounding the GB.
51
What is Emphysematous Cholecystitis?
A rare condition caused by gas forming bacteria, progresses rapidly.
52
Sonographic appearance of Emphysematous Cholecystitis
Dirty shadowing.
53
What is Acalculous Cholecystitis?
An inflamed gallbladder without stones, affects critically ill patients.
54
Sonographic appearance of Acalculous Cholecystitis
Similar to acute cholecystitis but without stones.
55
What is Chronic Cholecystitis?
The most common form of symptomatic gallbladder disease.
56
Clinical presentation of Chronic Cholecystitis 4
1. Intolerance to fatty foods 2. Belching/indigestion 3. Postprandial RUQ pain 4. Nausea and vomiting.
57
Sonographic appearance of Chronic Cholecystitis
Thick heterogeneous wall, contracted GB with gallstones, WES sign.
58
Complications of Chronic Cholecystitis 4
1. Bouveret syndrome 2. Gallstone ileus 3. Mirizzi’s syndrome 4. Associated with gallbladder carcinoma.
59
What is Mirizzi Syndrome?
A rare complication with impacted stone in the cystic duct, GB neck or Hartmann’s pouch.
60
Clinical symptoms of Mirizzi Syndrome
1. Fever 2. Pain 3. Jaundice.
61
Sonographic findings of Mirizzi Syndrome
Dilated bile ducts above the level of obstruction, CBD normal.
62
What is Xanthogranulomatous Cholecystitis?
A rare form of chronic inflammation.
63
Sonographic appearance of Xanthogranulomatous Cholecystitis
Hypoechoic nodules/bands in a thick GB wall.
64
What is Porcelain Gallbladder?
A rare condition with a calcified GB wall, high association with gallbladder carcinoma.
65
What is Cholangitis?
An inflammatory and fibrosing disorder of the biliary tree.
66
Types of Cholangitis 5
1. Acute (Bacterial) 2. Recurrent Pyogenic 3. AIDS 4. Biliary Ascariasis 5. Primary Sclerosing.
67
Clinical presentation of Acute Cholangitis 3
1. Fever 2. RUQ pain 3. Jaundice.
68
Sonographic findings of Acute Cholangitis
Dilated biliary tree with thickened walls, stones in the biliary tree, liver abscess.
69
What is Pancreatitis?
Inflammation of the pancreas, can be acute or chronic.
70
Clinical presentation of Acute Pancreatitis 6
1. Severe 2. Constant 3. Intense pain radiating to back 4. Relief by sitting up or bending at the waist 5. Nausea and vomiting 6. Possible fever.
71
Sonographic appearance of Acute Pancreatitis 7
1. May appear normal 2. Decreased echogenicity 3. Heterogeneous 4. Edematous 5. Smooth contour 6. Increased size 7. Possible fluid collections.
72
What is Chronic Pancreatitis?
Progressive, irreversible destruction of the pancreas, primarily due to alcoholism.
73
Sonographic appearance of Chronic Pancreatitis
1. Heterogeneous 2. Dilated pancreatic duct 3. Calcifications 4. Irregular contour 5. Decreased size.
74
Lab findings in Acute Pancreatitis 2
Increased amylase, increased lipase.
75
Lab findings in Chronic Pancreatitis 2
Normal amylase, increased lipase.
76
What is Inflammatory Bowel Disease?
Includes Crohn’s and Ulcerative Colitis.
77
Sonographic appearance of Crohn’s Disease 7
1. Markedly thickened hypoechoic wall 2. Narrowed lumen 3. Aperistalsis of the affected portion 4. Rigidity to pressure 5. Creeping fat 6. Hyperemia 7. Mesenteric lymphadenopathy.
78
What is Ulcerative Colitis?
Ulceration of the colon and rectum, inflammation of mucosal and submucosal layers of colon.
79
Clinical presentation of Ulcerative Colitis
Patients may present with rectal bleeding and abscesses.
80
Sonographic appearance of Ulcerative Colitis 2
1. Possibly normal or hypoechoic 2. Thickened bowel wall.
81
What is Pseudomembranous Colitis?
A necrotizing inflammation due to infection with C. difficile.
82
Clinical presentation of Pseudomembranous Colitis
1. Diarrhea 2. Fever 3. Pain.
83
Sonographic markers of Pseudomembranous Colitis 3
1. Rare, may see massive edema 2. Thickened hypoechoic bowel wall 3. Prominent haustral markings.
84
What is the increased risk associated with colon cancer?
Patients may present with rectal bleeding and abscesses. ## Footnote Sonographically: possibly normal or hypoechoic, thickened bowel wall.
85
What is Pseudomembranous Colitis?
A necrotizing inflammation caused by infection with C. difficile. ## Footnote Patients become susceptible to infection when oral antibiotics wipe out the normal intestinal flora.
86
What are the clinical presentations of Pseudomembranous Colitis?
1. Diarrhea 2. Fever 3. Pain. ## Footnote Sonographic markers are rare but may include massive edema, thickened hypoechoic bowel wall, and prominent haustral markings.
87
What is Pneumatosis Intestinalis?
A rare condition associated with underlying conditions and is typically asymptomatic. ## Footnote Sonographic appearance includes thick hypoechoic wall and hyperechoic areas in the wall with artifact.
88
What is the most common cause of acute abdominal pain?
Acute Appendicitis. ## Footnote More prevalent in young adults, with women possibly having an atypical presentation.
89
What causes Acute Appendicitis?
Obstruction of the appendiceal lumen leads to compromised venous return, bacterial overgrowth, and inflammation.
90
What are the signs and symptoms of Acute Appendicitis? 5
1. Starts with crampy peri-umbilical pain 2. Nausea, and vomiting 3. Leading to classic RLQ pain and tenderness 4. Leukocytosis 5. Peritoneal irritation. ## Footnote Guarding over McBurney’s point is noted.
91
What imaging is used for diagnosing Acute Appendicitis?
Ultrasound is used for slim adult patients and children with symptoms less than 48 hours in duration, while CT is used for normal to obese adult patients. ## Footnote CT can help identify chronic appendicitis and complications.
92
What are the sonographic landmarks for the appendix?
Ascending colon, cecum/cecal tip, terminal ileum, iliopsoas, and external iliac vessels.
93
What is the sonographic appearance of an inflamed appendix? What is the wall thickness? 2
1. A blind-ended non-peristalsing tube that is non-compressible 2. AP diameter > 6 mm or single wall thickness > 3 mm. ## Footnote Presence of fecalith (appendicolith) indicates a positive finding.
94
What are the complications of Acute Appendicitis? 3
1. Rupture 2. Abscess 3. Diffuse peritonitis.
95
What is Mesenteric Adenitis? 2
1. A condition where symptoms mimic appendicitis 2. Presenting with RLQ lymphadenopathy without appendicitis. ## Footnote Seen as enlarged lymph nodes with a thick-walled ileum.
96
What is a Mucocele?
Distension of the appendix with mucous, which is rare and more common in females. ## Footnote Can be benign or malignant, with benign causes including fecaliths and malignant causes including primary mucous cystadenoma/cystadenocarcinoma.
97
What is the sonographic presentation of a Mucocele? 3
1. A large cystic/hypoechoic mass in the RLQ with enhancement 2. Wall calcifications 3. Potential rupture leading to pseudomyxoma peritonei.
98
What is diverticular disease?
Outpouching of the bowel wall, known as diverticula.
99
What is diverticulosis?
Multiple diverticula in the bowel.
100
What is diverticulitis?
Inflammation that can occur due to diverticular disease.
101
What are the classic clinical presentations of diverticulitis? 3
1. Fever 2. Leukocytosis 3. Pain.
102
What is RLQ diverticulitis? Who is afflicted more commonly? 3
1. More common in women 2. Asian population, and young adults 3. Typically affects the cecum or ascending colon.
103
What are the sonographic findings of RLQ diverticulitis?
1. Sac-like structure protruding from the wall 2. Hyperemia 3. Fecalith 4. Inflamed fat 5. Focal wall thickening.
104
What is LLQ diverticulitis? How common is it?
The most common form of diverticulitis, typically affecting the sigmoid and left colon.
105
What are the sonographic findings of LLQ diverticulitis? 4
1. Hypoechoic concentric thickening of the bowel wall 2. Echogenic foci with posterior shadowing 3. Abscess 4. Mesenteric thickening.
106
What are bladder diverticula? 2
1. Outpouching of the bladder wall 2. Typically congenital or acquired.
107
What are the characteristics of congenital bladder diverticula? 2
1. All three wall layers involved 2. Located near the ureteral orifice.
108
What are the characteristics of acquired bladder diverticula? 2
1. Inner two wall layers involved 2. High occurrence with neurogenic bladder.
109
What is mechanical bowel obstruction (MBO)?
Physical obstruction of the bowel, may be related to a mass or extrinsic compression.
110
What are the signs and symptoms of MBO? 4
1. Abdominal pain 2. Distension 3. Vomiting 4. Diarrhea.
111
What is intussusception? which demographic of individuals are affected?
1. Invagination (telescoping) of bowel segment 2. Most common cause of small bowel obstruction in children.
112
What are the sonographic findings of intussusception?
Multiple concentric rings (donut sign) and target appearance (pseudokidney sign).
113
What is a urinary tract infection (UTI)?
Infection that travels from the bladder to the kidneys.
114
What are the signs and symptoms of UTI? 4
1. Flank pain 2. Fever 3. Frequency 4. Urgency.
115
What lab results indicate a UTI? 4
1. Increased WBCs 2. Pyuria 3. Bacteremia 4. Microscopic hematuria.
116
What is acute pyelonephritis? Who is typically affected?
Inflamed renal tubules, typically caused by E. coli, affecting young women.
117
What are the sonographic findings of acute pyelonephritis? 4
1. Usually normal 2. Loss of CM junction 3. Renal enlargement 4. Altered echotexture.
118
What is chronic pyelonephritis? Who is commonly affected?
Interstitial nephritis caused by vesicoureteric reflux, more commonly affects women.
119
What are the sonographic findings of chronic pyelonephritis? 3
1. Cortical scarring 2. Asymmetrical changes between kidneys 3. Dilated calyces.
120
What is an abscess in the context of pyelonephritis?
Possible complication that may decompress into the collecting system or perinephric space.
121
What is pyonephrosis?
Pus in the collecting system, associated with UPJ obstruction/stones in young adults.
122
What are the sonographic findings of pyonephrosis? 3
1. Hydronephrosis 2. Multiple low-level echoes 3. Mobile debris.
123
What is emphysematous pyelonephritis? Who is frequently affected?
1. Gas forms in the parenchyma 2. Frequently affecting diabetic older women.
124
What are the sonographic findings of emphysematous pyelonephritis?
Linear echogenic areas with dirty shadowing.
125
What is xanthogranulomatous pyelonephritis?
Chronic, pus-forming condition usually unilateral, associated with staghorn calculi.
126
What are the sonographic findings of xanthogranulomatous pyelonephritis? 3
1. Destruction of parenchyma 2. Loss of CM junction 3. Inflammatory mass.
127
What are fungal infections of the urinary tract typically associated with?
Diabetics/immunocompromised patients and indwelling catheters.
128
What is infectious cystitis?
Inflammation of the bladder usually caused by E. coli in women.
129
What is chronic cystitis? Who is commonly affected?
Chronic inflammation of the bladder, more commonly affects middle-aged women.
130
What is interstitial cystitis? What is it associated with?
Chronic bladder inflammation of unknown cause, associated with systemic diseases.
131
What is neurogenic bladder?
Loss of voluntary control of voiding.
132
What is retroperitoneal fibrosis?
Sheets of fibrous tissue form in the retroperitoneum, surrounding the ureters.
133
What is benign prostatic hyperplasia (BPH)?
Enlargement of the prostate in older men, with the transition zone becoming enlarged.
134
What are the signs and symptoms of BPH?
Nocturia and difficulty voiding.
135
What is TURP?
Transurethral resection of the prostate using an endoscope.
136
What is prostatitis?
Inflammation of the prostate and seminal vesicles, can be acute or chronic.
137
What are the signs and symptoms of acute prostatitis?
1. Lower back pain 2. Dysuria 3. Perineal pressure.
138
What are the sonographic findings of acute prostatitis? 3
1. Hypoechoic areas 2. Hypervascularity 3. Possible abscess.
139
What are the sonographic findings of chronic prostatitis? 3
1. Focal masses of varying echogenicity 2. Calcifications 3. Periurethral gland irregularity.
140
What are pleural effusions?
Fluid in the thoracic cavity between the visceral and parietal pleura.
141
What is splenomegaly?
Most frequent cause of a LUQ mass, can be due to various conditions.
142
What are the symptoms of splenomegaly? 3
1. LUQ fullness 2. Pain 3. Palpable spleen.
143
What is acquired immune deficiency syndrome (AIDS)?
A syndrome of opportunistic infections and the final stage of HIV infection.
144
What are the complications associated with AIDS? 3
1. Moderate splenomegaly 2. Candida infections 3. Kaposi’s sarcoma.

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