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SONOCAN ABD Review > Metabolic disorders > Flashcards

Metabolic disorders Flashcards

1
Q

What is a metabolic disorder?

A

An abnormality that occurs globally in the body and affects several organs, depending on the stage of the disease.

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2
Q

What is Hepatocellular Disease?

A

A diffuse process involving dysfunction of hepatocytes, replacing normal liver tissue with fat or fibrosis.

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3
Q

What is fatty infiltration?

A

Steatosis, the accumulation of triglycerides within hepatocytes, which can be diffuse or focal.

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4
Q

What are common causes of fatty infiltration?

A

Alcohol abuse and obesity.

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5
Q

What are the sonographic characteristics of mild fatty infiltration? 3

A
  1. Slight increase in liver echogenicity
  2. Diaphragm
  3. Vessels clearly defined.
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6
Q

What are the sonographic characteristics of moderate fatty infiltration? 2

A
  1. Increased liver echogenicity
  2. Vessels and diaphragm not sharply defined.
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7
Q

What are the sonographic characteristics of severe fatty infiltration? 2

A
  1. Liver echogenicity markedly increased
  2. Extremely difficult to define diaphragm and vessel walls.
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8
Q

What is cirrhosis?

A

A diffuse process that destroys liver cells, resulting in fibrosis with nodular changes.

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9
Q

What are potential lab values elevated with fatty infiltration? 7

A

AST, ALT, LDH, ALK PHOS, bilirubin (conjugated), and gamma globulins.

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10
Q

What is glycogen storage disease?

A

An autosomal recessive disorder, such as Von Gierke’s Disease, causing excess glycogen deposits in hepatocytes.

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11
Q

What is ascites?

A

Accumulation of free serous fluid in the peritoneal cavity.

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12
Q

What is the sonographic appearance of transudate fluid in ascites?

A

Anechoic fluid.

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13
Q

What is biliary sludge?

A

A mixture of particulate matter and bile, potentially a precursor to gallbladder disease.

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14
Q

What are the risk factors for gallstone disease? 5

A

Female, fat, fertile, forty, and family history.

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15
Q

What is the WES sign in sonography?

A

Wall, echo, shadow; seen when the gallbladder is filled with multiple stones or one large stone.

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16
Q

What is choledocholithiasis?

A

Stones in the biliary tree, which can be secondary (from gallbladder) or primary (formed in ducts).

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17
Q

What are the secondary causes of stones in the biliary tree?

A

Stones pass from gallbladder to ducts.

Most common cause.

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18
Q

What are the primary causes of stones in the biliary tree?

A

Stones form in the ducts due to inflammation, infection (parasitic), Caroli’s disease, or prior surgery.

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19
Q

Where is the most common location for stones in the biliary tree?

A

Distal CBD at the ampulla of Vater.

Difficult area to visualize due to bowel gas; look for a hyperechoic focus with posterior shadowing.

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20
Q

What scanning techniques can be used to visualize the biliary tree? 4

A
  1. Change patient position
  2. Compress the bowel
  3. Change windows
  4. Use the pancreatic head as a reference.
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21
Q

What are common false positives when scanning for biliary stones?

A

Surgical clips (post cholecystectomy), air, edge artifact.

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22
Q

What lab values are important in assessing biliary stones? 4

A

Alkaline phosphatase (ALP), AST, ALT, and Bilirubin.

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23
Q

What are the treatment options for biliary stones? 2

A

ERCP sphincterotomy, ERCP extraction, stenting.

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24
Q

What is urolithiasis?

A

Stones in the urinary system.

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25
Q

What is nephrolithiasis?

A

Stones in the renal collecting system.

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26
Q

What is nephrocalcinosis?

A

Calcifications in the renal parenchyma.

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27
Q

What factors increase the incidence of nephrolithiasis? 6

A
  1. Increased incidence with age
  2. More common in Caucasian males
  3. Hereditary factors
  4. Limited water intake
  5. High animal protein diet
  6. Urinary stasis.
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28
Q

Where can stones become lodged in the urinary system?

A

Just past the UPJ, at the iliac vessels, at the UVJ.

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29
Q

What is the clinical presentation of nephrolithiasis? 3

A
  1. Often asymptomatic
  2. Hematuria (microscopic or gross)
  3. Flank pain.
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30
Q

What is the sonographic appearance of stones?

A

Echogenic focus with posterior shadowing.

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31
Q

What information should be gathered for the radiologist regarding stones? 4

A
  1. Number
  2. Size
  3. Location
  4. Complications (look for hydronephrosis, jets in the bladder).
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32
Q

What artifact may help identify tiny stones?

A

Look for twinkling artifact.

33
Q

What are staghorn calculi?

A

Calcifications filling the collecting system.

34
Q

What are common false positives for renal stones? 5

A
  1. Intrarenal gas
  2. Renal artery calcifications
  3. Calcified sloughed papilla
  4. Calcified tumors
  5. Ureteric stent.
35
Q

What challenges are associated with imaging stones in the ureter? 2

A
  1. Location creates imaging challenges
  2. Stones lodge at the narrowest point.
36
Q

What should be looked for when imaging the ureter?

A

A dilated tube and an echogenic focus with shadowing at the distal end.

37
Q

What is the typical presentation of bladder calculi?

A
  1. Usually single
  2. Asymptomatic
  3. May present with hematuria and pain.
38
Q

How can bladder stones be assessed for mobility?

A

Change patient position.

39
Q

What is hydronephrosis?

A

Dilated renal collecting system that can be an incidental finding and may be asymptomatic.

40
Q

What are the causes of hydronephrosis?

A

Obstructive and non-obstructive causes.

41
Q

What are obstructive causes of hydronephrosis?

A

Intrinsic/extrinsic obstruction of flow. Look for jets.

42
Q

What are non-obstructive causes of hydronephrosis? 3

A
  1. Reflux
  2. Infection
  3. Polyuria.
43
Q

What may hydronephrosis lead to?

A

Renal atrophy.

44
Q

What are the classifications of hydronephrosis based on sonographic appearance?

A

Grade 1, Grade 2, and Grade 3.

45
Q

Describe Grade 1 hydronephrosis. 2

A
  1. Mild with slight separation (splaying) of renal collecting system
  2. 2mm separation.
46
Q

Describe Grade 2 hydronephrosis. 3

A
  1. Moderate with anechoic separation of the entire central renal sinus
  2. Dilated pelvis and calyces
  3. Clubbed calyces.
47
Q

Describe Grade 3 hydronephrosis. 3

A
  1. Severe with thinning of the renal cortex
  2. Extensive enlargement of renal sinus and calyces
  3. Loss of individual calyx definition.
48
Q

What are false positives for hydronephrosis? 4

A
  1. Over distended bladder
  2. Extra-renal pelvis
  3. Multiple parapelvic cysts
  4. AV malformation.
49
Q

What should always be performed in cases of hydronephrosis?

A

A post void assessment.

50
Q

What are renal parenchymal calcium deposits?

A

Nephrocalcinosis, which can be bilateral and diffuse.

51
Q

What causes renal parenchymal calcium deposits? 3

A
  1. Ischemia
  2. Necrosis
  3. Hypercalcemic states.
52
Q

What is the sonographic appearance of renal parenchymal calcium deposits? 3

A
  1. Increased cortical echogenicity
  2. Echogenic pyramids or wall of pyramids
  3. Possible shadowing.
53
Q

What is the Anderson-Carr Kidney theory?

A

Theory of stone progression due to high concentration of calcium in fluid around tubules.

54
Q

What is the sonographic appearance of the Anderson-Carr Kidney?

A

Non-shadowing echogenic rims of renal pyramids.

55
Q

What is medical renal disease? What does it describe? 2

A
  1. Disease affecting renal parenchyma diffusely and bilaterally
  2. Describing poorly functioning but unobstructed kidneys.
56
Q

What is needed for a specific diagnosis of medical renal disease?

A

A renal biopsy.

57
Q

What are the sonographic appearances in acute stages of medical renal disease? 3

A
  1. Diffuse increase in cortical echogenicity
  2. Prominent CM junction
  3. Enlarged kidneys.
58
Q

What are the sonographic appearances in chronic stages of medical renal disease?

A

Small, echogenic kidneys.

59
Q

What is the most common cause of acute reversible renal failure?

A

Acute Tubular Necrosis.

60
Q

What is the ultrasound appearance of Acute Tubular Necrosis?

A

Kidneys may appear normal but may be bilaterally enlarged with echogenic pyramids.

61
Q

What is a rare cause of acute renal failure?

A

Acute Cortical Necrosis.

62
Q

What is the ultrasound appearance of Acute Cortical Necrosis? 3

A
  1. Initially normal size
  2. Hypoechoic cortex
  3. Loss of CM junction.
63
Q

What is Acute Glomerulonephritis? 3

A

An autoimmune reaction presenting with
1. hematuria
2. Hypertension
3. Azotemia.

64
Q

What is the most common cause of chronic renal failure?

A

Diabetes Mellitus.

65
Q

What is renal failure?

A

Inability of kidneys to remove metabolites from blood, resulting in azotemia.

66
Q

What are the causes of renal failure?

A

Pre-renal, renal, and post-renal causes.

67
Q

What is the sonographic appearance of acute renal failure?

A

Most often normal; may be enlarged, hypoechoic.

68
Q

What is the treatment for renal failure?

A

Dialysis and renal transplant.

69
Q

What is Cushing’s Syndrome?

A

Results from excess secretion of cortisol.

70
Q

What are the clinical presentations of Cushing’s Syndrome? 6

A
  1. Moon face
  2. Buffalo hump
  3. Truncal obesity
  4. Hirsutism
  5. Amenorrhea
  6. Hypertension.
71
Q

What is the difference between Cushing’s syndrome and Cushing’s disease?

A

Cushing’s disease is due to hyperplastic adrenal glands secreting excessive cortisol from a pituitary adenoma.

72
Q

What is Conn’s Disease?

A

Excess aldosterone secretion.

73
Q

What are the clinical presentations of Conn’s Disease? 5

A
  1. Hypernatremia
  2. Hypokalemia
  3. Hypertension
  4. Muscle cramps
  5. Altered renal function.
74
Q

What is the sonographic appearance of Conn’s Disease? 3

A
  1. Small
  2. Solid
  3. Hypoechoic round mass.
75
Q

What is Multiple Endocrine Neoplasia (MEN)?

A

A condition where tumors develop in several endocrine glands.

76
Q

What are the types of MEN?

A

Three types, with benign or malignant tumors.

77
Q

What is Addison’s Disease?

A

Autoimmune disease leading to adrenal atrophy.

78
Q

What is Waterhouse-Friderichsen Syndrome?

A

Acute hypoadrenalism secondary to hemorrhage or infection.

SONOCAN ABD Review (32 decks)

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