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Abdomen 2 > Infectious & Inflammatory Diseases > Flashcards

Infectious & Inflammatory Diseases Flashcards

1
Q

What are the most common clinical presentation of infection

A

Fever
Pain
Leukocytosis

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2
Q

FUO

A

Fever of unknown origin

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3
Q

What is important about a FUO

A

History and lab tests are important
Assessing for organomegaly
An infectious process can lead to abscess

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4
Q

An abscess is

A

A localized collection of pus

A complication to infection

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5
Q

Patients at risk for abscesses are

A 
Diabetics
Immunosuppressed 
Cancer 
Pts with hematomas
Post-operative patients
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6
Q

Patients with abscesses will often present with what

A

Localized tenderness

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7
Q

What is the sonographic appearance of an abscess

A 
Fluid filled area
Posterior enhancement 
Thick, irregular walls
Debris 
Possible gas
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8
Q

Hepatitis is what

A

An inflammation of the liver

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9
Q

What may hepatitis be caused by

A

Viruses

Toxins

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10
Q

What are the signs and symptoms of hepatitis

A 
Fever
Chill
Nausea
Vomiting 
Possible jaundice
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11
Q

How many types of viral hepatitis is there

A

6

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12
Q

What are the four main types of hepatitis

A

Hep A
Hep B
Hep C
Hep D

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13
Q

What is the primary mode of spread of Hep A

A

Fecal-oral route

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14
Q

What is the primary mode of spread for Hep B

A

Blood and body fluids

Carrier state

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15
Q

What is a carrier state for Hep B

A

When a person tests positive for the disease but has no symptoms

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16
Q

What is the primary mode of spread for Hep C

A

Transfusions

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17
Q

What is the primary mode of spread for Hep D

A

Dependant on Hep B as they have to be infected with it first

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18
Q

What is the most common Hepatitis in IV drug users

A

Hep D

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19
Q

What are the 3 different types clinical presentation of hepatitis

A

Acute
Chronic
Subfulminant/fulminant

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20
Q

What is the clinical presentation for acute hepatitis

A

Clinical recovery within 4 months

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21
Q

99% of all cases of Hep A are what

A

Acute

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22
Q

subfulminant/fulminat hepatitis is due to what

A

Hepatitis B or drug toxicity

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23
Q

Subfulminant/fulminant hepatitis is what kind of hepatitis

A

Serious and rare form

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24
Q

Subfulminant/fulminant hepatitis causes

A

Hepatic necrosis

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25
Q

Death occurs if >40% of what is lost

A

Hepatic parenchyma

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26
Q

What is the clinical presentation for chronic hepatis

A

When the biochemical markers remain abnormal for >6months

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27
Q

What is the sonographic appearance for acute hepatitis

A 
Hepatomegaly 
Decreased liver echogencity 
Prominent portal vein walls 
GB wall thickening 
Liver appears normal 
Starry sky appearance
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28
Q

What is the most common appearance of acute hepatitis

A

Liver appears normal

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29
Q

What is the sonographic appearance of chronic hepatitis

A

Coarse liver parenchyma
Overall increase in echogencity
Portal hypertension
Cirrhosis

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30
Q

What are the important lab values for determining hepatitis

A

ALT
AST
Bilirubin

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31
Q

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

A

Biliary tract
Portal venous system
Hepatic artery
Trauma

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32
Q

Define pyogenic

A

Pus producing

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33
Q

What is the clinical presentation for bacterial liver infections

A

Fever
RUQ pain
Malaise
Anorexia

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34
Q

Define malaise

A

General feeling of unwellness

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35
Q

What is the sonographic appearance of bacterial liver infections

A 
Simple to complex cyst 
“Shaggy” wall
Internal septations 
Echogenic foci with posterior reverberations 
Fluid-fluid levels
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36
Q

What are the 2 types of fungal diseases

A

Candida

Pneumocystis Carinii

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37
Q

What is candidiasis

A

Yeast infection

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38
Q

Who is typically affected by candidiasis

A

Immunocompromised patients

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39
Q

What is the clinical presentation of candidiasis

A

Persistent fever with WBC returning to normal

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40
Q

What is the sonographic appearance of candida

A 
Uniformly hypoechoic 
Hyperechoic 
Bulls eye appearance 
Wheel within a wheel appearance 
Liver/kidney/spleen involvement
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41
Q

What is the most common sonographic appearance of candida

A

Uniformly hypoechoic

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42
Q

What is the bulls eye appearance

A

Focal areas with a hypoechoic rim and a hyperechoic center

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43
Q

What is the wheel within a wheel appearance

A

A hypoechoic rim with a hyperechoic center and hypoechoic nidus

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44
Q

Define nidus

A

Dot

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45
Q

Pneumocystis carinii used to be thought as a what and is not classified as a what

A

Parasitic infection and is now a fungal infection

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46
Q

Pneumocystis Carinii is what kind of infection

A

Opportunist

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47
Q

Pneumocystis Carinii affected what kind of patient

A

Immunocompromised

-most commonly AIDS

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48
Q

Pneumocystis Carinii can involve what

A 
Liver
Spleen 
Renal cortex
Pancreas
Lymph nodes
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49
Q

What is the most common organ involved when a patient has pneumocystis Carinii

A

Liver

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50
Q

What is the sonographic apperance of pneumocystis Carinii

A

Tiny non-shadowing echogenic foci

Progresses to shadowing clumps of calcifications

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51
Q

What are the 3 types of parasitic disease that involves sonography

A

Amebiasis
Schistisomiasis
Hydration disease

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52
Q

What is the route of spread for amebiasis to the liver

A

Fecal-oral

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53
Q

How does amebiasis travel to the liver

A

From the colon, through the portal vein to the liver

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54
Q

What lobe of the liver is most commonly affected in cases of amebiasis

A

Right

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55
Q

What is the sonographic appearance of amebiasis

A

Round/oval shape- abscess
Hypoechoic
Fine internal echoes

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56
Q

What is the most common clinical presentation of amebiasis

A

Pain

+/- diarrhea

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57
Q

What is another name for hydatid disease

A

Echinococcal

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58
Q

What kind of parasite is involved in hydatid disease

A

Tapeworm

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59
Q

What kind of countries is hydatid disease common in

A

Sheep and cattle raising countries

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60
Q

What organs can hydatid disease affect

A 
Liver 
Spleen 
Ureter 
Bladder
Kidneys
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61
Q

What is the organ most commonly affected by hydatid disease

A

Liver

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62
Q

In hydatid disease who is typically the definitive host

A

Dogs

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63
Q

In hydatid disease who is the intermediate host

A

Humans

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64
Q

What is a definitive host

A

The host where the parasite reaches maturity

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65
Q

What is a intermediate host

A

The host in which the parasite undergoes development but does not reach maturity

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66
Q

What is the typical route of spread of hydatid disease to humans

A

Fecal-oral

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67
Q

How does the parasite in hydatid disease travel to the liver

A

Through the portal venous system

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68
Q

The hydatid embryo is

A

Slow growing with 3 layers

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69
Q

What are the 3 layers of a hydatid embyro

A

Ectocyst
Pericyst
Endocyst

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70
Q

Define ectocyst

A

External membrane (~1mm thick)

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71
Q

Define pericyst

A

Dense connective tissue capsule around cyst

72
Q

Define endocyst

A

Inner germinal layer

73
Q

What layer of the tapeworm produces the embyro

74
Q

What are the 4 sonographic appearances that represent the embryo

A

Hydatid sand
Simple cyst
Daughter cysts
Calcified walls

75
Q

What is hydatid sand

A

Cyst with a bunch of low level echoes

76
Q

What is a daughter cyst

A

Multiple cyst within a cyst

77
Q

What are the signs and symptoms of hydatid disease

A 
Dependent on stage 
Pain/discomfort
Jaundice 
Vascular thrombosis/infarction 
Anaphylactic shock
78
Q

Is anaphylactic shock common or rare and what is it caused from

A

Rare, from cyst rupture

79
Q

What is the treatment for hydatid disease

80
Q

What is schistosomiasis

A

Parasitic infection

81
Q

How do the worms get into the body

A

Penetrate the skin

Travel to mesenteric veins via lymph and blood vessels

82
Q

Where do the worms from schistosomiasis invade

A

Liver
Spleen
Bowel
Bladder

83
Q

Schistosomiasis ova can penetrate what

A

The portal vein wall and connective tissue

84
Q

What does schistosomiasis ova migration to the portal vein lead to

A

Granulonatous reaction and periportal fibrosis

Over time can lead to portal hypertension and cirrhosis

85
Q

What is the sonographic appearance of schistosomiasis

A

Thickening/increased echogenicity of the periportal walls
Initially, the liver is enlarged
Over time the liver shrinks
Portal hypertension
Splenomegaly
Thickened bladder wall (if it is infected by it)

86
Q

TB

A

Tuberculosis

87
Q

What is TB

A

Opportunistic infection

88
Q

Who is typically infected by TB

A

Immunosupressed patients

89
Q

Where does TB start

90
Q

What other organs does TB affect

A

Spleen
Adrenal Glands
Urinary tract

91
Q

What is the sonographic appearance of the spleen with TB

A

Tiny echogenic foci with or without shadowing

92
Q

What is the sonographic appearance of the adrenal glands with TB

A

Acute: bilateral, diffuse enlargement
Chronic: atrophied and calcified

93
Q

What can TB lead to

A

Atrophy of the adrenal glands and hypoadrenalism (Addison’s disease)

94
Q

What is peritonitis

A

Inflammation of the peritoneum

95
Q

What can peritonitis be caused by

A

Infectious or non-infectious factors

96
Q

What are the infectious causes of peritonitis

A

Bacteria
Viruses
Fungi
Parasites

97
Q

What are the non-infectious factors of peritonitis

A

Pancreatitis

Foreign bodies

98
Q

What does the patient present with when they have peritonitis

A

Severe pain

99
Q

Who is affected by tuberculosis peritonitis

A

Immunocompromised

100
Q

What kind of immunocompromised patients are affected by tuberculosis peritonitis

A

AIDS
Alcoholics
Cirrhosis

101
Q

What is the sonographic appearance of tuberculosis peritonitis

A

Exudative fluid

Lymphadenopathy

102
Q

What are the different types of cholecystitis

A 
Acute 
Gangrenous 
Perforation
Emphysematous 
Acalculous 
Chronic 
Mirizzi syndrome
Xanthogranulomatous 
Procelain GB
103
Q

What is acute cholecystitis most often due to

A

Impacted stones

104
Q

How does an impacted stone cause inflammation

A

It interferes in blood supply leading to an inflammatory reaction which predisposes the patient to infection

105
Q

Who is more susceptible to cholecystitis

106
Q

What is the clinical presentation of cholecystitis

A 
RUQ pain
Fever 
Leukocytosis 
Nausea and vomiting 
Jaundice 
Pain radiating around the back
107
Q

What is the sonographic findings of cholecystitis

A 
GB wall >3mm 
Hyperemia 
Gallstones 
Impaction at neck 
GB hydrops 
Pericholecystic fluid 
Positive Murphy sign
108
Q

What is pericholecystic fluid

A

Slip of fluid surrounding the GB

109
Q

What is a positive Murphy sign

A

Maximum pain with transducer pressure applied over the GB area

110
Q

What are the important lab values in cases of cholecystitis

A 
Serum bilirubin
ALP
Leukocytosis 
AST 
ALT
111
Q

What are the complications of cholecystitis

A 
Empyema
Gangrenous cholecystitis 
Emphysematous cholecystitis 
Perforation 
Abscess
112
Q

What is empyema

A

Pus in the GB

113
Q

What is gangrenous cholecystitis

A

Necrosis of the GB

114
Q

What does the patient present with when they have gangrenous cholecystitis and why

A

No pain because the nerves of the GB are dying

115
Q

What is the appearance of gangrenous cholecystitis on US

A

Non-layering bands if echogenic tissue within the GB

116
Q

Where does a perforation of the GB usually occur

A

At the fundus

117
Q

What is the apperance of a GB perforation on US

A

Free fluid in the peritoneal cavity
Low level collection adjacent to the GB
Ill-defined hypoechoic mass surrounding the GB
May identify the perforation in the wall

118
Q

Is emphysematous cholecystitis common or rare

119
Q

What emphysematous cholecystitis caused by

A

Gas forming bacteria

120
Q

How does emphysematous cholecystitis progress

121
Q

Who is affected by emphysematous cholecystitis

A

Men and diabetics

122
Q

What us acalcukous cholecystitis

A

An inflamed GB without stones

123
Q

Who is typically affected by acalculous cholecystitis

A

Critically ill patients

124
Q

What are the predisposing factors for acalculous cholecystitis

A

Trauma
Previous unrelated surgery
Burn victims
Hyperalimentation

125
Q

Will a patient with acalculous cholecystitis feel pain

A

No not typically because they are already on pain medication

126
Q

What is the sonographic appearance of acalculous cholecystitis similar too

A

Acute cholecystitis but without stones

127
Q

What is the most common form of symptomatic GB disease

A

Chronic cholecystitis

128
Q

What is the clinical presentation of chronic cholecystitis

A 
Intolerance to fatty foods
Belching
Indigestion 
Postprandial RUQ pain 
Nausea 
Vomiting
129
Q

What is the sonographic appearance of chronic cholecystitis

A

Thick heterogenous wall
Contracted GB with stones
WES sign

130
Q

What lab values are significant in cases of chronic cholecystitis

A

AST
ALT
ALP
Bilirubin

131
Q

What are the complications associated with chronic cholecystitis

A

Bouveret syndrome
Gallstone ileum
Mirizzis syndrome

132
Q

What is bouveret syndrome

A

Gastric outlet obstruction; stone lodged in the duodenum

133
Q

What is gallstone lieus

A

Distal bowel obstruction; stone lodged in the iliosacral valve

134
Q

What is chronic cholecystitis associated with

A

Gallbladder carcinoma

135
Q

What is mirizzi syndrome

A

A rare complication caused by a having a stone impacted in the cystic duct/GB neck or Hartmann’s pouch

136
Q

What becomes compressed by the stone or inflammatory reaction in cases of mirizzi syndrome and what does it result in

A

CHD leads to jaundice

137
Q

What may form between the cystic duct and CHD in cases of mirizzi syndrome

138
Q

What are the clinical symptoms of mirizzi syndrome

A

Fever
Pain
Jaundice

139
Q

What is the sonographic appearance of mirizzi syndrome

A

Dilated bile duct above the level of obstruction

CBD normal

140
Q

What is xanthogranulomatous cholecystitis

A

A rare form of chronic inflammation

141
Q

What is the sonographic appearance of xanthogranulomatous cholecystitis

A

Hypoechoic nodules/bands in a thick GB wall

-represent fatty granulomatous nodules

142
Q

A porcelain GB is

A

Rare

Found in predominantly in the older female population

143
Q

A porcelain GB has a high association with what

A

GB carcinoma

144
Q

What is the cause of porcelain GB

145
Q

What is associated with a porcelain GB and what can may it be a form of

A

Stones and form of chronic cholecystitis

146
Q

What is the sonographic appearance of a porcelain GB

A

Calcified GB wall

147
Q

Cholangitis is

A

Is a rare inflammatory and fibrosing disorder of the biliary tree

148
Q

What are the 5 types of cholangitis

A 
Acute 
Recurrent pyogenic
AIDS
Biliary ascariasis 
Primary sclerosing
149
Q

Acute cholangitis is

A

Bacterial

Due to a biliary obstruction(choledocholiathiasis)

150
Q

What is the clinical presentation of acute cholangitis

A

Fever
RUQ pain
Jaundice

151
Q

What are the sonographic findings of actue cholangitis

A

Dilated biliary tree with thickened walls
Stones in the biliary tree
Liver abscess

152
Q

What lab values are increased in acute cholangitis

A

WBC
ALP
Bilirubin

153
Q

Recurrent pyogenic cholangitis is most common where

A

SE and east Asia

154
Q

What is the etiology of recurrent pyogenic cholangitis

155
Q

What does chronic obstruction of the bile ducts in cases of recurrent pyogenic chola lead to

A

Statis and stone formation

156
Q

What lobe of the liver is affected most often in cases of recurrent pyogenic cholangitis

A

Lateral left lobe

157
Q

What are the possible long term complications of recurrent pyogenic cholangitis

A

Biliary cirrhosis

Choleangiocarcinoma

158
Q

What is the sonographic appearance of recurrent pyogenic cholangitis

A

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

159
Q

In cases of advanced stages of AIDS what is cholangitis due to

A

Opportunistic infection

160
Q

What is the appearance of AIDS cholangitis on US

A

Thickened bile duct and GB walls
Focal strictures
Intra/extra hepatic duct dilation
Dilated CBD

161
Q

What are will the important lab values reflect in AIDS cholangitis

A

Elevated ALP

Normal bilirubin

162
Q

What is biliary ascariasis cholangitis caused by

A

Roundworm infestation

163
Q

What is the appearance of biliary ascariasis cholangitis on US

A

Echogenic non-shadowing parallel lines/tubes in the ducts and GB

164
Q

What should be assessed for in cases of biliary ascariasis cholangitis

165
Q

Primary sclerosing cholangitis is

A

A chronic inflammatory asymptomatic process of unknown cause that occurs more commonly in men

166
Q

What occurs in primary sclerosing cholangitis

A

The bile ducts fibrosis and inflame

167
Q

What does primary sclerosing cholangitis leas to

A

Biliary cirrhosis
Portal hypertension
Hepatic failure

168
Q

80% of patients with primary sclerosing cholangitis will also have what

A

Ulcerative colitis

169
Q

Pancreatisits is

A

Chronic or acute Inflammation of the pancreas that ranges from mild, moderate and severe and can be focal or diffuse

170
Q

What is the diagnosis of acute pancreatitis typically based on

A

Lab and clinical findings

171
Q

What is the clinical presentation for acute pancreatitis

A

Severe, constant, intense pain radiating to back
Relief by sitting up or bending at the waist
Nausea
Vomiting
Possible fever

172
Q

What is the role of US in cases of acute pancreatitis

A

Identify stones in the GB or duct
Detect fluid collections
Monitor the inflammatory process

173
Q

What is the possible etiology for acute pancreatitis

A

Alcohol abuse

Biliary stones

174
Q

What is the sonographic appearance of diffuse acute pancreatitis

A 
May appear normal
Decreased echogenicity 
Heterogenous 
Edematous 
Smooth contour 
Increased size 
Possible fluid collections
175
Q

What is the sonographic appearance of focal acute pancreatitis

A

Focal hypoechoic area; most commonly in the pancreatic head

Mimic a neoplasm

176
Q

Focal acute pancreatitis is often found in patient who suffer from

A

Chronic alcohol abuse

177
Q

What are the complications of acute pancreatitis

A 
Fluid accumulation 
Pseudocysts
Phlegmons
Hemorrhage 
Necrotizing pancreatitis 
Peritonitis 
Abscess formation

Abdomen 2 (6 decks)

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