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ABD 313 > Infectious and Inflammatory 2 > Flashcards

Infectious and Inflammatory 2 Flashcards

1
Q

Porcelain gallbladder has a high association with what?

A

Gallbladder carcinoma

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2
Q

What is porcelain gallbladder?

A

A calcified gallbladder wall that is rare and common in older females that may be a form of chronic cholecystitis and is associated with stones

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3
Q

What is an inflammatory and fibrosing disorder of the biliary tree?

A

Cholangitis

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4
Q

What are the 5 types of cholangitis?

A
  1. Acute (bacterial)
  2. Recurrent pyogenic
  3. AIDS
  4. Biliary ascariasis
  5. Primary sclerosing
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5
Q

What is acute cholangitis due to and what is it called?

A

Biliary obstruction (choledocholithiasis)

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6
Q

What values would you expect to see increased with acute cholangitis? (3)

A

WBC, ALP, bilirubin

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7
Q

What can recurrent pyogenic cholangitis also be known as less commonly?

A

Oriental cholangitis (most common in SE and East Asia)

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8
Q

Which lobe is affected most often with recurrent pyogenic cholangitis?

A

Lateral left lobe

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9
Q

What are some possible long term complications with recurrent pyogenic cholangitis?

A

Biliary cirrhosis and choleangiocarcinoma

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10
Q

What would you see sonographically with recurrent pyogenic cholangitis?

A

Dilated ducts with stones and sludge in one segment of the liver

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11
Q

What is AIDS cholangitis and what is important to note about the lab values?

A

An opportunistic infection in advanced stages of AIDS that results in thickened ducts and GB walls with a dilated CBD.

ALP will be elevated but bilrubin will be normal.

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12
Q

What is biliary ascariasis cholangitis caused by and how does it appear sonographically?

A

Roundworm infestation

Echogenic non-shadowing parallel lines in the ducts and GB that may move around.

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13
Q

What is primary sclerosing cholangitis?

A

Chronic inflammatory process with an unknown cause

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14
Q

What happens with primary sclerosing cholangitis?

A

Bile ducts fibrose and inflame which leads to biliary cirrhosis, portal hypertension, and hepatic failure

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15
Q

What percentage of primary sclerosing cholangitis patients have ulcerative colitis?

A

80%

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16
Q

Primary sclerosing cholangitis affects who more?

A

Men

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17
Q

What is pancreatitis?

A

Inflammation of the pancreas that can be acute or chronic, focal or diffuse and mild/mod/severe.

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18
Q

What is the clinical presentation of acute pancreatitis? (4)

A
  • Severe, constant pain that radiates to the back
  • Relief by sitting up or bending at the waist
  • N and V
  • Possible fever
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19
Q

What is the possible etiology of acute pancreatitis?

A

Alcohol abuse and biliary stones

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20
Q

What is the difference between focal and diffuse acute pancreatitis sonographically?

A

Diffuse:

  • Normal looking or:
  • Decreased echogenicity
  • Heterogenous
  • Increased size
  • Smooth contour

Focal:

  • Focal hypoechoic area
  • Mimics neoplasm
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21
Q

What is the most common area to see focal acute pancreatitis?

A

Pancreatic head

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22
Q

What are phlegmons and pseudocysts? And what are they a result of?

A

Phlegmons = Inflamed fat and connective tissue

Pseudocysts = Debris and fluid that has been walled off by the body

Resulting complications from acute pancreatitis

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23
Q

Chronic pancreatitis describes what kind of destruction?

A

Progressive and irreversible fibrous scarring

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24
Q

What is the predominant cause of chronic pancreatitis?

A

Alcoholism

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25
Q

What is the most common appearance of chronic pancreatitis? (3)

A
  • Dilated pancreatic duct
  • Calcifications
  • Decreased panc size
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26
Q

Pseudocysts are seen in both acute and chronic pancreatitis but which is it most common in?

A

Chronic pancreatitis

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27
Q

What lab findings would you see in acute pancreatitis?

A

Increased amylase and increased lipase

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28
Q

What lab findings would you see in chronic pancreatitis?

A

Normal amylase and increased lipase

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29
Q

What does imflammatory bowel disease include?

A

Crohn’s and ulcerative colitis

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30
Q

What are the most common methods of assessing IBD and what is ultrasound and CT’s role with inflammatory bowel disease?

A

Most common = barium studies and endoscopy

US/CT = Scan on the bowel wall, lymph nodes, and mesentery

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31
Q

What is Chron’s disease?

A

Chronic granulmatous inflammation affecting all layers of the terminal ileum and colon

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32
Q

What are signs and symptoms of Chron’s Disease? (3)

A
  • Intermittent diarrhea
  • Fever
  • Crampy RLQ and LLQ pain
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33
Q

What are complications of Chron’s disease? (4)

A
  • Abscess formation
  • Fistula formation
  • Phlegmon
  • Appendicitis
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34
Q

What is ulcerative colitis?

A

Inflammation of mucosal and submucosal layers of the colon causing ulceration of the colon and rectum

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35
Q

Ulcerative colitis is sonographically similar to what?

A

Crohn’s disease

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36
Q

What is pseudomembranous colitis?

A

A necrotizing inflammation (inflammation with C. Difficile)

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37
Q

Why does pseudomembranous colitis happen?

A

Patients become susceptible to infection when oral antibiotics wipe out the normal intestinal flora

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38
Q

What prominent markings may you see with pseudomembranous colitis?

A

Prominent haustral markings

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39
Q

What is the sonographic appearance of pneumatosis intestinalis? (3)

A
  • Thick hypoechoic wall
  • Hyperechoic areas in the wall with artifact (intramural pockets of gas)
  • Air in portal sysetm
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40
Q

What is the most common cause of acute abdominal pain?

A

Acute appendicitis

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41
Q

What is the cause of acute appendicitis?

A

Obstruction of the appendiceal lumen causing decreased venous return leading to bacterial overgrowth and inflammation

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42
Q

What is the classic presentation of acute appendicitis and what are two other common signs?

A

Classic = RLQ pain and tenderness, leukocytosis

Common signs:

  1. peritoneal irritation
  2. Guarding over McBurney’s point
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43
Q

What are the 4 main sonographic appearances of acute appendicitis?

A
  • Blind ended non-peristalsing tube
  • Non-compressible
  • > 6mm in AP diameter
  • Single wall thickness of > 3mm
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44
Q

What is mesenteric adenitis and what does it mimic?

A

RLQ lymphadenopathy without appendicitis but mimics appendicitis symptoms

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45
Q

What is a mucocele and who does it affect most commonly?

A

A rare distension of the appendix with mucous

Affects females more often

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46
Q

What are the benign causes of mucoceles?

A

Fecaliths, inflammatory scarring, polyps

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47
Q

What are the malignant causes of mucoceles?

A

Primary mucous cystadenoma/cystadenocarcinoma

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48
Q

Rupture of the malignant form of mucocele can cause what?

A

Pseudomyxoma peritonei

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49
Q

What is a diverticula?

A

Outpouching of bowel wall

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50
Q

What is diverticulosis?

A

Multiple diverticula

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51
Q

What is diverticulitis?

A

Inflammation of the bowel

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52
Q

What is the classic triad of bowel diverticular disease?

A

Fever, leukocytosis, and pain

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53
Q

What are the two types of diverticular disease?

A

RLQ diverticulitis and LLQ diverticulitis

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54
Q

What is the most common form of diverticular disease?

A

LLQ diverticulitis

55
Q

RLQ diverticulitis involves all layers of the gut wall whereas LLQ diverticulitis involves what?

A

Only affects the muscular layer

56
Q

What is a bladder diverticula?

A

Outpouching of bladder wall (typically lateral wall)

57
Q

Explain what congenital bladder diverticula involves:

A

All 3 wall layers involved

58
Q

Explain what acquired bladder diverticula involves:

A

Inner 2 wall layers involved

59
Q

What does MBO stand for?

A

Mechanical bowel obstruction

60
Q

What will you see in the early and late stages of MBO?

A

Hyperperistalsis in the earlier stages, no peristalsis in the late stage

61
Q

What are two examples of MBO?

A

Intussusception and volvulus

62
Q

What is intussusception?

A

Invagination (telescoping) of bowel segments

63
Q

What is the most common cause of small bowel obstruction in children?

A

Intussusception

64
Q

What is a very indicative sign of intussusception?

A

Currant jelly stools (blood and mucus)

65
Q

What is volvulus?

A

Close looped obstruction (like a kink in a hose) that is seen as a U or C shaped bowel

66
Q

What is paralytic ileus?

A

Bowel obstruction related to lack of function (paralyzed wall) that is marked by extreme gas with no perastalsis

67
Q

Why is there a higher incidence of UTI’s in women?

A

Due to anatomy and our urethra being shorter

68
Q

What lab results would you expect to see in someone with a UTI? (4)

A
  • WBC
  • Pyuria
  • Bacteremia
  • Microscopic hematuria
69
Q

What is acute pyelonephritis and who does it affects more often?

A

Inflamed renal tubules caused by e. Coli

Affects young women

70
Q

What does acute pyelonephritis look like sonographically? (3)

A
  • Loss of CM junction
  • Renal enlargement
  • Compression of sinus
71
Q

What is chronic pyelonephritis and who does it affect more often?

A

Interstitial nephritis caused by vesicoureteric reflux

Affects women starting at a young age

72
Q

What does chronic pyelonephritis look like sonographically? (3)

A
  • Coritcal scarring
  • Atrophy
  • Dilated, blunted calyces
73
Q

What is a possible complication of pyelonephritis?

74
Q

What is pyonephrosis?

A

Pus in the collecting system

75
Q

What is pyeonephrosis associated with?

A

UPJ obstruction/stones

76
Q

What are rare forms of pyelonephritis?

A

Emphysematous and xanthogranulomatous

77
Q

What is emphysematous pyelonephritis and who does it affect more commonly?

A

Gas that forms in the parenchyma

Affects older diabetic women

78
Q

What is xanthogranulomatous pyelonephritis?

A

Chronic form with pus. Usually unilateral, with staghorn calculi.

79
Q

What does xanthogranulomatous pyelonephritis look like sonographically? (4)

A
  • Destruction of parenchyma
  • Loss of CM junction
  • Dilated calyces
  • Inflammatory mass
80
Q

What is glomerulonephritis? What does is present as?

A

Autoimmune reaction which causes inflammation at the level of the glomerulus. Presents as medical renal disease.

81
Q

What are fungal infections of the urinary tract associated with?

A

Indwelling catheters and immunocompromised patients

82
Q

Which fungal infection of the urinary tract is most common?

A

Candida albicans

83
Q

What are the sonographic findings associated with fungal infections of the urinary tract?

A

Hypoechoic parenchymal masses (absences) and fungal balls

84
Q

What are two parasitic infections of the urinary tract?

A

Schistosomiasis and hydatid disease

85
Q

What is cystitis?

A

Inflammation of the bladder

86
Q

What is infectious cystitis usually caused by in women? Men?

A

Women: usually caused by E. Coli

Men: Prostatitis or bladder outlet obstruction

87
Q

What does infectious cystitis result in?

A

Mucosal edema which thickens the bladder wall and decreases bladder capacity and may cause hematuria

88
Q

What is chronic cystitis?

A

Chronic inflammation of the bladder

89
Q

What is the sonographic appearance of chronic cystitis?

A

Thick walled bladder with possible TCC appearance (mass protruding from the bladder wall)

90
Q

What is interstitial cystitis?

A

Chronic bladder inflammation of unknown cause, associated with systemic diseases

91
Q

What can interstitial cystitis mimic?

A

Bladder cancer (TCC)

92
Q

What is a neurogenic bladder?

A

Loss of voluntary control of voiding (pt cant empty bladder and can’t sense fullness of the bladder)

93
Q

What would the sonographic appearance of a neurogenic bladder be? (3)

A
  • Trebeculated bladder
  • Possible debris or stones in bladder
  • Hydro
94
Q

What is retroperitoneal fibrosis?

A

Sheets of fibrous tissue form in the retroperitoneum and drape over the great vessels and surround the ureters

95
Q

What is the modality of choice for retroperitoneal fibrosis and what does it look like sonographically?

A

CT

Hypoechoic homogenous masses that obstruct retroperitoneal structures

96
Q

What is BPH?

A

Benign prostatic hyperplasia

97
Q

What happens with BPH?

A

Transition zone becomes enlarged and nodular

98
Q

What is the sonographic appearance of BPH? (5)

A
  • Hypoechoic enlargement of inner gland
  • Calcs (mini calcs w/ malignancy, larger calcs with benign)
  • Degenerative cysts
  • Nodules
  • Heterogeneous
99
Q

What is TURP?

A

Transurethral resection of the prostate

100
Q

How is TURP done and why?

A

Endoscope inserted into penile urethra and the prostate is resected

Done to relieve the symptoms of BPH

101
Q

What are two ways the prostate can be resected with TURP?

A

Electrocautery and laser

102
Q

What is prostatitis?

A

Inflammation of prostate and semical vesicles

103
Q

What causes prostatitis?

A

Infectious organisms from the lower urethra invade the ducts in the peripheral zone

104
Q

What are signs and symptoms of prostatitis? (3)

A

Lower back pain, dysuria, and perineal pressure

105
Q

What lab values would you expect to see altered with prostatitis?

106
Q

Most cases of chronic prostatitis are associated with what?

A

E. Coli infections

107
Q

What is the sonographic appearance of chronic prostatitis? (4)

A
  • Focal masses of varying echogenicity
  • Calcifications
  • Periurethral gland irregularity
  • Dilated SV
108
Q

What is a pleural effusion?

A

Fluid in the thoracic cavity between the visceral and parietal pleura

109
Q

What are the two types of pleural effusions?

A

Transudative and exudative

110
Q

Which type of pleural effusion is anechoic and typically seen with CHF and cirrhosis?

A

Transudative

111
Q

Which type of pleural effusion is echogenic, has septations, and is typically seen with infections and neoplasms?

112
Q

What is the most frequent cause of a LUQ mass?

A

Splenomegaly

113
Q

What are causes of splenomegaly? (6)

A
  • Hematologic disorders
  • Neoplasia
  • Congestion
  • Infection
  • Inflammation
  • Infiltration (HNCIII)
114
Q

In what circumstances will we see mild to moderate splenomegaly? What size?

A

Portal hypertension, infection, and AIDS. 12-18 cm

115
Q

In what circumstances will we see marked splenomegaly? What size?

A

Leukemia and lymphoma, >18 cm

116
Q

What is a complication of splenomegaly?

A

Spontaneous rupture

117
Q

What does AIDS stand for?

A

Acquired Immune Deficiency Syndrome

118
Q

What is the final stage of infection by HIV?

119
Q

What kind of cancer can we see in people with AIDS?

A

Kaposi’s sarcoma

120
Q

How does Kaposi’s sarcoma appear sonographically?

A

Hypoechoic liver nodules, non-specific solid mass in the adrenal gland

121
Q

What is acute typhitis?

A

Inflammation to the cecum/ascending colon which appears as hypoechoic uniform thickening of the colon

122
Q

What is the sonographic appearance of Crohns disease? (7)

A
  • Thick hypoechoic wall
  • Narrowed lumen
  • Aperistalsis
  • Rigid
  • Echogenic halo of creeping fat
  • Hyperemia
  • Mesenteric lymphadenopathy
123
Q

How does fistula formation appear sonographically?

A

Linear bands of variable echogenicity

124
Q

How does phlegmon appear sonographically?

A

Poorly defined hypoechoic areas

125
Q

What is the most common form of diverticulitis?

126
Q

Who does RLQ diverticulitis most commonly affects?

A

Women, asians, young adults

127
Q

Who does LLQ diverticulitis most commonly affect?

A

Elderly and people with low bulk diets

128
Q

What areas does LLQ diverticulitis most commonly affect?

A

Sigmoid and left colon

129
Q

What areas does RLQ diverticulitis most commonly affect?

A

Cecum or ascending colon

130
Q

What is the difference between LLQ and RLQ diverticulitis?

A

RLQ = congenital, solitary, all layers

LLQ = age, multiple sacs, fecal material causes inflammation

131
Q

Read module 5 notes about medical renal disease

132
Q

What is the sonographic appearance of fungal balls?

A

Echogenic, non-shadowing, mobile mass

133
Q

What are the differentials of fungal balls? (3)

A

Blood clots, tumors, polyps

134
Q

What conditions may be seen in people with AIDS? (8)

A
  • Moderate spleonmegaly
  • Candida
  • Pneumocystis carinii infections
  • Kaposi’s sarcoma
  • Lymphoma
  • Cholangitis
  • Acute typhlitis
  • Adrenal insufficiency

ABD 313 (11 decks)

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