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Abd / SS 2 > Module 5 : Infectious And Inflammatory Disease > Flashcards

Module 5 : Infectious And Inflammatory Disease Flashcards

1
Q

3 most common clinical presentations of an infection

A
  • fever
  • pain
  • leukocytosis
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2
Q

What is leukocytosis

A
  • increase number of white blood cells
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3
Q

What two things are important when patient presents with fever of unknown origin (FUO) and why

A
  • history = immunocomprimised, chemo, chronic disease

- lab tests = can tell you what organs are being affected

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4
Q

What should we look for with FUO in relation to organ size

A
  • organomegally in acute stage
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5
Q

What can infectious processed lead to

A
  • abscess
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6
Q

What is an abscess and what is it a complication of

A
  • localized collection of pus

- complication to infection

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7
Q

Which type of patients are more at risk for abscesses

A
  • diabetics
  • immunosuppressed patients
  • cancer patients
  • patients with hematoma
  • post op
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8
Q

What symptom do patients with abscesses present with

A
  • localized tenderness
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9
Q

Sonographic appearance of an abscess

A
  • fluid filled area
  • posterior enhancement
  • thick irregular walls
  • debris
  • possible gas (with dirty shadowing)
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10
Q

What is hepatitis and what is it caused by

A
  • inflammation of the liver

- caused by viruses and toxins (cleaning supplies, Tylenol)

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11
Q

What are 4 signs and symptoms of hepatitis

A
  • fever
  • chills
  • nausea and vomitting
  • possible jaundice
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12
Q

How many types of viral hepatitis are there, and what are the 4 we talk about

A
  • 6

- hep A, B, C, D

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13
Q

What is the primary mode of spread for 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 it’s he primary mode of spread for hep C

A
  • transfusions
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16
Q

What is the primary mode of spread for hep D

A
  • dependant on hep B (have to be infected with hep B before hep D)
  • IV drug users
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17
Q

Three different clinical presentations of hepatitis

A
  • acute
  • subfulminant/fulminant
  • chronic
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18
Q

Clinical presentation of acute hepatitis

A
  • clinical recovery within 4 months

- usually hep A

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19
Q

Clinical presentation of subfulminant/fulminant hepatitis

A
  • due to hep B or drug toxicity
  • hepatic necrosis
    + death of patient occurs if > 40% of hepatic parenchyma lost
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20
Q

Clinical presentation of chronic hepatitis

A
  • biochemical markers remain abnormal for > 6 month
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21
Q

Sonographic appearance of acute hepatitis

A
  • hepatomegaly
  • decreased liver echogenicity
  • prominent portal vein walls (starry sky appearance)
  • GB wall thickening
  • MOST OFTEN LIVER IS NORMAL
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22
Q

Sonographic appearance of chronic hepatitis

A
  • coarse liver parenchyma (heterogenous)
  • overall increase in echogenicity
  • portal hypertension, cirrhosis (liver decreases in size)
    + splenomegaly
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23
Q

Lab values affected with hepatitis

A
  • ALT
  • AST
  • bilirubin
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24
Q

4 routes of spread by progenitor bacteria to the liver

A
  • biliary tract (cholecystitis)
  • portal venous system (diverticulitis, appendicitis)
  • hepatic artery (endocarditis from heart)
  • trauma (blunt or penetrated)
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25
Q

What is pyogenic bacteria

A
  • produces pus
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26
Q

Clinical presentation of bacterial infection

A
  • fever
  • RUQ pain
  • malaise (general feeling of unwell ness)
  • anorexia (loss of appetite results in weight loss and muscle deterioration)
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27
Q

Sonographic appearance of bacterial liver infection

A
  • simple to complex cyst
  • shaggy wall
  • internal separations
  • echogenic foci with posterior reverberation ( gas = dirty shadow)
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28
Q

Two types of fungal disease

A
  • candida

- pneumocystis

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29
Q

What is candida and who does it usually affect

A
  • yeast infection

- typically infects immunocompromised patients

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30
Q

Clinical presentation of candida

A
  • persistent fever

- WBC count returning to normal

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31
Q

Sonographic appearance of candida

A
  • UNIFORMLY HYPOECHOIC (MOST COMMON)
  • hyperechoic
  • bulls eye appearance
  • wheel within a wheel appearance
  • liver kidney and spleen involvement
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32
Q

What is the bulls eye appearance

A
  • focal areas of hypoechoic rim with hyperechoic center
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33
Q

What is the wheel within a wheel appearance

A
  • hypoechoic rim with hyperechoic center, and hypoechoic nidus (dot) in very center
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34
Q

What is pneumocystis carinii and who does it commonly affect

A
  • an opportunistic infection

- affects immune compromised patients (aids)

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35
Q

What is an opportunistic infection

A
  • wont effect people with normal immune system

- goes after weak immune system people

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36
Q

What other structures are involved with pneumocystis carinii

A
  • LIVER (most common)
  • spleen
  • renal cortex
  • pancreas
  • lymph nodes
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37
Q

Sonographic appearance of pneumocystis

A
  • DIFFUSE, tiny non shadowing, echogenic foci

- progresses to shadowing clumps of calcification

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38
Q

Three parasitic diseases

A
  • amebiasis
  • hydatid (echinococcal) disease
  • schistosomiasis
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39
Q

What is the primary route of spread to the liver with amebiasis

A
  • fecal-oral route
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40
Q

Route of travel to the liver with amebiasis

A
  • travels from colon, through PORTAL VEINS, to teh liver
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41
Q

Which lobe of the liver is most commonly affected by amebiasis and why

A
  • right lobe is more commonly affected

- may be due to a gravity thing

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42
Q

Sonographic appearance of amebiasis

A
  • round/oval in shape
  • hypoechoic
  • fine internal echoes
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43
Q

What is the most common clinical presentation of amebiasis

A
  • PAIN

- diarrhea

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44
Q

What is hydatid (echinococcal) disease

A
  • parasitic infection (tapeworm)
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45
Q

What type of countries are hydatid disease more common in

A
  • sheep and cattle raising countries
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46
Q

What structures can be affected of hydatid disease

A
  • LIVER (MOST COMMON)
  • spleen
  • ureter
  • bladder
  • kidneys
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47
Q

What is the definitive host of a hydatid tape worm

A
  • dogs
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48
Q

What is the definitive host

A
  • the host in which the parasite reaches maturity
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49
Q

Who is the intermediate host of a hydatid tapeworm

A
  • humans
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50
Q

What is the intermediate host

A
  • a host in which the parasite undergoes development but does not reach maturity
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51
Q

How does the hydatid tapeworm spread to humans

A
  • fecal-oral route
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52
Q

How does the parasite travel to the liver adn what lobe is most affected

A
  • via the portal venous system

- right lobe is more commonly affected

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53
Q

What are the three layers of the embryo cyst of the parasite

A
  • ectocyst
  • pericyst
  • endocyst
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54
Q

What is the ectocyst

A
  • external membrane (1mm)
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55
Q

What is the pericyst

A
  • dense connective tissue capsule around the cyst

- body tries to protect itself by walling off the cyst

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56
Q

What is the endocyst

A
  • inner germinal layer
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57
Q

What is the order of the layers of the embryo parasitic cyst (outer to inner)

A
  • pericyst
  • ectocyst
  • endocyst
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58
Q

What are the 4 sonographic appearances of the parasitic embryo

A
  • hydatid sand (cyst full of low level echoes)
  • simple cyst
  • daughter cyst (multiple cysts within a cyst)
  • calcified walls
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59
Q

5 signs and symptoms of hydatid disease

A
  • dependant on stage
  • pain/discomfort
  • jaundice
  • vascular thrombosis/ infarction (cysts compress veins of the liver)
  • anaphylactic shock (from cyst rupture allergic reaction)
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60
Q

What is the treatment of hydatid parasitic disease

A
  • surgery

- only safe option so rupture does not occur

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61
Q

what type of infection is schistosomiasis

A
  • parasitic infection
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62
Q

how do the worms travel to infected organs in schistosomiasis

A
  • worms penetrate the skin and trace to the mesenteric veins via lymph and blood vessels
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63
Q

what organs do worms invade in schistosomiasis

A
  • liver
  • spleen
  • bowel
  • bladder
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64
Q

how can schistosomiasis lead to cirrhosis

A
  • ova penetrate portal vein wall and connective tissue
  • this leads to a granulomatous reaction (inflammatory response) and periportal fibrosis
  • this leads to portal hypertension and cirrhosis
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65
Q

sonographic appearance of schistosomiasis

A
  • thickening/increased echogenicity of the periportal wall
  • initially liver is enlarged
  • then liver shrinks due to hypertension
  • splenomegaly
  • thickened bladder wall (only if bladder affected)
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66
Q

what type of infection is tuberculosis (TB)

A
  • opportunistic infection
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67
Q

where does TB start and what organs does it infect

A
  • lungs

- spleen, adrenal glands, urinary tract

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68
Q

sonographic appearance of spleen with TB

A
  • tiny echogenic foci with or without shadowing
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69
Q

sonographic appearance of adrenal gland with TB

A
  • acute = bilateral diffuse enlargement

- chronic = atrophied and calcified (may not see adrenals themselves just calc)

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70
Q

what other disease of adrenal could result from TB

A
  • Addisons disease

- TB lead to adrenal atrophy and hypoadrenalism

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71
Q

what is peritonitis

A
  • inflammation of the peritoneum
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72
Q

what are the types of the cases of peritonitis

A
  • infectious

- non infectious

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73
Q

what are the 4 infectious causes of peritonitis

A
  • bacteria
  • viruses
  • fungi
  • parasites
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74
Q

what are the 2 non infectious causes of peritonitis

A
  • pancreatitis

- foreign bodies (TALC)

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75
Q

what do patients with peritonitis present with

A
  • severe pain
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76
Q

what group of people does tuberculosis peritonitis target

A
  • immunocompromised

+ aids, cirrhosis, alcoholics

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77
Q

what is the sonographic appearance of tuberculosis peritonitis

A
  • exudate fluid

- lymphadenopathy

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78
Q

what are the 2 types of cholecystitis

A
  • acute

- chronic

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79
Q

what is the most common cause of acute cholecystitis

A
  • impacted stone
    + interference in blood supply leads to an inflammatory reaction
    + predisposes the patient to infection
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80
Q

is acute cholecystitis more common in females or males

A
  • females
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81
Q

what is the clinical presentation of acute cholecystitis

A
  • RUQ pain, fever, leukocytosis
  • nausea and vomiting
  • jaundice
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82
Q

what are the 7 sonographic signs of acute cholecystitis

A
  • GB wall > 3mm
  • hyperaemia
  • gallstones
  • impaction at neck
  • GB hydrops (dilated GB)
  • pericholecystic fluid (fluid around GB)
  • postive Murphys sign
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83
Q

what lab values will be affected with acute cholecystitis

A
  • bilirubin
  • ALP
  • leukocytosis
  • AST
  • ALT
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84
Q

what are the 5 complications of acute cholecystitis

A
  • empyema (pus in bile)
  • gangrenous cholecystitis
  • emphysematous cholecystitis
  • perforation
  • abscess
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85
Q

what is gangrenous cholecystitis and what is the patient presenting with

A
  • necrosis of the gall bladder

- no pain

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86
Q

ultrasound appearance of gangrenous cholecystitis

A
  • no layering bands of echogenic tissue within the GB lumen
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87
Q

where does perforation occur in the gall bladder and why

A
  • occur at fundus

- most distal from where the blood supply is

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88
Q

ultrasound appearance of perforation

A
  • free fluid in peritoneal cavity
  • low level collection adjacent to the GB
  • ill defined hypo echoic mass surrounding the GB
  • may identify perforation
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89
Q

what is emphysematous cholecystitis caused by and is it common or rare

A
  • caused by gas forming bodies
  • progress rapidly
  • diabetes
  • rare
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90
Q

who is more effected by emphysematous cholecystitis men or women

A
  • men
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91
Q

what is acalculous cholecystitis

A
  • inflamed gallbladder without stoned
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92
Q

who is most commonly affected by acalculous cholecystitis

A
  • critically ill patients
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93
Q

4 predisposing factors to aclaculous cholecystitis

A
  • trauma
  • previous unrelated surgery
  • burn victims
  • hyperalimentation (IV nutrition)
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94
Q

will patients with aclalculous cholecystitis experience pain usually

A
  • won’t have pain because ill patients in hospital hopped up on pain meds
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95
Q

ultrasound appearance of acalculous cholecystitis

A
  • similar to acute cholecystitis nut without stoned
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96
Q

what is the most common form of symptomatic gallbladder disease

A
  • chronic cholecystitis
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97
Q

what are the 4 clinical presentations of chronic cholecystitis

A
  • intolerance to fatty foods
  • belching/indigestion
  • postprandial RUQ pain
  • N&V
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98
Q

ultrasound appearance of chronic cholecystitis

A
  • thick heterogeneous wall
  • contracted GB wall with gallstones
  • WES signs
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99
Q

what lab values will be effected with chronic cholecystitis

A
  • ALT
  • bilirubin
  • AST
  • ALP
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100
Q

3 complications from chronic cholecystitis

A
  • bouveret syndrome
  • gallstone illeus
  • mirizzis syndrome
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101
Q

what is bouveret syndrome

A
  • gastric outlet obstruction

- gallstones lodge in duodenum and block stomach contents

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102
Q

what is gallstone ileus

A
  • distal bowel obstruction

- gallstones lodge at ileocecal valve

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103
Q

what is chronic cholecystitis associated with

A
  • gallbladder carcinoma
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104
Q

what is mirizzi syndrome

A
  • impacted stone in the cystic duct, GB neck, or Hartmanns pouch
  • the CHD becomes compressed (extrinsic) by the stone or inflammatory reaction and results in jaundice
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105
Q

what abnormality will form between the cystic duct and CHD with mirizzi syndrome

A
  • fistula
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106
Q

3 clinical symptoms of mirizzi syndrome

A
  • fever
  • pain
  • jaundice
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107
Q

ultrasound appearance of mirizzi syndrome

A
  • dilated bile ducts above the level of obstruction

- CBD normal

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108
Q

what is xanthogranulomatous cholecystitis

A
  • rare form of chronic inflammation
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109
Q

ultrasound appearance of xanthogranulomatous cholecystitis

A
  • hypo echoic nodule/bands in a thick GB wall

- represents fatty granulomatous nodules

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110
Q

in what age group and gender is porcelain gallbladder most common in

A
  • older women

- 6th decade of life

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111
Q

is porcelain gallbladder common or rare

A
  • rare
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112
Q

what is the cause of porcelain gallbladder

A
  • idiopathic

- unknown

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113
Q

what disease has a high association with porcelain gallbladder

A
  • GB carcinoma
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114
Q

what is associated with porcelain gallbladder

A
  • stones

- may be a form of chronic cholecystitis

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115
Q

ultrasound appearance of porcelain gallbladder

A
  • calcified GB wall
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116
Q

is cholangitis common or rare

A
  • rare
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117
Q

what is cholangitis

A
  • inflammatory and fibrosing disorder of the biliary tree
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118
Q

what are the 5 types of cholangitis

A
  • acute (bacterial)
  • recurrent pyogenic
  • AIDS
  • biliary ascariasis
  • primary sclerosing
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119
Q

what is acute (bacterial) cholangitis caused by

A
  • due to biliary obstruction (choledochalithiasis)
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120
Q

what is the clinical presentation of acute cholangitis

A
  • fever
  • RUQ pain
  • jaundice
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121
Q

sonographic findings of acute cholangitis

A
  • dilated biliary tree with thickened walls
  • stones in biliary tree
  • liver abscess
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122
Q

what lab values are increased acute cholangitis

A
  • WBC
  • ALP
  • bilirubin
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123
Q

in what countries is recurrent pyogenic cholangitis most common in

A
  • SE

- east Asia

124
Q

what is the etiology of recurrent pyogenic cholangitis and what does chronic obstruction lead to

A
  • unknown

- chronic obstruction leads to stasis and stone formation

125
Q

which lobe of the liver is most commonly affected with recurrent pyogenic cholangitis

A
  • lateral left lobe
126
Q

what are 2 possible long term complications to recurrent pyogenic choalngitis

A
  • biliary cirrhosis

- choleangiocarcinoma

127
Q

ultrasound look of recurrent pyogenic cholangitis

A
  • dilated ducts with stone and sludge in one segment of the liver
128
Q

what is AIDS cholangitis due to

A
  • opportunistic infection

- advanced stages of AIDS

129
Q

what is ultrasound look of AIDS cholangitis

A
  • thickened bile duct and GB walls
  • focal strictures
  • intra and extra hepatic duct dilatation
  • CBD dilated
130
Q

what lab values will be elevated and normal with AIDS cholangitis

A
  • ALP elevated

- bilirubin normal

131
Q

what is biliary ascariasis caused by

A
  • roundworm infestation
132
Q

what is ultrasound look of biliary ascariasis

A
  • echogenic non shadowing parallel lines/tubes in the ducts and GB
  • look for movement
133
Q

how do the roundworms get to the bile ducts and gallbladder

A
  • start in intestinal tract then move retrogradely through ampulla of vater into the GB and bile ducts
134
Q

what is primary sclerosing cholangitis

A
  • chronic inflammatory process

- bile ducts fibrose and inflame

135
Q

what is the cause of primary sclerosing cholangitis

A
  • unknown

- maybe autoimmune

136
Q

what does primary sclerosing cholangitis can lead to what 3 things

A
  • biliary cirrhosis
  • portal hypertension
  • hepatic failure
137
Q

does primary sclerosing cholangitis affect women or men more

138
Q

do patients tend to have symptoms with primary sclerosis cholangitis

A
  • no

- until leads to other larger conditions

139
Q

what other condition will 80% of patients with primary sclerosis cholangitis have

A
  • ulcerative colitis

+ autoimmune disorder

140
Q

what is pancreatitis

A
  • inflammation of the pancreas
141
Q

can pancreatitis be acute or chronic, mild moderate and severe, and focal or diffuse

142
Q

how is acute pancreatitis diagnosed

A
  • based on lab or clinical findings
143
Q

what is the clinical presentation of acute pancreatitis

A
  • severe, constant, intense pain radiating to the back
  • relief by sitting up or bending at the waist
  • N&V
  • possible fever
144
Q

what are the 3 roles of ultrasound with acute pancreatitis

A
  • identify stones in GB or duct
  • detect fluid collections
  • monitor the inflammatory process
145
Q

what are 2 possible etiologies for acute pancreatitis

A
  • alcohol abuse (binge drinking benders)

- biliary stones

146
Q

sonographic appearance of diffuse acute pancreatitis

A
  • normal
  • decreased echogenicity
  • heterogeneous
  • edematous
  • smooth contour
  • increased size
  • possible fluid collections
147
Q

sonographic appearance of focal acute pancreatitis

A
  • focal hypo echoic area
  • panc head most common
  • mimics a neoplasm
  • alcohol abusers
148
Q

what are 6 complications of acute pancreatitis

A
  • fluid accumulations
  • pseudocysts and phlegmons
  • hemorrhage
  • necrotizing pancreatitis
  • peritonitis
  • abscess formation
149
Q

what is a pseudocyst

A
  • walled off collection of inflammatory fluid and debris
150
Q

what is a phlegmon

A
  • inflammatory fat
151
Q

what are 3 main characteristics of chronic pancreatitis

A
  • progressive
  • IRREVERSIBLE DAMAGE
  • fibrous scarring
152
Q

what is the predominant cause of chronic pancreatitis

A
  • alcohol abuse
153
Q

sonographic appearance of chronic pancreatitis

A
  • heterogeneous
  • dilated panc ducts
  • calcifications
  • irregular contour
  • decreased size
154
Q

what are the 2 hallmark appearance of chronic pancreatitis

A
  • dilated panc duct

- calcifications

155
Q

2 complications of chronic pancreatitis

A
  • pseudocysts

- portosplenic thrombosis

156
Q

what 2 lab values will be changed and how with acute pancreatitis

A
  • increased amylase

- increased lipase

157
Q

what 2 lab values will be affected and how with chronic pancreatitis

A
  • normal amylase

- increased lipase

158
Q

what are the 2 inflammatory bowel diseases

A
  • crohns diease

- ulcerative colitis

159
Q

what are the 2 most common methods of assessment for inflammatory bowel disease

A
  • barium studies

- endoscopy

160
Q

what is crohns disease

A
  • chronic granulomatous inflammation
161
Q

what portion of the bowel does crohns disease affect most commonly

A
  • terminal ileum

- colon

162
Q

what layers of the bowel does Crohns disease affect

A
  • all layers of the wall
163
Q

what is the cause of crohns disease

A
  • etiology unkown
164
Q

sonographic appearance of crohns disease

A
  • MARKEDLY THICKENED HYPOECHOIC WALL (concentric)
  • narrowed lumen
  • peristalsis of affected portion
  • rigidity to pressure
  • creeping fat (echogenic halo)
  • hyperemia and mesenteric lymphadenopathy
165
Q

4 complications of crohns disease

A
  • abscess formation
  • fistula formation
    + linear bands of variable echogenicity
  • inflamed fat
    + poorly defined hypo echoic areas
  • appendicitis
166
Q

what is ulcerative colitis

A
  • ulceration of colon and rectum
167
Q

what layers of the wall are affected with ulcerative colitis

A
  • mucosal and submucosal layers of colon
168
Q

what other disease has an increase chance of occurring with ulcerative colitis

A
  • colon cancer
169
Q

clinical presentation of ulcerative colitis

A
  • rectal bleeding

- abscesses

170
Q

ultrasound appearance of ulcerative colitis

A
  • possibly normal or hypoechoic bowel

- thickened wall

171
Q

what is pseudomembranous colitis

A
  • a necrotizing inflammation (infection with c difficile)
172
Q

what causes pseudomembranous colitis

A
  • patients become susceptible to infection when oral antibiotics wipe out the normal intestinal flora
173
Q

what is the clinical presentation of pseudomembranous colitis

A
  • diarrhea

- fever and pain

174
Q

what are the sonographic markers of pseudomembranous colitis

A
  • rare
  • massive edema
  • thickened hypo echoic bowel wall
  • prominent haustral markings
175
Q

is pneumatosis intestinal common or rare

176
Q

what is pneumatosis inestinalis associated with

A
  • underlying condition s
    + COPD
    + traumatic endoscopy
177
Q

are patents usually asymptomatic or symptomatic with pneumatosis intestinalis

A
  • asymptomatic
178
Q

sonographic appearance of pneumatosis intestinalis

A
  • thick hypo echoic wall
  • hyperechoic areas in the wall with ring down artifact
    + packets of gas
  • look for air in portal venous system
179
Q

what is the most common cause of acute abdominal pain

A
  • acute appendicitis
180
Q

which age group usually presents with acute appendicitis

A
  • younger people
181
Q

what gender has atypical presentation of acute appendicitis and why

A
  • women

- could be related to pelvic issue instead

182
Q

what are 3 causes fo acute appendicitis

A
  • obstruction of appendiceal lumen
  • venous return is compromised
  • leads to bacterial overgrowth leading to inflammation
183
Q

signs and symptoms of acute appendicitis

A
  • starts with crampy peri-umbilical pain
  • nausea
  • vomitting
  • classic presentation
  • peritoneal irritation
  • guarding over mcburneys point
184
Q

what is the classic presentation of acute presentation

A
  • RLQ pain
  • tenderness
  • leukocytosis
185
Q

how can we determine if a patient has peritoneal irritation

A
  • rebound tenderness
186
Q

what mcburneys point

A
  • 2/3 from umbilicus 1/3 from iliac crest
187
Q

when should ultrasound be used in acute appendicitis

A
  • slim adult patient
  • children
  • symptoms less than 48 hours in duration
  • differentiating between gynaecological symptoms
188
Q

when should CT be used in acute appendicitis

A
  • normal - obese adult patients
  • chronic appendicits
  • complication to appendicits
  • equivocal ultrasound
189
Q

what are the landmarks for the appendix

A
  • ascending colon, cecum/cecal tip, terminal ileum
  • iliopsoas
  • external iliac vessels
190
Q

sonographic appearance of acute appendicitis

A
  • blind ended no peristalsis tube
  • non compressible
  • > 6mm in AP diameter or single wall thickness of >3mm
  • appendix with fecalith is positive
  • hypervascularity
  • prominent fat around cecum
  • perforation - loculated fluid collection
191
Q

three complications of acute appendicitis

A
  • rupture
  • abscess
  • diffuse peritonitis
192
Q

what is mesenteric adenitis

A
  • symptoms mimic appendicitis
  • RLQ lymphadenopathy without appendicitis
  • seen as enlarged lymphnodes with a thick walled ileum
193
Q

what is mucocele

A
  • distension of appendix with mucous
194
Q

is mucocele common and who does it affect the most

A
  • rare

- females

195
Q

benign causes of mucocele

A
  • fecaliths
  • inflammatory scarring
  • polyps
196
Q

malignant causes of mucocele

A
  • primary mucous cyst adenoma

- primary mucous cystadenocarcinoma

197
Q

are patients with mucocele usually symptomatic

A
  • asymptomatic
198
Q

sonographic presentation of mucocele

A
  • large cystic/ hypo echoic mass in RLQ
  • enhancement
  • wall calcs
  • rupture of malignant form can cause pseuomyxoma peritonei
199
Q

what is a diverticula

A
  • outpouching of bowel wall
200
Q

what is diverticulosis

A
  • multiple diverticula
201
Q

what is diverticulitis

A
  • can lead to inflammation
202
Q

clinical presentation of bowel diverticular disease

A
  • fiver
  • leukocytosis
  • pain
203
Q

in what gender and culture is RLQ diverticulitis more common in

A
  • women
  • asian population
  • young adults
204
Q

is RLQ diverticulitis congenital or acquired and bilateral or solitary

A
  • congenital

- solitary

205
Q

which portion of the GI tract does RLQ diverticulitis most commonly affect and what layers of the wall

A
  • cecum and ascending colon

- all layers of the gut wall

206
Q

sonographic appearance of RLQ diverticulitis

A
  • sac like structure protruding from wall
  • hyperaemia
  • fecalith
  • inflamed fat
  • focal wall thickening
207
Q

what is the most common form of diverticulitis

A
  • LLQ diveriticulitis
208
Q

what increases incidence of LLQ diverticulitis

A
  • increased with age

- low bulk diet (low fibre)

209
Q

what causes LLQ diverticulitis

A
  • defect in muscular layer that causes the mucosal layer to protrude out
  • multiple saccular outpouchings
  • fecal material incites inflammation
210
Q

which portion of the colon is affected by LLQ diverticulitis

A
  • sigmoid

- left colon

211
Q

sonographic appearance of LLQ diverticulitis

A
  • hypo echoic concentric thickening of bowel
  • echogenic foci with posterior shadowing or ring down
  • abscess
  • mesenteric thickening
212
Q

what is bladder diverticula and what are the two types

A
  • out pouching of bladder wall (lateral)

- congenital or acquired

213
Q

what is congenital bladder diverticula

A
  • all 3 layers of the wall involved

- located near ureteral orifice

214
Q

what is acquired bladder diverticula

A
  • inner 2 layers of wall involved

- high occurrence with neurogenic bladder (cannot empty bladder fully)

215
Q

can bladder diverticula disappear

A
  • yes post void
216
Q

what can bladder diverticula lead to

A
  • urinary stasis which can lead to infection or stone formation
217
Q

what is mechanical bowel obstruction (MBP) and what can it be caused by

A
  • physical obstruction
  • GI mass
  • impinging external mass
218
Q

where would the bowel be dilated with mechanical bowel disease

A
  • bowel loops dilated proximal to the site of the blockage
219
Q

how will peristalsis change with time in mechanical bowel obstruction

A
  • hyperparitstalis = earlier stages

- no peristalsis = later stage

220
Q

signs and symptoms of mechanical bowel obstruction

A
  • abdominal pain and distension

- committing and diarrhea

221
Q

what is intussusception

A
  • invagination (telescoping) of bowel segments
222
Q

what is the most common cause of small bowel obstruction in children

A
  • intussusception
223
Q

signs and symptoms of intussusception

A
  • pain
  • vomitting
  • currant jelly stools
224
Q

ultrasound appearance of intussusception

A
  • multiple concentric rings
    + donuts
  • target appearance / pseudo kidney
225
Q

what is volvulus

A
  • close looped obstruction (kink in bowel)
  • U or C shaped loop of bowel
  • not an ultrasound diagnosis
226
Q

what is paralytic ileus

A
  • bowel obstruction related to lack of function
  • paralyzed muscle wall
  • +++ gas with no peristalsis
227
Q

How does the infection travel in a urinary tract infection (UTI)

A
  • infection travels from bladder to the kidneys
228
Q

Which gender has a higher incidence of getting a UTI

229
Q

What type of patients have increased incidence of getting a UTI

A
  • diabetics

- immunocompromised

230
Q

Signs and symptoms of UTI

A
  • flank pain
  • fever
  • frequency (needing to go a lot)
  • urgency (needing to go right away)
231
Q

What will the lab test changes be with a UTI

A
  • increase WBC
  • pyuria
  • bacteremia
  • microscopic hematuria
232
Q

What are the 2 types of pyelonephritis

A
  • acute

- chronic

233
Q

What is acute pyelonephritis and what is it caused by

A
  • inflamed renal tubules

- caused by E. Coli

234
Q

What patient group is usually affected by acute pyelonephritis

A
  • young women

- 15-35

235
Q

Can acute pyelonephritis be focal or diffuse

236
Q

How is acute pyelonephritis usually diagnosed

A
  • diagnosed clinically with lab work
237
Q

When is imaging done with acute pyelonephritis

A
  • symptoms or lab abnormalities persist
238
Q

Ultrasound appearance of acute pyelonephritis

A
  • normal
  • loss of CM junction
  • enlargements
  • compression of sinus
  • change in echotexture
  • focal masses (abscess)
  • gas
239
Q

What is chronic pyelonephritis and what is it caused by

A
  • interstitial (intercellular connective tissue) nephritis

- caused by vesicoureteric refluxfrom congenital ureteric problems

240
Q

When does chronic pyelonephritis start and who is most commonly affected

A
  • starts at young age

- women

241
Q

Ultrasound appearance of chronic pyelonephritis

A
  • cortical scarring
  • asymmetric changes between right and left
  • atrophy
  • dilated, blunted calyces
242
Q

What is a possible complication of pyelonephritis

A
  • abscess

- may decompress (rupture) in to the collection system or perinephric space

243
Q

What is the usual initial screening test for abscesses when is ultrasound used

A
  • CT

- follow resolving abscess

244
Q

Ultrasound appearance of abscess

A
  • solitary
  • round
  • thick walled
  • complex cyst
  • gas bubbles
245
Q

What is pyonephrosis

A
  • pus in the collecting system
246
Q

What is the cause of pyonephrosis in young adults

A
  • UPJ obstruction/stones
247
Q

What is the cause of pyonephrosis in elderly

A
  • malignant obstruction
248
Q

Ultrasound appearance of pyonephrosis

A
  • hydronephrosis
  • multiple low level echoes within hydro
  • mobile debris
249
Q

What are the 2 rare forms of pyelonephritis

A
  • emphysematous

- xanthogranulomatous

250
Q

What is emphysematous pyelonephritis and who is most commonly effected adn what is the preferred method of evaluation

A
  • gas forms in kidney parenchyma
  • diabetic older women
  • CT
251
Q

Ultrasound appearance of emphysematous pyelonephritis

A
  • linear echogenic areas with dirty shadowing
252
Q

What is xanthogranulomatous pyelonephritis

A
  • chronic pus formin g
  • unilateral
  • focal or diffuse
253
Q

What kind of calculus is associated with xanthogranulomatous pyelonephritis

A
  • staghorn calculi
254
Q

Ultrasound appearance of xanthogranulomatous pyelonephritis

A
  • destruction of parenchyma
  • loss of CM junction
  • dilated calyces
  • inflammatory mass
    + cannot be distinguished betweenabscess
255
Q

What si glomeruonephritis

A
  • autoimmune reaction which causes inflammation at the level of the glomerulus
  • presents as medical renal disease
256
Q

What patients are usually affected by fungal infections of the urinary tract and what is it associated with

A
  • diabetics
  • immunocompromised
  • indwelling catheters
257
Q

What kind of fungal infection is most common in the urinary tract

A

Candida albicans

258
Q

Ultrasound appearance of fungal infection of urinary tract

A 
- hypoechoic parenchymal masses
   \+ abscesses
- fungal balls 
  \+ echogenic, non shadowing, ,mobile mass
   \+ DDX blood clot, tumor, polyp
259
Q

What are the two parasitic infections of the urinary tract

A
  • schistosomiasis

- hydatid disease

260
Q

what is cystitis

A
  • inflammation of the bladder
261
Q

what causes infectious cystitis in women

262
Q

what causes infectious cystitis in men

A
  • caused by prostatitis or bladder outlet obstruction
263
Q

what does infectious cystitis result in and what can patients present with

A
  • results in mucosa edema and decreased bladder capacity

- present with hematuria

264
Q

ultrasound appearance of infectious cystitis

A
  • thick bladder
265
Q

what is chronic cystitis and who does it most commonly affect

A
  • chronic inflammation of bladder

- more commonly affects middle aged women

266
Q

signs and symptoms of chronic cystitis

A
  • frequency
  • urgency
  • hematuria
267
Q

ultrasound appearance of chronic cystitis

A
  • thick walled bladder

- possible TCC appearance

268
Q

what is interstitial cystitis and what is the cause

A
  • chronic bladder inflammation

- unknown cause

269
Q

what is interstitial cystitis associated with

A
  • systemic disease

+ lupus

270
Q

what is the sonographic appearance of interstitial cystitis

A
  • mimic bladder cancer
271
Q

what is neurogenic bladder

A
  • loss of voluntary control of voiding
  • have lots of urinary stasis
  • have to self catheterize
272
Q

ultrasound appearance of neurogenic bladder

A
  • trebeculated bladder
  • possible debris or stones in the bladder
  • hydronephrosis
273
Q

what is the etiology of retroperitoneal fibrosis

A
  • unknown etiology
274
Q

what is retroperitoneal fibrosis

A
  • sheets of fibrosis tissue form in retroperitoneum

- fibrous sheets drape over the great vessels and surround the ureters

275
Q

what is the modality of choice for assessing retroperitoneal fibrosis

276
Q

ultrasound appearance of retroperitoneal fibrosis

A
  • hypo echoic homogeneous masses

- envelope and obstruct retroperitoneal structures

277
Q

what is benign prostatic hyperplasia (BPH)

A
  • enlargement of the prostate in older men (over 50)

- 40g / 40cc upper limit of normal

278
Q

what zone of the prostate changes with BPH

A
  • transition zone becomes enlarged and nodular
279
Q

does the size of the prostate vary to the amount of symptoms

A
  • not directly correlated to severity of the symptoms
280
Q

signs and symptoms of BPH

A
  • nocturia
  • difficulty voiding
    + prostate compress urethra
281
Q

ultrasound appearance of BPH

A
  • hypo echoic enlargement of the inner gland
  • calc
  • degenerative cysts
  • nodules
  • heterogeneous
282
Q

what is a TURP

A
  • transurethral resection of the prostate
  • endoscope is inserted into penile urethra and the prostate is resected
    + electrocautery and laser
  • done to relieve symptoms
283
Q

what is prostatitis

A
  • inflammation of prostrate and seminal vesicles
284
Q

what causes prostatitis and what are the two forms

A
  • infectious organisms from lower urethra invade the ducts in the peripheral zone
  • acute and chronic
285
Q

signs and symptoms of prostatitis

A
  • lower back pain
  • dysuria
  • perineal pressure
286
Q

what lab value will be increased with prostatitis

A
  • increased PSA
287
Q

who is usually effected by acute prostatitis

A
  • younger and have increased pain
288
Q

ultrasound appearance of acute prostatitis

A
  • hypo echoic areas
  • hypervascularity
  • possible abscess
289
Q

what is chronic prostatitis caused by

290
Q

ultrasound appearance sonographic appearance

A
  • focal masses of varying echogenicity
  • calcification
  • periurethral glad irregularity
  • dilated SV
291
Q

what is pleura

A
  • serous membrane

- enfolds in both lungs (visceral layer) and reflected upon walls of thorax and diaphragm (parietal)

292
Q

what is a pleura effusion

A
  • fluid in thoracic cavity between the visceral and parietal pleura
293
Q

what are the 2 types of pleura effusion

A
  • transudative

- exudative

294
Q

what is transudative fluid and what is it seen with

A
  • anechoic fluid

- CHF and cirrhosis

295
Q

what is exudative fluid and what is it seen with

A
  • echogenic fluid
  • septations
  • pleural thickening
  • infection and neoplasm
296
Q

what is the most common cause of ? LUQ mass

A
  • splenomegaly
297
Q

what are 3 symptoms of splenomegaly

A
  • LUQ fullness
  • pain
  • palpable
298
Q

what are 6 causes of splenomegaly

A
  • infection
  • inflammation
  • hematologic disorders
  • neoplasia
  • connection
  • infiltration
299
Q

what 3 things can lead to mild to moderate splenomegaly

A
  • portal hypertension
  • infection
  • AIDS
300
Q

what are 2 causes of marked splenomegaly

A
  • leukaemia

- lymphoma

301
Q

what is a complication of splenomegaly

A
  • spontaneous rupture
302
Q

is splenomegaly a true infectious or inflammatory response

A
  • no but a part of the immense system and plays a role in immunity
303
Q

what is acquired immune deficiency syndrome AIDS

A
  • a syndrome of opportunistic infections

- final stage of infection by HIV

304
Q

what other things are associated with AIDS

A
  • moderate splenomegaly
  • candida infection
  • pneumocystis carinii infection
  • kaposis sarcoma
  • lymphoma
  • cholangitis
  • acute typhlitits
  • adrenal insufficiency
305
Q

what is kaposis sarcoma on ultrasound

A
  • difficult to identify sonographically
  • hyperechoic liver nodules
  • non specific solid mass in the adrenal gland
306
Q

what is lymphoma on ultrasound

A
  • hypo echoic liver nodules or adrenal gland or GI tract
307
Q

what is acute typhlitis on ultrasound

A
  • hypo echoic uniform thickening of the colon

+ cecum and ascending colon

Abd / SS 2 (7 decks)

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