Metabolic Diseases Flashcards
A metabolic disease is an abnormality that occurs
Globally in the body
A metabolic disease affects ____ and is dependant on
Several organs
The stage of the disease
What makes the underlying cause of a metabolic numerous
Many substances metabolized in the body
What are the different metabolic diseases of the liver
Hepatocellular disease
Glycogen storage disease
What are the different types of hepatocellular disease
Fatty infiltration
Cirrhosis
What is hepatocellular disease
A diffuse process what is caused by the dysfunction of hepatocytes
What is normal liver tissue replaced with in hepatocellular disease
Fat or fibrosis
Hepatocellular disease ranges from
Simple fatty changes to cirrhosis
What does hepatocellular disease often result in
Abnormal LFT’s
Hepatocellular disease often affects the
Liver size
What is Fatty infiltration
Steatosis
Define steatosis
Accumulation of triglycerides within hepatocytes
Is fatty infiltration uniform throughout the liver
No, not always
Fatty infiltration can be what kind of processes
Focal or diffuse
Fatty infiltration is
Acquired and reversible
What are the 2 most common causes of fatty infiltration
Alcohol abuse
Obesity
Fatty infiltration is the precursor to
Significant chronic disease
What is assessed when evaluating the liver for fatty infiltration
Echogenicity changes
Echotexture changes
Attenuation characteristics
Ability to visualize vessels
What is imperative when assessing for fatty infiltration
Appropriate gains, TGC’s and focus
What is the sonographic characteristics for mild fatty infiltration
Slight increase in liver echogencity
Diaphragm and vessels clearly defined
What is the sonographic characteristics for moderate fatty infiltration
Increase in liver echogencity
Vessels and diagram not sharply defined
What is the sonographic characteristics for severe fatty infiltration
Liver echogencity is markedly increased
Extremely difficult to define diaphragm and vessel walls
What are the different types of focal fatty changes
Infiltration
Sparing
What is the sonographic characteristics of infiltration
Focal areas of increased echogencity (fatty deposits)
Mostly normal liver parenchyma
What is the sonographic characteristics of sparing
Focal hyperechoic areas (normal liver tissue)
Majority if liver parenchyma has fatty infiltration
What lab values could potentially be elevated with fatty infiltration
ALT
AST
BBT is associated with alcohol abuse
What is cirrhosis
A diffuse process that destroys the liver cells
What does cirrhosis result in
Fibrosis of the liver parenchyma with nodular changes
What are the underlying causes for cirrhosis
Alcohol abuse
Chronic viral hepatitis
Primary sclerosing cholangitis
What is the progressive change of cirrhosis
Cell death
Fibrosis
Regeneration
Is cirrhosis reversible
No
What are the 2 types of nodular changes with cirrhosis
Micro nodular
Marco nodular
What is mirco nodular changes in cirrhosis caused by
Alcohol consumption
What is macro nodular changes in cirrhosis caused by
Chronic viral hepatitis
What does the acute stage of cirrhosis look like
Some appearance of severe fatty infiltration
Enlarged liver
Textural changes
What does the chronic stage of cirrhosis look like
Small liver (CL/RL >0.65)
Course echotexture
Nodular surface
Paucity of vessels
What is quite common with liver cirrhosis
Ascites
Cirrhosis has the potential to progress to what
End stage liver failure
What do the lab values for cirrhosis depend on
The stage of the disease
What are the increased lab values for cirrhosis
AST ALT LDH ALK PHOS (ALP) Bilirubin (conjugated) Gamma globulins (BBT)
What lab value is decreased with liver cirrhosis
Serum albumin
Which other organ is affected by liver cirrhosis and why
Spleen and because of portal hypertension
What is the classic clinical presentation of liver cirrhosis
Hepatomegaly
Jaundice
Ascites
What are the other clinical presentations for liver cirrhosis
Diarrhea
Feeling of fullness
Weight loss
What is glycogen storage disease
Autosomal recessive disorder
What is another name for glycogen storage disease
Von Gierke’s disease
Glycogen storage disease is cause by what
An enzyme deficiency (G6P) which leads to excess glycogen deposits in hepatocytes
What is the most common disease of the gallbladder
Cholelithiasis
What are the factors affecting gallstone formation
Abnormal bile composition
Stasis of bile
Infection
What is the compulsion of gallstones
Cholesterol
Bilirubin
Calcium
What is the most common composition of gallstones
Cholesterol
What is the stone called when it is composed of bilirubin
Pigment stone
What are the risk factors for cholelithiasis
Female Fat Fertile Forty Family history
What is the clinical presentation of cholelithiasis
Can be asymptomatic
RUQ pain (after meals)
Nausea and vomiting
Belching
If a patient is found to have cholelithiasis and has RUQ pain how does the pain radiate
Towards the back
What is the sonographic appearance of cholelithiasis
Echogenic focus Posterior shadowing Mobility May float in the bile WES sign
If a cholelithiasis stone is <5mm what may it not have
A shadow
When is the WES sign seen
When the gallbladder is filled with multiple stones or one large stone
What does WES stand for
Wall
Echo
Shadow
What lab values will be altered with cholelithiasis
ASTT
ALT
ALP
Bilirubin
What are the complications of gallstones
Biliary colic Obstruction of the cystic duct or CBD Bacterial infection Cholecystitis Ascending cholangitis
What is the most common complication of gallstones and what does it cause
Biliary colic; causes severe pain
What does the obstruction of the cystic duct or CBD lead to
GB hydrops
An US examination to investigate possible obstruction of the biliary tree tree should focus on which 3 questions
- Is the bile duct or GB dilated
- If yes, to what level
- If yes, what is the cause
What are the 2 different types of biliary tree obstruction
Biliary dilation
Choledocholiathiasis
Biliary dilation can be
Intra-hepatic or extra-hepatic
Mild, moderate or severe
What causes the ducts to dilate
Obstruction
Loss of duct elasticity
Ampulla of vaster dysfunction
What is the most common cause of duct dilation
Obstruction
What is the typical cause of biliary obstruction
Stone
Tumor
What is the clinical presentation of obstruction
Painless jaundice
Painful jaundice
What causes painless jaundice
Neoplastic conditions
Choledochal cysts
When is painful jaundice seen
With acute obstruction (stones)
And/Or
Infection of the biliary tree
What are the signs and symptoms of obstruction
Jaundice Clay coloured stool Abnormal LFT’s Pain Nausea
Can choledocholiathiasis be intrahepatic or extrahepatic
Yes
What is choledocholiathiasis
Stones in the biliary tree
Are there primary and secondary causes of choledocholiathiasis
Yes
What is the secondary cause of choledocholiathiasis
Stones that pass from the gallbladder to ducts
What is the primary cause of choledocholiathiasis
Stones that form in the ducts
What is the most common cause of choledocholiathiasis
Secondary
What causes the primary cause of choledocholiathiasis
Inflammation
Infection
Caroli’s disease
Prior surgery
What kind of infection will lead to the primary cause of choledocholiathiasis
Parasitic
What is the most common location for stones in the biliary tree
Distal CBD at the ampulla of Vater
when does glycogen storage disease begin
neonatally
what is associated with glycogen storage disease
begin adenomas
HCC
how is glycogen storage disease managed
through controlled and monitored diet
what is the sonographic appearance of glycogen storage disease
presents as diffuse fatty infiltration
adenomas
what is the metabolic disease that affects the peritoneum
ascites
define ascites
accumulation of free serous fluid in the peritoneal cavity
what are the 2 different types of ascites fluid
transudate
exudate
what does transudate fluid contain
little protein or cells
what does transudate fluid suggest
a non-inflammatory process
what kind of non-inflammatory processes does transudate fluid typically indicate
cirrhosis
CHF
why does cirrhosis cause transudate fluid to be leaked
because pressures in the liver increases which causes fluid to leak out of the hepatocytes
or
hypoalbuminemia
what is the sonographic appearance of transudate fluid
anechoic fluid
what does exudate fluid contain
high protein
blood (hemoperitoneum)
pus
chylous
define chylous
milky fluid with a high fat content
where is chyous from
lympathic system
what does exudate fluid suggest
an inflammatory or malignant cause
what is the sonographic appearance of exudate fluid
internal echoes
echogenic
loculations
what are the 2 different ways fluid in the perioneal cavty can present
free
loculated
how does free fluid in the perioteum change
with patient position
does free fluid in the perioteum confrom to the surrounding organs
yes, with acute angles with organ contact
how does loculated fluid in the peritoeum change with movement
it doesn’t
what is the appearance of loculated fluid in the peritoneum
rounded margins mass effect (walled off)
what are the 3 most dependant spaces in the perioneal cavity
morrison’s pouch
pouch of douglas
paragolic gutter
what are the different metabolic diseases of the gallbladder and biliary tree
biliary sludge
gallstones
biliary tree obstruction
what is biliary sludge
a mixture of particulate matter and bile
what are the different names for biliary sludge
biliary sand
microlithiasis
what is biliary sludge a potential presursor for
gallbladder disease
if a patient has biliary sludge how do they present
may or may not have symptoms
if a patient is asymptomatic and has biliary sludge, what does it typically indicate
biliary colic
inflammation of the gallbladder and pancreas
can biliary sludge resolve spontaneously
yes
what is the most likely cause of biliary sludge
bile stasis
what are the causes of bile stasis
prolanged fasting
rapid weight loss
TPN
extrahepatic biliary obstruction
what is the sonographic appearance of biliary sludge
non-shadowing homogeneous low level echoes layers in the dependant portion of the gallbladder -fluid-fluid level moves with patient position
what are the different types of biliary sludge
tumefactive sludge/sludge balls hepatization pseudo sludge empyema hemobila milk of calcium
what is tumefactive sludge/sludge ball
sludge that mimics polypoid tumors
how do you differiciate tumefactive sludge from polypoid tumor
look at vascularity mobility and GB wall thickness
what is hepatization sludge
sludge that has the same echogenicity as the liver
camouflages the GB
what is pseudo sludge
an imaging artifact that is independant of gravity
caused by excessive gains, slice thickness or side lobe artifact
what is empyema sludge
presence of pus in bile
what is hemobilia sludge
the presence of blood in bile
what is hemobila usually due to
liver biopsy
percutaneous biliary procedures
what is another term for milk of calcium
limey bile
What is milk of calcium
Rare, semi solid substance that fills the GB that is in a separate category from biliary sludge
What is milk of calcium composed of
Calcium carbonate
What is the sonographic appearance of milk of calcium
Highly echogenic material with posterior shadowing that changes with patient position and it forms a calcium/bile fluid level
Stones in the distal CBD can be difficult to visualize due to what
Bowel gas
What do you look for in the distal CBD if there is bowel gas blocking the stone
Hyperechoic focus with posterior shadowing
What are scanning techniques to resolve the distal CBD
Changing patient position
Compression of bowel
Change windows
Use the pancreatic head as a reference
What can cause false positives of stones in the distal CBD
Surgical clips; post cholecystectomy
Air
Edge artifact
What lab values will change with choledocholiathiasis
Alkaline phosphatase (ALP)
AST
ALT
Bilirubin
what is the treatment for choledocholiathiasis
ERCP spincterotomy
ERCP extraction
stenting
what does ERCP stand for
endoscopic retrograde cholangiopanreatography
what are the metabolic diseases that affect the urinary tract
calculi in the urinary collecting system
medical renal disease
renal failure
what are the different types of stones in the urinary system
nephrolithiasis bladder calculi hydronephrosis renal parenchymal calcium deposits Anderson-Carr kidney
define urolithiasis
stones in the urinary system
define nephrolithiasis
stones in the renal collecting system
define nephrocalcinosis
calcifications in the renal parenchyma
is nephrolithiasis very common
yes
who is more commonly affected by nephrolithiasis
caucasian males
the incidence of nephrolithiasis increases with what
age
what is the etiology of nephrolithiasis
unknown
what are the underlying risk factors for developing nephrolithiasis
hereditary
limited water intake
high animal protein diet
urinary stasis
stones that form in the kidneys can move through what
the collecting system
stones can become lodged in the natural narrowings of the ureter where
just past the UPJ
at the iliac vessels
at the UVJ
what is the most common place for a stone to become lodged in the ureter
the UVJ
stones < what can be passed
5mm
what is the clinical presentation of nephrolithiasis
often asymptomatic
heamturia
flank pain
hematuria in cases of nephrolithiasis can be what
microscopic or gross
what is the sonographic appearance of nephrolithiasis
echogenic focus
posterior shadowing
what information of nephrolithiasis should be gathered for the radiologist
number
size
location
compilcations
what complications are being assessed for in cases of nephrolithiasis
hydronephrosis
jets in the bladder
tiny stones can be difficult to identify, so what should be looked for
twinkle artifact
define staghorn calculi
calcifications in the collecting system
what can cause false postives for nephrolithiasis
intrarenal gas renal artery calcifcations calcified sloughed papilla calcified tumors ureteric stent
whaat are the 3 other imaging modalities that can detect urolithiasis
xray
tomagraphy
CT
bladder calculi are
usually single
asymptomatic
bladder calculi can be the result of
a stone migrating from the kidney
urinary stasis
what can the patient present with if they have bladder calculi
hematuria
pain
what is checked for in cases of bladder calculi and how is it done
mobility of the stone to the dependant portion of the bladder by changing patient position
what is hydronephrosis
dilated renal collecting system
hydronephrosis can be a
incidental finding, asymptomatic patient
hydronephrosis can be due to what causes
obstructive
non-obstructive
what are the obstructive causes of hydronephrosis
intrinsic/extrinsic obstruction of flow
what should be assessed for in obstructive cases of hydronephrosis
jets
what are the non-obstructive causes of hydronephrosis
reflux
infection
polyuria
what may hydronephrosis lead to
renal atrophy
classifications for hydronephrosis are based on what
sonographic appearance
how many grades of hydrone[hrosis are there
3
what is grade 1 hydronephrosis
mild
slight seperation of the renal collecting system
what is grade 2 hydronephrosis
moderate
anechoic seperation of the entire central renal sinus
pelvis and calcyes (major and minor) are dilated
clubbed calcyes
what is degree of separation of the renal collecting system when there is mild hydronephrosis
2mm
what is grade 3 hydronephrosis
severe
thinning of the renal cortex
extensive enlargement of the renal sinus and calyces
loss of individual calyx definition
why are the ureters and bladder assessed in cases of hydronephrosis
looking for the cause
what can lead to false positives of hydronephrosis
over distened bladder
extra-renal pelvis
multiple parapelvic cysts
AV malformation
in cases of hydronephrosis what must always be performed
a post-void assessment
what is another term for renal parenchymal calcium deposits
nephrocalcinosis
renal parenchymal calcium deposits occur ___ and are
bilateral and diffuse
renal parenchymal calcium deposits are either
cortical or medullary
renal parenchymal calcium deposits can be caused by
ischemia
necrosis
wall of pyramids
what is the sonographic appearance of renal parenchymal calcium deposits
increased cortical echogenicity
echogenic pyramids or wall of pyramids
possible shadowing
what is Anderson-Carr kidney
theory of stone progression
what causes Anderson-Carr kidney
high concetration of calcium in fluid around tubules
what does Anderson-Carr kidney result in
deposits of calcium in the margins of the medulla
what is the sonographic appearance Anderson-Carr kidney
non-shadowing echogenic rims of renal pyramids
medical renal disease affects what
renal parenchyma bilaterally and diffusly in the cortex and medulla
medical renal disease is a broad term to describe what
renal disorders
medical renal disease describes what
poorly functioning but unobstructed kidneys
what needs to be doen to identify the cause of medical renal disease
renal biopsy
medical renal disease is intially treated by what rather than what
medication rather than surgery
what can medical renal disease lead to
renal failure
in cases of medical renal disease what are the areas to evaulate
renal size and conture cortical echogencity CM junction distinction renal pyramids renal sinus
what may the sonographic appearance of medical renal disease depend on
the varying underlying cause
what is the sonographic appearance of the acute stages of medical renal disease
diffuse increase in cortical echogencity
prominent CM junction
enlarged kidneys
can also appear normal
what is the exception in acute stages of medical renal disease if the pyramids are affected
the CM junction will not be defined
what is the sonographic appearance of the chronic stage of medical renal disease
small echogenic kidneys
what are the causes of medical renal disease
acute tubular necrosis acute cortical necrosis acute glomerulonephritis amyloidosis diabetes mellitus
what is the most common cause of acute reversible renal failure
acute tubular necrosis
what is acute tubular necrosis
deposits of debris in the renal collecting tubules
what can acute tubular necrosis be the result of
toxic or ischemic insults
what is the appearance of acute tubular necrosis on ultrasound
kidneys most often appear normal but maybe bilateral enlarged with echogenic pyramids
RI >0.75
acute cortical necrosis is a rare cause of what
acute renal failure
what is acute cortical necrosis
ischemic necrosis of the cortex with sparing of the pyramids
what is acute cortical necrosis due to
sepsis
burns
severe dehyrdations
PIH
what is the sonographic appearance of acute cortical necrosis
initally normal size, hypoechoic cortex and loss of CM junction
over time, kidneys atrophy and cortex calcifies
acute glomerulonephritis is a
autoimmune reaction
what does the patient present with when they have acute glomerulonephritis
hematuria
hypertension
azotemia
what is the early appearance of acute glomerulonephritis on US
kindey may be normal size or enlarged
cortex may be normal echogenic ot hypoechoic
what is the appearance of the later stages of acute glomerulonephritis
small, echogenic kidneys
what is amyloidosis
systemic metabolic disorder resulting in amyloid deposits in the kidneys
what will the patient present with when they have amyloidosis
proteinuria
what is the appearance of amylodosis on US
variable; large, normal or small kidney size
hypo or hperechoic
what is the most common cause of chronic renal failure
diabetes mellitus
initally what happens to the kidneys when a patient has diabetes mellitus
kidneys will be enlarged
at end-stage of diabetes mellitus what is the appearance of the kidneys
small
echogenic
loss of CMJ
renal failure is
the inability of kidneys to remove metabolites from blood
what is azotemia
overload of urea and nitrogenous wastes in the blood
what does renal failure result in
azotemia
what are the 3 different causes of renal failure
pre-renal
renal
post-renal
what leads to the cause of pre-renal, renal failure
sepsis
renal artery stenosis
what leads to renal, renal failure
parenchymal disease
what leads to post-renal renal failure
obstruction of collecting system
if there is complete obtruction how long does it take for the renal damage to be irreversible
3 weeks
if there is incomplete obstruction how long will it take for the renal damage to be irreversible
3 months
acute stage renal failure is
reversible
typically due to medical renal disease
what is the sonographic appearance of acute stage renal failure
most normal, possible enlargeme
hypoechoic
assess for hydronephrosis, obstruction
check echogencity of parenchyma
chronic stage renal failure is
irreversible
most common caused by diabetes mellitus
what is the sonographic appearance of chronic stage renal failure
small kidney
echogenic cortex
what lab vaules are increased with renal failure
serum creatinine BUN uric acid RBC/WBC in urine proteinuria
what is the treatment for renal failure
dialysis
renal transplant
what are the different metabolic diseases of the adrenal glands
hyperadrenalism
hypoadrenalism
what can cause hyperadrenalism
cushing’s syndrome
conn’s disease
MEN
what does cushing’s syndrome result from
excess secretion of cortisol
cushing’s sydrome can occur as the result of
adrenal hyperplasia
adrenal adenoma
adrenal carcinoma
exogenous corticosteriod administration
what is the clinical presentation of cushing’s disease
moon face buffalo hump truncal obesity hirsutisim amenorrhea HTN
what is the difference between cushing’s syndrome and cushing’s disease
snydrome is cause by adreanal dysfunction
disease is caused by a pitutary disorder
what is Conn’s disease
excess aldosterone secreation
what can Conn’s disease occur as a result of
adenoma (aldosteronoma)
hyperplasia
carcinoma
is carcinoma causing Conn’s disease common or uncommon
uncommon
what is the clincial presentation of Conn’s disease
hypernatemia hypokalemia HTN muscle cramps altered renal function
what is the sonographic appearance of Conn’s disease
small,solid, round mass
hypoechoic
what does MEN stand for
multiple endocrine neoplasia
how many types of MEN are there
3
MEN tumores develop in several endocrine glands, like
adrenal
pancreas
pituitary
parathyroid gland
MEN causes excess what to be produced
hormones
MEN can be either
benign or malignant
is type 2 MEN malignant or benign
malignant
MEN type 2 is and occurs
autosomal dominant and occurs typically bilaterally in the phenochromocytomas in adrenal
hypoadrenalism is due to
primary disorders of the adrenal cortex or disorders of the hypothalamus or pituitary
hypoadrenalism may cause what
adrenal atrophy
what can cause hypoadrenalism
Addison’s disease
waterhouse-friderichsen syndrome
what are the 2 types of addison’s disease
autoimmune
TB
what % of addison’s disease is autoimmune
80
autoimmune addison’s disease is
found in females
not typically identified sonographically
what % of addison’s disease is TB
20
TB addison’s disease is found in
males
TB addison’s disease causes
enlarged, firm, nodular adrenals hyperpigmentation low blood pressure muscle weakness fatigue
what % of the gland is nonfunction when the patient has TB addison’s disease
90
what is waterhouse-frederichsen syndrome
acute hypoadrenlism
waterhouse-frederichsen syndrome is from
massive destruction of adrenals
waterhouse-frederichsen syndrome is secondary to
hemorrhage
infection
what is necessary with waterhouse-frederichsen syndrome
glucocorticoid therapy