Metabolic Disease Flashcards
Diffuse process that is dysfunction of hepatocytes and normal tissue is replaced with fat or fibrosis
Hepatocellular disease
Fat accumulation within the hepatocytes that is acquired and reversible
Fatty infiltration (steatosis)
The liver becomes more hyperechoic and heterogenous with a change in the ability to visualize vessels
Fatty infiltration
The grades of fatty infiltration
Grade 1: Mild: slight increase in echogenicity, diaphragm and vessels clearly visible
Grade 2: Moderate: increased echogenicity, diaphragm and vessels not well defined
Grade 3: Severe: markedly increased echogenicity, very difficult to see diaphragm and vessels
Focal areas of increased echogenicity (fat deposits) within mostly normal liver tissue
Focal fatty infiltration
Focal hypoechoic areas (normal liver tissue) within a mostly fatty liver
Focal fatty sparing
Which area is mostly involved in focal fatty changes? What are some characteristics?
Medial left lobe. Map like boundaries and rapid change over time
A diffuse process that destroys liver cells and is not reversible
Cirrhosis
Appears as severe fatty infiltration and enlarged liver
Acute cirrhosis
Small liver, coarse echotexture, nodular surface, small vessel sizes
Chronic cirrhosis
What are some lab values associated with cirrhosis?
AST, ALT, LDH, ALP, bilirubin (conjugated)
What are the 3 main clinical presentations of cirrhosis?
Hepatomegaly, jaundice, ascites
Autosomal recessive disorder that causes excess glycogen deposits in hepatocytes
Glycogen storage disease/ Von Gierke’s
GSD sonographic appearance
Diffuse fatty infiltration and adenomas
2 types of ascites
Transudate: anechoic (little/no protein or cells), suggests non-inflammatory process
Exudate: echogenic, high protein content (blood, pus, chylous), inflammatory or malignant cause
Free vs loculated fluid
Free fluid: changes with patient position, conforms to organs
Loculated: no change with movement, round/mass like effect
The 3 most dependent spaces in the abdominopelvic cavity?
Morison’s Pouch, paracolic gutters, Pouch of Douglas
A mixture of particulate matter and bile that can be a precursor to GB disease, most commonly caused by bile stasis
Biliary sludge
When sludge becomes the same echogenicity as the liver and camouflages the GB
GB hepatization
Pseudo sludge
Artifact due to excessive gains
The presence of pus in bile
Empyema
Blood in the bile
Hemobilia
GB filled with semi solid deposits
Milk of calcium (limey bile)
Most common disease of the GB
Cholelithiasis (gallstones)
Three factors that affect gallstone formation
- abnormal bile composition
- biliary stasis
- infection
3 different types of GB stones
- Cholesterol
- Bilirubin
- Calcium
Who’s most at risk for GB stones? (5 f’s)
Female, fat, fertile, forty, family history
What are some of the clinical presentations for gallstones?
Asymptomatic, RUQ pain, N&V, belching
What is the WES sign?
Wall, echo, shadow.
When the GB is completely filled with stones
What lab values may indicate stones?
AST, ALT, ALP, BILI
What are 3 complications associated with gallstones?
Biliary colic (most common), obstruction of cystic duct or CBD, bacterial infection, cholecystitis, ascending cholangitis
Differentiate painful/painless jaundice
Painless: neoplastic condition, choledochal cysts
Painful: acute obstruction or infection of the biliary tree
What are some S/S of biliary obstruction
- jaundice
- clay coloured stool
- abnormal LFT’s
- pain
- nausea
Stones in the biliary tree
Choledocholithiasis
Most common location for choledocholithiasis
Distal CBD at Ampulla of Vater
Stones in the urinary system
Urolithiasis
Stones in the renal collecting system
Nephrolithiasis
Calcifications in the renal parenchyma
Nephrocalcinosis
Where are the narrowings in the ureter that are common for stones to get lodged? What size stones can be passed?
1.UPJ
2. Iliac vessels
3. UVJ (most common)
stones <5mm can pass
What artifact is associated with stones?
Twinkling artifact
Dilatation of the renal collecting system
Hydronephrosis
Obstructive vs non obstructive hydro
Obstructive: intrinsic/extrinsic obstruction of flow. Look for jets
Non-obstructive: reflux, infection, polyuria
Grade hydronephrosis
Grade 1: slight separation of the renal sinus
Grade 2: separation of the entire central sinus, clubbed calyces
Grade 3: severe, cortical thinning, loss of individual calyx definition
Anderson-Carr Kidney on U/S
Non-shadowing echogenic rims of pyramids
Poorly functioning but unobstructed kidneys
Medical renal disease
Diffuse increase in cortical echogenicity with prominent CM junction, enlarged kidneys
Acute medical renal disease
Chronic medical renal disease
Small, echogenic kidney
Most common cause of ARF and is reversible
Acute tubular necrosis
Necrosis of the cortex with sparing of the pyramids
Acute cortical necrosis
Acute glomerulonephritis
Autoimmune reaction
Amyloid deposits in the kidneys
Amyloidosis
Most common cause of chronic renal failure
Diabetes mellitus
Inability of kidneys to remove waste from blood and results in azotemia
Renal failure
What are the 3 causes of renal failure?
- Pre-renal: sepsis, stenosis
- Renal: tissue
- Post renal: obstruction of collecting system
What lab values may be abnormal with renal disease?
- Creatinine **
- BUN
- Uric acid
- RBC/WBC in urine
- proteinuria
Excessive cortisol secretion
Cushing’s syndrome
Cushing’s disease
Due to malfunctioning pituitary (too much ACTH)
Hyperadrenalism vs hypoadrenalism
Hyper: too much hormone
Hypo: not enough hormone
Excessive aldosterone secretion
Conn’s Disease
MEN type 2
Bilateral, autosomal dominant, malignant
Tumours developing in several endocrine glands
MEN
Chronic primary hypoadrenalism that is usually autoimmune & affects mostly females
Addison’s disease
Acute hypoadrenalism
Waterhouse-Friderichsen Syndrome
Which enzyme is most sensitive indicator of biliary obstruction
ALP
