Lesson 1D (Part 1)

Question 1

What are the most common routes for pyogenic bacteria? (4)

Answer 1

1. Through the biliary tract in patients with suppurative (pus) cholangitis or cholecystitis
2. Goes through the portal venous system
   - diverticulitis and appendicitis
3. Goes through the hepatic artery
   - osteomyelitis and bacterial endocarditis
4. Occurs as a result of blunt or penetrating trauma to the liver

Question 2

Cholangitis

Answer 2

Inflammation of the bile duct

Question 3

Cholecystitis

Answer 3

Inflammation of the GB

Question 4

Diverticulitis

Answer 4

Inflammation of the diverticulum

- impairing bowel function

Question 5

Appendicitis

Answer 5

Inflammation of the appendix

Question 6

Osteomyelitis

Answer 6

Inflammation of bone/bone marrow

Question 7

Bacterial endocarditis

Answer 7

Inflammation of the endocardium

Question 8

Hepatic abscess

Answer 8

Is a mass filled with pus inside the liver

Question 9

Pyogenic bacteria

Answer 9

Things coming from the bowel and are going into the portal system
- bacteria passing through blood

Question 10

What is hepatic abscesses mainly caused by?

Answer 10

Aanaeurobic (bacterial) infection

Question 11

What are symptoms of pyogenic liver abscess? (6)

Answer 11

1. Fever
2. Malaise
3. Anorexia
4. RUQ pain
5. Jaundice
6. Leukocytosis

Question 12

Is sonography helpful with detection of hepatic absesses?

Answer 12

Yes

Question 13

What are some sonographic signs of liver abscesses? (5)

Answer 13

1. Frankly purulent
   - cystic with fluid ranging from echo free to highly echogenic
2. Early supperation
   - solid with altered echogenicity, usually hypoechoic due to necrotic hepatocytes
3. Gas producing organisms give rise to echogenic foci with posterior reverberation artifacts ***
4. Fluid/fluid interfaces, internal septations and debris
5. Walls can be thick, irregular or well defined

Question 14

Fluid/filled

Answer 14

Clear fluid on the top and sludgy fluid on the bottom

Question 15

What confirms diagnosis for liver abscesses? (2)

Answer 15

1. Presence of pus

2. Positive gram stain and culture

Question 16

What kind of patients get fungal disease? (3)

Answer 16

1. Immunosuppressed ***
2. Females after pregnancy
3. People after hyperalimentation

Question 17

What is an example of a fungal disease?

Answer 17

Candidiasis

Question 18

How does candidiasis present?

Answer 18

With a persistent fever in a neutropenic patient (low white blood cell count) whose leukocyte count is returning to normal

Question 19

Neoplasm

Answer 19

Any unidentified mass

Question 20

What is the difference between a liver abscess and a hematoma?

Answer 20

A liver abscess needs to be drain, where as a hematoma can resolve on its own

Question 21

What are 9 examples of patients that are immunosuppressed?

Answer 21

1. Transplant pre and post
2. Cancer
3. Chemotherapy/radiation therapy
4. AIDS/HIV
5. Inherited disease
   - blood disorders
6. Underlying systemic infection
7. Poor nutrition
8. Shift workers
9. Pregnant

Question 22

What are some sonographic features of candidiasis?

Answer 22

1. Wheel within a wheel
2. Central nidus
3. Hyperechoic foci
4. Bull’s eye
5. Uniformly hypoechoic
6. Echogenic

Question 23

Wheel within a wheel

Answer 23

Peripheral hypoechoic zone with an inner echogenic wheel and a central hypoechoic nidus

Question 24

Central nidus

Answer 24

Focal necrosis where fungal elements are found

Question 25

Hyperechoic foci

Answer 25

Multiple small abscesses with air

Question 26

Bull’s eye

Answer 26

Hyperechoic center with a hypoechoic rim

- echogenic center contains inflammatory cells

Question 27

Uniformly hypoechoic

Answer 27

Due to progressive fibrosis

Question 28

Echogenic feature of candidiasis

Answer 28

Variable calcification

- scarring

Question 29

What is the most common sonographic feature of candidiasis?

Answer 29

Uniformly hypoechoic