C4: Metabolic Diseases Flashcards
(146 cards)
1
Q
hepatocellular disease is due to dysfunction of which cells in the liver
A
hepatocytes
2
Q
describe fatty infiltration
is it acquired
A
accumulation of triglycerides w/in hepatocytes that can be diffuse or focal… its a precursor to chronic disease
yes, and reversible by lifestyle
3
Q
2 most common causes of fatty infiltration
A
alcohol abuse and obesity
4
Q
what 4 specific things do we evaluate w/ fatty infiltration
A
echogenicity changes
echotexture changes
attenuation characteristics
ability to visualize vessels/pausity
5
Q
what technical parameters are important to optimize when assessing fatty infiltration
A
gain, TGC and focus
6
Q
another term for fatty infiltration
A
steatosis
7
Q
describe the US appearance of mild (grade 1) fatty infiltration
A
slight increase in echogenicity
diaphragm and vessels well seen
8
Q
describe the US appearance of moderate (grade 2) fatty infiltration
A
increased liver echogenicity
diaphragm and vessels not sharply defined
9
Q
describe the US appearance of severe (grade 3) fatty infiltration
A
echogenicity markedly increased
very hard to define diaphragm and vessel walls
10
Q
describe focal fatty changes
2 types
A
- focal areas of altered echogenicity that commonly occur in the periportal area of the medial left lobe
- can change rapidly in short periods of time
focal fatty infiltration
focal fatty sparing
11
Q
how do the boundaries of focal fatty changes appear
does FFC show the mass effect
A
map like, not like a mass
no
12
Q
describe focal fatty infiltration
A
focal areas of increased echogenicity w/ mostly normal liver tissue
13
Q
describe focal fatty sparing
A
mostly fatty liver tissue w/ focal hypoechoic areas of norm liver tissue
14
Q
potential lab value changes w/ fatty infiltration
A
ALT, AST, GGT
15
Q
describe cirrhosis
A
a diffuse and progressive process that destroys liver cells and results in liver fibrosis w/ nodular changes
16
Q
most common cause of cirrhosis
other causes
A
alcohol abuse
multiple causes chronic viral hepatitis, primary sclerosing cholangitis
17
Q
chain of events w/ cirrhosis
is it reversible
A
cell death, fibrosis, regeneration
no, but the progression can be slowed
18
Q
2 types of nodular changes w/ cirrhosis
A
micro nodular - due to alcohol consumption
macro nodular - due to chronic viral hepatitis
19
Q
describe acute and chronic cirrhosis
A
acute - same appearance of severe fatty infiltration (enlarged liver, coarse textural changes)
chronic - small liver, course texture, nodular surface and paucity of vessels
20
Q
what can cirrhosis lead to
A
portal hypertension and then end stage liver failure
21
Q
what lab values might be increase w/ cirrhosis
decrease
A
AST, ALT, LDH, ALK phos, GGT
conjugated bilirubin
albumin
22
Q
which other organ can be affected by cirrhosis
why
A
spleen
portal hypertension
23
Q
classic clinical presentation of cirrhosis
A
hepatomegaly, jaundice and ascites
24
Q
describe glycogen storage disease
A
an autosomal recessive disorder that causes an enzyme deficiency which leads to excessive glycogen deposits in the liver
25
another name for GSD
when does GSD start
von gierke's disease
neonatally
26
GSD is associated w/ which conditions
benign adenomas and HCC
27
does a liver transplant help w/ GSD
how is GSD managed and controlled
no, enzyme deficiency still present
diet
28
US appearance of GSD
presents as diffuse fatty infiltration w/ adenomas that have variable echogenicity (often they appear hypo due to fatty liver)
29
define ascites
accumulation of serous fluid in a peritoneal cavity
can be transudate or exudate fluid
30
what is transudate fluid
fluid that contains little protein or cells and suggests a non-inflammatory process (cirrhosis or CHF)
31
what causes ascites w/ cirrhosis
hypoalbuminemia and increased pressure in the liver causing fluid to leak out of the hepatocytes
32
what disease process of the heart can cause ascites
CHF
33
what is exudate fluid
fluid w/ high protein content
....can contain blood, pus, chylous
suggests an inflammatory or malignant cause
34
define chylous
milky fluid w/ high fat content, usually from lymphatic system
35
US appearance of exudate ascites
fluid w/ internal echos and loculations
36
define free fluid vs loculated
free: conforms to surroundings and changes w/ patient position
loculated: walled off, no changes w/ position, will show mass effect
37
3 most dependent spaces in the peritoneal cavity
morrisons pouch
pouch of douglas
paracolic gutters
38
describe biliary sluge
other names for it
a mixture of particulate matter and bile
biliary sand and microlithiasis
39
most likely cause of biliary sluge
other causes
bile stasis
```
prolonged fasting
fast weight lost
IV nutrition (TPN - total parenteral nutrition)
extrahepatic biliary obstruction
```
40
progression of biliary stasis
asymp. , biliary colic and inflammation of GB and panc`
41
US appearance of biliary sluge
non shadowing, homogenous low level echos that layer in the dependent part of the GB (fluid-fluid levels)
42
describe tumefactive sludge/sludge balls
how can you tell the difference b/w them and polypoid tumors
sluge that mimics polypoid tumors
look at vascularity, mobility and GB wall thickness
43
most reliable way to tell the difference b/w polypoid tumors and tumefactive sludge/sludge balls
mobility (sludge is mobile, polyps don't)
44
describe hepatization
when sludge has the same echogenicity as the liver
45
what is pseudosludge
an imaging artifact caused by gains, slice thickness or side lobe artifacts
46
one way to tell pseudosludge from true sludge
pseudosludge is usually seen in the fundus and is independent or gravity
47
what is empyema
pus is the bile
48
what is hemobila
common causes
blood in the bile often due to liver biopsy or percutaneous biliary procedures
49
describe milk of calcium
US appearance
GB becomes filled w/ semi solid substance (calcium carbonate), different than biliary sludge
highly echogenic w/ posterior shadowing that changes w/ patient position and forms a calcium/bile fluid level
50
most common disease of the GB
cholelithiasis
51
factors effecting GB stone formation/cholelithiasis
abnorm bile composition
stasis of bile
infection
52
most common composition of cholelithiasis
others
cholesterol
bilirubin
calcium
53
risk factors for cholelithiasis
5 Fs
```
female
fat
fourty
fertile
Fam Hx
```
54
clinical presentation of cholelithiasis
asymptomatic (common)
RUQ pain that radiates to the back
nausea and vomitting
belching
55
US appearance of cholelithiasis
stones smaller than what size may not shadow
echogenic focus w/ posterior shadowing
will be mobile and may float in bile
< 5mm
56
GB stones are commonly mistaken for which other structures
duodenal gas (most common)
valves of heister
fat in porta hepatis
57
how to tell b/w GB stone and duodenal gas
duodenal gas will parastalisis and you'll see a direly shadow vs clean one w/ the stone
58
WES sign
an US sign seen when the GB is compacted w/ multiple stones or one large stone - W: wall E: echo S: shadow
59
altered lab values w/ GB stones
AST, ALT, ALP, bilirubin
60
complications of GB stones
- biliary colic - stone temporarily lodged in the GB neck causing severe pain
- obstruction of cystic duct or CBD
- bacterial infection
- cholecystitis
- ascending cholangitis - spreading of infection from GB to the rest of the biliary tree
61
most common complication of GB stones
biliary colic
62
what causes ducts to dilate
obstruction
loss of duct wall elasticity
dysfunction of ampulla of vater
63
what should we look for on US w/ biliary tree obstruction
check for dilation of ducts or GB, if they're dilated, @ what level and determine the cause
64
clinical presentation of biliary obstruction
when are they see?
painless or painful jaundice
painless: w/ neoplastic conditions (check panc head) and choledocal cysts
painful: w/ acute obstruction and/or infection
65
signs and symptoms of biliary obstruction
jaundice
clay coloured stool
abnormal LFTs
pain, nausea
66
what is choledocholiathiasis
stones in the biliary tree, can be extra or intrahepatic
67
primary and secondary causes of choledocholiathiasis
which is most common
primary: stones form in the ducts
secondary: stones pass from GB to ducts
secondary
68
causes of primary choledocholiathiasis
inflammation
infection
carolis
surgery
69
most common location for stones in the biliary tree
why can it be hard to visualize
distal CBD at the ampulla of vater
bowel gas.... look for hyper foci w/ posterior shadowing
70
how can you improve visualization when looking for a stone @ the distal CBD
change patient position
compress bowel
change windows
71
false + for stone in the distal CBD
surgical clips
air
edge artifact
72
altered lab values w/ choledocholiathiasis
ALP, AST, ALT
| bilirubin
73
treatment for choledocholiathiasis
ERCP spincterotomy (enlarge the sphincter for stone to pass)
ERCP extraction
stenting
74
what does ERCP stand for
endoscopic retrograde cholangiopancreatography
75
define urolithiasis
stones in the urinary sys
76
describe nephrolithiasis
most common in which gender
- stones in the renal collection system
- very common and unknown etiology
- incidence increases with age
male, caucasian
77
risk factors for nephrolithiasis
hereditary
limited water intake
animal protein
urinary stasis
78
natural points of narrowing in the ureters
UPJ
iliac vessels
UVJ - narrowest part, 80% of stones get stuck here
79
stones under what size can be passed
< 5mm (80% this size are passed)
80
clinical presentation of nephrolithiasis
asymp
hematuria
flank pain
81
what to look for w/ nephrolithiasis
number of stones
size
location
complications (look for hydro and jets)
82
easy way to identify small stones
use colour and look for twinkling artifact
83
what are staghorn calculi
calcifications filling the collecting system
84
define nephrocalcinosis
calcifications in the renal parenchyma
85
3 other DI modalities the can detect urolithiasis
Xray, tomography and CT
86
cause of bladder calculi
what should you check for
```
stone migrates from kidney
urinary stasis (neurogenic bladder or BPH)
```
mobility of the stone
87
clinical presentation of bladder calculi
asymp
OR
hematuria
pain
88
what do you need to check for if you suspect a stone in the ureter
jets and hydro to see if its obstructive or not
89
describe hydronephrosis
what can it lead to
dilated renal collecting sys due to obstructive or non-obstructive causes
can lead to renal atropy
90
obstructive causes of hydro
non-obstructive causes of hydro
O: can be intrinsic (stone, mass) or extrinsic (mass) obstruction
N-O: reflux, infection, polyuria
91
what is polyuria
too much urine production
92
which type of hydro can we diagnose on US
obstructive
93
classifications of hydro
Grade 1, 2, 3
94
describe grade 1 hydro
```
mild
slight separation (2 mm) of renal collecting system
```
95
describe grade 2 hydro
moderate
anechoic separation of entire central renal sinus.... pelvis and calyces are dilated
clubbes calyces
96
describe grade 3 hydro
severe
thinning of renal cortex w/ extensive enlargement of renal sinus and calyces
loss of calyx definition
97
false + for hydro
over distended bladder
extra renal pelvis
multiple parapelvic cysts
AV malformation
98
why is it important to do a post void w/ possible hydro
to avoid false +'s
99
another name for renal parenchymal calcium deposits
nephrocalcinosis
100
describe renal parenchymal calcium deposits
causes
bilateral and diffuse, can be cortical or medullary
ischemia, necrosis or hypercalcemic states
101
US appearance of renal parenchymal calcium deposits
- increased cortical echogenicity
- echogenic pyramids or walled of pyramids
- possible shadowing
102
renal parenchymal calcium deposits are difficult to differentiate from which other renal condition
medullary sponge kidney
103
describe anderson-carr kidney
a high [ ] of calcium in fluid around the tubules that leads to calcium deposits in the margins of the medulla
represents the early development of a stone
104
Us appearance of anderson-carr kidney
non-shadowing echogenic rims of renal pyramids
105
describe medical renal disease
what can it cause
general term that refers to poorly functioning but un-obstructive kindeys
describes a disease affecting the renal parenchyma (cortex and medulla) bilaterally and diffusely..... can lead to renal failure
106
how do we find the cause of medical renal disease
how is it treated
biopsy
medication initially, then surgery
107
areas to evaluate on US w/ medical renal disease
renal size and contour
echogenicity
CM junction distinction
renal pyramids and sinus
108
what lab values will be elevated w/ medical renal disease
whats the next step
creatinine..... this elevation prompts an US to check for mechanical obstruction... if theres no obstruction this indicates a renal parenchymal abnormality
109
Us appearance of acute medical renal disease
when would the CM junction not be prominent
most common: normal
- varies depending on cause
- diffuse increase in cortical echogenicity and renal size
- prominent CM junction
+if the pyramids are affect, CMJ will not be defined
110
US appearance of chronic medical renal disease
vary depending on cause
small echogenic kidneys
111
another name for medical renal disease
renal parenchymal disease
112
5 causes of medical renal disease
```
acute tubular necrosis
acute cortical necrosis
acute glomerulonephritis
amyloidosis
diabetes mellitus
```
113
describe acute tubular necrosis
deposits of debris in the renal collecting tubules that can be the result of toxic or ischemic insults (chemo, antibiotics, anti-freeze)
most common cause of acute reversible renal faliure
114
whats the most common cause of acute reversible renal failure
acute tubular necrosis
115
US appearance of acute tubular necrosis
how does acute tubular necrosis affect resistance to arterial blood flow
usually normal, maybe bilaterally enlarged w/ echogenic pyramids
more resistance, RI >0.75
116
describe acute cortical necrosis
causes
ischemic necrosis of the cortex w/ sparing of pyramids.... rare cause of acute renal faliure
sepsis, burns, severe dehydration, preg induced HTN
117
US appearance of acute cortical necrosis
Initial and chronic
initially: normal size, hypo cortex and loss of CMJ
chronic: atrophy and cortical calcification
118
describe acute glomerulonephritis
patient presentation
an autoimmune rxn
hematuria, HTN, azotemia
119
what is azotemia
another name for azotemia
high [ ] of nitrogen containing compounds in the blood
uremia
120
US appearance of acute glomerulonephritis
Early and late
early: variable
late: small echogenic kidneys
121
describe amyloidosis
clinical presentation
systemic metabolic disorder that leads to amyloid deposits in the kidneys
proteinuria
122
US appearance of amyloidosis
variable
123
US appearance of diabetes mellitus
Early and late
early: enlarged kidneys
late: small, echogenic, loss of CMJ
124
most common cause of chronic renal failure
diabetes mellitus
125
describe renal failure
what does it lead to
treatment
inability of kidneys to remove metabolites from blood
azotemia
dialysis (removes waste from kidneys) or renal transplant
126
3 causes of renal failure
describe them
pre-renal - sepsis, renal artery stenosis
renal - parenchymal disease
post-renal - obstruction of collecting sys, can be complete or imcomplete
127
if renal obstruction if complete when will irreversible damage occur
incomplete
C: 3 wks
IC: 3 months
128
common cause of acute renal failure
is it reversible
usually medical renal disease
yes
129
US appearance of acute renal failure
what should you check for
usually normal
hydro, obstruction, echogenicity of parenchyma (usually increased)
130
common cause of chronic renal failure
is it reversible
diabetes mellitus
no
131
US appearance of chronic renal failure
small kidney, echogenic
132
which lab values are increased w/ renal failure
serum creatinine (most important and most common)
BUN, uric acid
RBC/WBC in urine
proteinuria
133
describe cushings syndrome
causes
results from excess secretion or cortisol
adrenal hyperplasia
adrenal adenoma
adrenal carcinoma
exogenous corticosteroids
134
clinical presentation of cushings
```
moon face
buffalo hump
truncal obesity (eggs on legs)
hirsutism
amenorrhea
HTN
```
135
difference b/w cushings syndrome and cushings disease
S: due to adrenal abnormality
D: due to pituitary adenoma resulting in too much cortisol
136
describe Conn's disease
most common cause
other causes
excessive aldosterone secretion
adenoma/aldosteronoma (most common)
hyperplasia
carcinoma (uncommon)
137
clinical presentation of Conn's disease
hypernatremia (NA = sodium)
hypokalemia (K = potassium)
HTN
138
US appearance of Conn's disease
small, solid, round mass
| hypo
139
describe MEN (multiple endocrine neoplasia) syndrome
where do the tumors usually grow
- tumors develop in several endocrine glands and produce excessive hormones (3 types)
- can be benign or malignant
adrenal, panc, pituitary, parathyroid
140
type 2 MEN
- autosomal dominant condition w/ malignant pheochromocytomas in the adrenal
- usually bilateral
141
causes of hypoadrenalism
what can it lead to
primary disorders of the adrenal cortex or disorders of the hypothalamus or pituitary
adrenal atrophy
142
causes of addisons disease
80% are autoimmune:
these types are chronic, primary hypoadrenalism
affects mostly females
20% due to TB
143
describe addison's disease caused by TB
clinical presentation
affects mostly males
90% of the gland is nonfunctioning
hyperpigmentation
low BP, weakness, fatigue
144
describe waterhous-friderichsen syndrome
causes
acute hypoadrenalism that causes massive adernal destruction (big name, big destruction)
hemorrhage, infection
145
treatment for waterhous-friderichsen syndrome
glucocorticoid therapy
146
Name for blood in ascites
Hemoperitoneum
