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ABD 313 > Infectious and Inflammatory > Flashcards

Infectious and Inflammatory Flashcards

1
Q

What is the most common clinical presentation of infection? (3)

A
  • Fever
  • Pain
  • Leukocytosis
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2
Q

What complication can infection lead to?

A

An abscess

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3
Q

Who is at risk of getting an abscess? (4)

A
  • Diabetics
  • Immunosuppressed patients
  • Patients with hematomas
  • Post-operative patients
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4
Q

What may hepatitis be caused by?

A

Viruses or toxins

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5
Q

How many types of hepatitis are there and what are the 4 most common types of hepatitis?

A

6 Types

Hepatitis A, B, C, and D are the most common

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6
Q

What is the primary mode of spread for Hepatitis A?

A

Fecal-oral route

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7
Q

What is the primary mode of spread for Hepatitis B?

A

Blood and body fluids, carrier state

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8
Q

What is the primary mode of spread for Hepatitis C?

A

Transfusions

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9
Q

What is the primary mode of spread for Hepatitis D?

A

Dependent on Hep B/IV drug users (cannot get Hep D unless you have already contracted Hep B)

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10
Q

What percentage of Hepatitis A cases are acute and what is the prognosis?

A

99%

Clinical recovery with 4 months

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11
Q

What is a rare and severe form of hepatitis and what does it cause?

A

Subfulminant/fulminant

Causes hepatic necrosis

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12
Q

What is subfulminant/fulminant hepatitis due to?

A

Hepatitis B or drug toxicity

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13
Q

Death will occur with subfulminant/fulminant hepatitis after what percentage of hepatic parenchyma is lost?

A

> 40%

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14
Q

When would you consider hepatitis to be chronic?

A

If biochemical markers remain abnormal for >6 months

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15
Q

How will the liver appear sonographically with acute hepatitis? (5)

A
  • Hepatomegaly
  • Decreased liver echogenicity
  • Prominant portal vein walls
  • Gallbladder wall thickening
  • More often, liver usually appears normal
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16
Q

What is the prominent portal vein walls in acute stage hepatitis referred to as?

A

Starry sky appearance

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17
Q

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

A
  • Coarse liver parenchyma
  • Overall increase in echogenicity
  • Portal hypertension
  • Cirrhosis
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18
Q

What lab values are typically increased with hepatitis?

A

ALT, AST bilirubin

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19
Q

What are the 4 routes of spread by pyogenic bacteria to the liver?

A
  1. Biliary tract
  2. Portal venous system
  3. Hepatic artery
  4. Trauma
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20
Q

What is the sonographic appearance of a bacterial liver infection? (4)

A
  • Simple to complex cyst
  • “Shaggy wall”
  • Internal septations
  • Echogenic foci with posterior reverb (gas)
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21
Q

What are fungal diseases that can affect the liver?

A

Candida and pneumocystis carinii

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22
Q

What is sonographic presentation of candida fungal liver disease and what is the most common? (4)

A
  • Hyperechoic
  • Bulls eye appearance
  • Wheel within a wheel appearance

Most common = Uniformly hypoechoic

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23
Q

Which fungal disease of the liver is an opportunistic infection?

A

Pneumocystis carinii

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24
Q

Which group of people contract pneumocystis carinii?

A

Immunocompromised (AIDS)

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25
Q

What is the sonographic appearance of pneumocystis carinii?

A

Tiny non-shadowing echogenic foci that could progress to shadowing clumps of calcifications

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26
Q

How do amoeba travel with amebiasis and what other disease travels the same route?

A

Fecal-oral route

(Colon -> Portal vein -> Liver)

Hydatid disease has the same route

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27
Q

Which lobe of the liver is more commonly affected by amebiasis and hydatid disease?

A

Right

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28
Q

What is the most common clinical presentation of amebiasis?

A

PAIN

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29
Q

What is hydatid disease also called?

A

Echinococcal

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30
Q

What is hydatid disease and what are the most common structures affected? (5)

A

It is a parasitic infection (tapeworm) common in sheep and cattle raising countries.

Affects the liver most commonly but also:

  • Spleen
  • Ureter
  • Bladder
  • Kidneys
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31
Q

Which hosts are “definitive” and “intermediate” in hydatid disease?

A

Dogs = definitive host (tapeworm matures)

Humans = intermediate (parasite undergoes development but doesn’t mature)

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32
Q

What is the “embryo” in hydatid disease and what are it’s layers?

A

The embryo of the parasite is a slow growing cyst with three layers:

Ectocyst, pericyst, endocyst

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33
Q

Define ectocyst in terms of the embryo parasite in hydatid disease:

A

External membrane (~1mm thick)

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34
Q

Define pericyst in terms of the embryo parasite in hydatid disease:

A

Dense connective tissue capsule around cyst

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35
Q

Define endocyst in terms of the embryo parasite in hydatid disease:

A

Inner germinal layer

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36
Q

What are 4 sonographic appearances that represent the embryo in hydatid disease?

A
  • Hydatid sand
  • Simple cyst
  • Daughter cysts
  • Calcified walls
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37
Q

What is a rare result that could happen due to the embyronic cyst rupturing in hydatid disease and what are 3 other signs of Hydatid?

A

Rare due to rupture = Anaphylactic shock

  • Pain/discomfort
  • Jaundice
  • Vascular thrombosis/infarction
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38
Q

What is shistosomiasis?

A

A parasitic infection where worms penetrate the skin and travel to mesenteric veins via lymph and blood vessels

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39
Q

What structures are invaded with schistosomiasis?

A

Liver, spleen, bowel, and bladder

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40
Q

What affects does schistosomiasis have and how do they occur?

A
  • Granulomatous reaction (“walling off” inflammation)
  • Periportal fibrosis

Occurs from the ova penetrating the portal vein wall and connective tissue

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41
Q

What is the sonographic appearance of schistosomiasis? (6)

A
  • Thickening/increased echogenicity of the periportal walls
  • Hepatomegaly (initially)
  • Shrunken liver (over time due to portal hypertension)
  • Splenomegaly
  • Thickened bladder wall
  • “Turtle back appearance”
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42
Q

What can periportal fibrosis lead to over time?

A

Portal hypertension and cirrhosis

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43
Q

What is another name to the thickening and brightened appearance of the granulomatous reaction?

A

Turtle back appearance

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44
Q

What is tuberculosis?

A

Opportunistic infection that starts in the lungs and may spread to the spleen, adrenals, urinary tract/

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45
Q

What is the sonographic appearance of TB in the spleen?

A

Tiny echogenic foci with or without shadowing

46
Q

What is the sonographic appearance of acute TB in the adrenal glands?

A

Bilateral diffuse enlargement

47
Q

What is the sonographic appearance of chronic TB in the adrenal glands?

A

Atrophied and calcified

48
Q

What can TB lead to?

A

Atrophy of the adrenals and hypoadrenalism (Addison’s disease)

49
Q

What is peritonitis?

A

Inflammation of the peritoneum

50
Q

What is peritonitis caused by and what is the main symptom?

A

Infectious or non-infectious factors

Main symptom = severe pain

51
Q

What are examples of infectious causes of peritonitis?

A

Bacteria, viruses, fungi, and parasites

52
Q

What are examples of non-infectious causes of peritonitis?

A

Pancreatitis, foreign bodies

53
Q

What is a type of peritonitis that affects immunocompromised patients?

A

Tuberculosis peritonitis

54
Q

What would you see sonographically in a patient with tuberculosis peritonitis?

A

Exudative fluid, lymphadenopathy

55
Q

What is acute cholecystitis most often due to?

A

Impacted stones (most often in the GB neck) which interfere with blood supply leading to inflammation and infection

56
Q

Who does acute cholecystitis affect more?

57
Q

What are things you may see sonographically with acute cholecystitis? (7)

A
  • GB wall >3mm
  • Hyperemia
  • Gallstones
  • Impaction at neck
  • GB hydrops
  • Pericholecystic fluid
  • Postitive murphy’s sign
58
Q

What lab values would you expect to see altered in acute cholecystitis?(5)

A
  • Bilirubin
  • ALP
  • Leukocytosis
  • AST
  • ALT
59
Q

What are the complications of acute cholecystitis?(6)

A
  • Empyema
  • Gangrenous
  • Cholecystitis
  • Emphysematous cholecystitis
  • Perforation
  • Abscess
60
Q

Where does perforation typically occur in the gallbladder?

61
Q

What is gangrenous cholecystitis?

A

Necrosis of the gallbladder (typically no pain due to dead nerves)

62
Q

What is a rare form of cholecystitis that is caused by gas forming bacteria?

A

Emphysematous cholecystitis

63
Q

Emphysematous cholecystitis affects who more? (3)

A

Men, diabetics and immunocompromised people

64
Q

What is acalculous cholecystitis?

A

Inflamed gallbladder without stones that typically affects critically ill patients.

65
Q

What are predisposing factors for acalculous cholecystitis? (4)

A
  • Trauma
  • Previous unrelated surgery
  • Burn victims
  • Hyperalimentation (prolonged sickness w/IV nutrition)
66
Q

What is the sonographic appearance of acalculous cholecystitis?

A

Same as acute cholecystitis, but without stones

67
Q

What is the most common form of symptomatic gallbladder disease?

A

Chronic cholecystitis

68
Q

What is the sonographic appearance of chronic cholecystitis? (3)

A
  • Thick heterogeneous wall
  • Contracted GB with stones
  • WES sign
69
Q

What lab values would you expect to see altered with chronic cholecystitis?

A

AST, ALT, ALP, and Bilirubin

70
Q

What are complications of chronic cholecystitis? (3)

A
  • Bouveret syndrome
  • Gallstone ileus
  • Mirizzi’s syndrome
71
Q

What is Bouveret syndrome?

A

A gastric outlet obstruction due to a fistula between the cystic duct and duodenum allowing a stone to pass into the duodenum and lodge there

72
Q

What is gallstone ileus?

A

Distal bowel obstruction due to a gall stone passing into the intestinal tract and lodging distally

73
Q

What is chronic cholecystitis associated with?

A

Gallbladder carcinoma

74
Q

What is a rare complication of chronic cholecystitis?

A

Mirizzi syndrome

75
Q

What happens in Mirizzi syndrome?

A

CHD is compressed by an impacted stone in GB neck, cystic duct, Hartmann’s pouch, or inflammatory reaction which results in obstructive jaundice

76
Q

What may form in Mirizzi syndrome?

A

Fistula between the cystic duct and CHD

77
Q

What is xanthogranulomatous cholecystitis?

A

Rare form of chronic inflammation

78
Q

What is the term for “The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body”?

79
Q

What is the term for “ A localized reaction that produces redness, warmth, swelling, and pain as a result of infection”?

A

Inflammation

80
Q

What are the two terms for “the abnormal enlargement of organs”?

A
  • Organomegaly

- Visceromegaly

81
Q

What is the term for “A local accumulation of pus anywhere in the body”?

82
Q

What is the term for “The red streaking and lymph node swelling in the area of an injury usually caused by a bacterial infection with Streptococcus”?

A

Lymphangitis

83
Q

What is the term for “inflammation of a gland”?

84
Q

What is the term for “the swelling of soft tissues as a result of excess fluid accumulation”?

85
Q

What are the two terms for “Large or swollen lymph nodes”?

A
  • Adenopathy

- Lymphadenopathy

86
Q

What is the term for “a mosquito-borne parasitic disease caused by tiny thread-like worms that live in the human lymph system causing blockage and enlargement of limbs”?

A

Elephantiasis

87
Q

What is the term for “an above normal range of white blood cells in the blood”?

A

Leukocytosis

88
Q

What is the term for “a below normal range of white blood cells in the blood”?

A

Leukopenia

89
Q

What is the term for “a clump or wad of swallowed food or hair that blocks the digestive system”?

90
Q

What is the term for “an infection of the kidneys’ collecting system causing pus to collect in the renal pelvis and distension of the kidney”?

A

Pyonephrosis

91
Q

What is the term for “a region of normally compressible lung tissue that has filled with liquid and become swollen and hard”?

A

Lung consolidation

92
Q

What is the term for “a complete or partial collapse of a lung or lobe of a lung”?

A

Atelectasis

93
Q

What is the term for “a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse”?

A

Pneumothorax

94
Q

What is FUO?

A

Fever of Unknown Origin

95
Q

What is the sonographic appearance of an abscess?

A

A fluid filled area with posterior enhancement, debris and thick, irregular walls. Possible gas as well.

96
Q

What is hepatitis and what are the signs/symptoms? (5)

A

An inflammation of the liver

  • Fever
  • Chills
  • Nausea
  • Vomiting
  • Jaundice
97
Q

What determines chronic hepatitis?

A

Biochemical markers remain abnormal for > that 6 months

98
Q

The classical presentation of fever, RUQ pain, malaise and anorexia indicates what?

A

Bacterial liver infections

99
Q

What is the clinical presentation of candida infection?

A

A persistent fever with a WBC count returning to normal

100
Q

What organs are involved in a candida infection?

A

Liver, kidney and spleen

101
Q

What organs are involved with Pneumocystis Carinii? (5)

A

Liver, Spleen, renal cortex, pancreas, lymph nodes

102
Q

What is the sonographic appearance of amebiasis? (3)

A
  • Round/oval shape
  • Hypoechoic
  • Fine internal echoes
103
Q

What is the clinical presentation of acute cholecystitis? (5)

A
  • RUQ pain
  • Fever
  • Leukocytosis
  • Nausea and Vomitting (N&V)
  • Jaundice (25%)
104
Q

How does gangrenous cholecystisitis appear on U/S?

A

Non-layering bands of echogenic tissue within the GBB (image page 186)

105
Q

How does gallbladder perforation appear on U/S? (4)

A
  • Free fluid in the peritoneal cavity
  • Low level collection adjacent to the GB
  • Ill-defined hypoechoic mass surrounding GB
  • May see perforation in wall
106
Q

How does emphysematous cholecystitis appear on Ultrasound?

A

Dirty shadowing (due to gas forming bacteria)

107
Q

What is the clinical presentation of chronic cholecystitis? (4)

A
  • Intolerance to fatty foods
  • Belching/indigestion
  • Postprandial RUQ pain
  • N&V
108
Q

What is the WES sign most commonly associated with?

A

Chronic cholecystitis

109
Q

What are the clinical symptoms of Mirizzi Syndome? (3)

A

Fever, pain, jaundice

110
Q

What is the sonographic appearance of Mirizzi syndrome?

A
  • Dilated bile ducts above level of obstruction (CHD)

- Normal CBD

111
Q

What is the sonographic appearance of xanthogranulomatous cholecystitis?

A

Hypoechoic nodules/bands in a thick GB wall that represent fatty granulomatous nodules (abnormal, fibrous tissue).

112
Q

How to remember ALT, AST and ALP?

A

ALT = “a liver transplant” - specific indicator of liver damage

AST = “a serious trauma” - injury to cells

ALP = “a lith problem” - stones or biliary issue

ABD 313 (11 decks)

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