Infectious and Inflammatory 2 Flashcards
1
Q
Porcelain gallbladder has a high association with what?
A
Gallbladder carcinoma
2
Q
What is porcelain gallbladder?
A
A calcified gallbladder wall that is rare and common in older females that may be a form of chronic cholecystitis and is associated with stones
3
Q
What is an inflammatory and fibrosing disorder of the biliary tree?
A
Cholangitis
4
Q
What are the 5 types of cholangitis?
A
- Acute (bacterial)
- Recurrent pyogenic
- AIDS
- Biliary ascariasis
- Primary sclerosing
5
Q
What is acute cholangitis due to and what is it called?
A
Biliary obstruction (choledocholithiasis)
6
Q
What values would you expect to see increased with acute cholangitis? (3)
A
WBC, ALP, bilirubin
7
Q
What can recurrent pyogenic cholangitis also be known as less commonly?
A
Oriental cholangitis (most common in SE and East Asia)
8
Q
Which lobe is affected most often with recurrent pyogenic cholangitis?
A
Lateral left lobe
9
Q
What are some possible long term complications with recurrent pyogenic cholangitis?
A
Biliary cirrhosis and choleangiocarcinoma
10
Q
What would you see sonographically with recurrent pyogenic cholangitis?
A
Dilated ducts with stones and sludge in one segment of the liver
11
Q
What is AIDS cholangitis and what is important to note about the lab values?
A
An opportunistic infection in advanced stages of AIDS that results in thickened ducts and GB walls with a dilated CBD.
ALP will be elevated but bilrubin will be normal.
12
Q
What is biliary ascariasis cholangitis caused by and how does it appear sonographically?
A
Roundworm infestation
Echogenic non-shadowing parallel lines in the ducts and GB that may move around.
13
Q
What is primary sclerosing cholangitis?
A
Chronic inflammatory process with an unknown cause
14
Q
What happens with primary sclerosing cholangitis?
A
Bile ducts fibrose and inflame which leads to biliary cirrhosis, portal hypertension, and hepatic failure
15
Q
What percentage of primary sclerosing cholangitis patients have ulcerative colitis?
A
80%
16
Q
Primary sclerosing cholangitis affects who more?
A
Men
17
Q
What is pancreatitis?
A
Inflammation of the pancreas that can be acute or chronic, focal or diffuse and mild/mod/severe.
18
Q
What is the clinical presentation of acute pancreatitis? (4)
A
- Severe, constant pain that radiates to the back
- Relief by sitting up or bending at the waist
- N and V
- Possible fever
19
Q
What is the possible etiology of acute pancreatitis?
A
Alcohol abuse and biliary stones
20
Q
What is the difference between focal and diffuse acute pancreatitis sonographically?
A
Diffuse:
- Normal looking or:
- Decreased echogenicity
- Heterogenous
- Increased size
- Smooth contour
Focal:
- Focal hypoechoic area
- Mimics neoplasm
21
Q
What is the most common area to see focal acute pancreatitis?
A
Pancreatic head
22
Q
What are phlegmons and pseudocysts? And what are they a result of?
A
Phlegmons = Inflamed fat and connective tissue
Pseudocysts = Debris and fluid that has been walled off by the body
Resulting complications from acute pancreatitis
23
Q
Chronic pancreatitis describes what kind of destruction?
A
Progressive and irreversible fibrous scarring
24
Q
What is the predominant cause of chronic pancreatitis?
A
Alcoholism
25
What is the most common appearance of chronic pancreatitis? (3)
- Dilated pancreatic duct
- Calcifications
- Decreased panc size
26
Pseudocysts are seen in both acute and chronic pancreatitis but which is it most common in?
Chronic pancreatitis
27
What lab findings would you see in acute pancreatitis?
Increased amylase and increased lipase
28
What lab findings would you see in chronic pancreatitis?
Normal amylase and increased lipase
29
What does imflammatory bowel disease include?
Crohn's and ulcerative colitis
30
What are the most common methods of assessing IBD and what is ultrasound and CT's role with inflammatory bowel disease?
Most common = barium studies and endoscopy
US/CT = Scan on the bowel wall, lymph nodes, and mesentery
31
What is Chron's disease?
Chronic granulmatous inflammation affecting all layers of the terminal ileum and colon
32
What are signs and symptoms of Chron's Disease? (3)
- Intermittent diarrhea
- Fever
- Crampy RLQ and LLQ pain
33
What are complications of Chron's disease? (4)
- Abscess formation
- Fistula formation
- Phlegmon
- Appendicitis
34
What is ulcerative colitis?
Inflammation of mucosal and submucosal layers of the colon causing ulceration of the colon and rectum
35
Ulcerative colitis is sonographically similar to what?
Crohn's disease
36
What is pseudomembranous colitis?
A necrotizing inflammation (inflammation with C. Difficile)
37
Why does pseudomembranous colitis happen?
Patients become susceptible to infection when oral antibiotics wipe out the normal intestinal flora
38
What prominent markings may you see with pseudomembranous colitis?
Prominent haustral markings
39
What is the sonographic appearance of pneumatosis intestinalis? (3)
- Thick hypoechoic wall
- Hyperechoic areas in the wall with artifact (intramural pockets of gas)
- Air in portal sysetm
40
What is the most common cause of acute abdominal pain?
Acute appendicitis
41
What is the cause of acute appendicitis?
Obstruction of the appendiceal lumen causing decreased venous return leading to bacterial overgrowth and inflammation
42
What is the classic presentation of acute appendicitis and what are two other common signs?
Classic = RLQ pain and tenderness, leukocytosis
Common signs:
1. peritoneal irritation
2. Guarding over McBurney's point
43
What are the 4 main sonographic appearances of acute appendicitis?
- Blind ended non-peristalsing tube
- Non-compressible
- > 6mm in AP diameter
- Single wall thickness of > 3mm
44
What is mesenteric adenitis and what does it mimic?
RLQ lymphadenopathy without appendicitis but mimics appendicitis symptoms
45
What is a mucocele and who does it affect most commonly?
A rare distension of the appendix with mucous
Affects females more often
46
What are the benign causes of mucoceles?
Fecaliths, inflammatory scarring, polyps
47
What are the malignant causes of mucoceles?
Primary mucous cystadenoma/cystadenocarcinoma
48
Rupture of the malignant form of mucocele can cause what?
Pseudomyxoma peritonei
49
What is a diverticula?
Outpouching of bowel wall
50
What is diverticulosis?
Multiple diverticula
51
What is diverticulitis?
Inflammation of the bowel
52
What is the classic triad of bowel diverticular disease?
Fever, leukocytosis, and pain
53
What are the two types of diverticular disease?
RLQ diverticulitis and LLQ diverticulitis
54
What is the most common form of diverticular disease?
LLQ diverticulitis
55
RLQ diverticulitis involves all layers of the gut wall whereas LLQ diverticulitis involves what?
Only affects the muscular layer
56
What is a bladder diverticula?
Outpouching of bladder wall (typically lateral wall)
57
Explain what congenital bladder diverticula involves:
All 3 wall layers involved
58
Explain what acquired bladder diverticula involves:
Inner 2 wall layers involved
59
What does MBO stand for?
Mechanical bowel obstruction
60
What will you see in the early and late stages of MBO?
Hyperperistalsis in the earlier stages, no peristalsis in the late stage
61
What are two examples of MBO?
Intussusception and volvulus
62
What is intussusception?
Invagination (telescoping) of bowel segments
63
What is the most common cause of small bowel obstruction in children?
Intussusception
64
What is a very indicative sign of intussusception?
Currant jelly stools (blood and mucus)
65
What is volvulus?
Close looped obstruction (like a kink in a hose) that is seen as a U or C shaped bowel
66
What is paralytic ileus?
Bowel obstruction related to lack of function (paralyzed wall) that is marked by extreme gas with no perastalsis
67
Why is there a higher incidence of UTI's in women?
Due to anatomy and our urethra being shorter
68
What lab results would you expect to see in someone with a UTI? (4)
- WBC
- Pyuria
- Bacteremia
- Microscopic hematuria
69
What is acute pyelonephritis and who does it affects more often?
Inflamed renal tubules caused by e. Coli
Affects young women
70
What does acute pyelonephritis look like sonographically? (3)
- Loss of CM junction
- Renal enlargement
- Compression of sinus
71
What is chronic pyelonephritis and who does it affect more often?
Interstitial nephritis caused by vesicoureteric reflux
Affects women starting at a young age
72
What does chronic pyelonephritis look like sonographically? (3)
- Coritcal scarring
- Atrophy
- Dilated, blunted calyces
73
What is a possible complication of pyelonephritis?
Abscess
74
What is pyonephrosis?
Pus in the collecting system
75
What is pyeonephrosis associated with?
UPJ obstruction/stones
76
What are rare forms of pyelonephritis?
Emphysematous and xanthogranulomatous
77
What is emphysematous pyelonephritis and who does it affect more commonly?
Gas that forms in the parenchyma
Affects older diabetic women
78
What is xanthogranulomatous pyelonephritis?
Chronic form with pus. Usually unilateral, with staghorn calculi.
79
What does xanthogranulomatous pyelonephritis look like sonographically? (4)
- Destruction of parenchyma
- Loss of CM junction
- Dilated calyces
- Inflammatory mass
80
What is glomerulonephritis? What does is present as?
Autoimmune reaction which causes inflammation at the level of the glomerulus. Presents as medical renal disease.
81
What are fungal infections of the urinary tract associated with?
Indwelling catheters and immunocompromised patients
82
Which fungal infection of the urinary tract is most common?
Candida albicans
83
What are the sonographic findings associated with fungal infections of the urinary tract?
Hypoechoic parenchymal masses (absences) and fungal balls
84
What are two parasitic infections of the urinary tract?
Schistosomiasis and hydatid disease
85
What is cystitis?
Inflammation of the bladder
86
What is infectious cystitis usually caused by in women? Men?
Women: usually caused by E. Coli
Men: Prostatitis or bladder outlet obstruction
87
What does infectious cystitis result in?
Mucosal edema which thickens the bladder wall and decreases bladder capacity and may cause hematuria
88
What is chronic cystitis?
Chronic inflammation of the bladder
89
What is the sonographic appearance of chronic cystitis?
Thick walled bladder with possible TCC appearance (mass protruding from the bladder wall)
90
What is interstitial cystitis?
Chronic bladder inflammation of unknown cause, associated with systemic diseases
91
What can interstitial cystitis mimic?
Bladder cancer (TCC)
92
What is a neurogenic bladder?
Loss of voluntary control of voiding (pt cant empty bladder and can't sense fullness of the bladder)
93
What would the sonographic appearance of a neurogenic bladder be? (3)
- Trebeculated bladder
- Possible debris or stones in bladder
- Hydro
94
What is retroperitoneal fibrosis?
Sheets of fibrous tissue form in the retroperitoneum and drape over the great vessels and surround the ureters
95
What is the modality of choice for retroperitoneal fibrosis and what does it look like sonographically?
CT
Hypoechoic homogenous masses that obstruct retroperitoneal structures
96
What is BPH?
Benign prostatic hyperplasia
97
What happens with BPH?
Transition zone becomes enlarged and nodular
98
What is the sonographic appearance of BPH? (5)
- Hypoechoic enlargement of inner gland
- Calcs (mini calcs w/ malignancy, larger calcs with benign)
- Degenerative cysts
- Nodules
- Heterogeneous
99
What is TURP?
Transurethral resection of the prostate
100
How is TURP done and why?
Endoscope inserted into penile urethra and the prostate is resected
Done to relieve the symptoms of BPH
101
What are two ways the prostate can be resected with TURP?
Electrocautery and laser
102
What is prostatitis?
Inflammation of prostate and semical vesicles
103
What causes prostatitis?
Infectious organisms from the lower urethra invade the ducts in the peripheral zone
104
What are signs and symptoms of prostatitis? (3)
Lower back pain, dysuria, and perineal pressure
105
What lab values would you expect to see altered with prostatitis?
PSA
106
Most cases of chronic prostatitis are associated with what?
E. Coli infections
107
What is the sonographic appearance of chronic prostatitis? (4)
- Focal masses of varying echogenicity
- Calcifications
- Periurethral gland irregularity
- Dilated SV
108
What is a pleural effusion?
Fluid in the thoracic cavity between the visceral and parietal pleura
109
What are the two types of pleural effusions?
Transudative and exudative
110
Which type of pleural effusion is anechoic and typically seen with CHF and cirrhosis?
Transudative
111
Which type of pleural effusion is echogenic, has septations, and is typically seen with infections and neoplasms?
Exudative
112
What is the most frequent cause of a LUQ mass?
Splenomegaly
113
What are causes of splenomegaly? (6)
- Hematologic disorders
- Neoplasia
- Congestion
- Infection
- Inflammation
- Infiltration (HNCIII)
114
In what circumstances will we see mild to moderate splenomegaly? What size?
Portal hypertension, infection, and AIDS. 12-18 cm
115
In what circumstances will we see marked splenomegaly? What size?
Leukemia and lymphoma, >18 cm
116
What is a complication of splenomegaly?
Spontaneous rupture
117
What does AIDS stand for?
Acquired Immune Deficiency Syndrome
118
What is the final stage of infection by HIV?
AIDS
119
What kind of cancer can we see in people with AIDS?
Kaposi's sarcoma
120
How does Kaposi's sarcoma appear sonographically?
Hypoechoic liver nodules, non-specific solid mass in the adrenal gland
121
What is acute typhitis?
Inflammation to the cecum/ascending colon which appears as hypoechoic uniform thickening of the colon
122
What is the sonographic appearance of Crohns disease? (7)
- Thick hypoechoic wall
- Narrowed lumen
- Aperistalsis
- Rigid
- Echogenic halo of creeping fat
- Hyperemia
- Mesenteric lymphadenopathy
123
How does fistula formation appear sonographically?
Linear bands of variable echogenicity
124
How does phlegmon appear sonographically?
Poorly defined hypoechoic areas
125
What is the most common form of diverticulitis?
LLQ
126
Who does RLQ diverticulitis most commonly affects?
Women, asians, young adults
127
Who does LLQ diverticulitis most commonly affect?
Elderly and people with low bulk diets
128
What areas does LLQ diverticulitis most commonly affect?
Sigmoid and left colon
129
What areas does RLQ diverticulitis most commonly affect?
Cecum or ascending colon
130
What is the difference between LLQ and RLQ diverticulitis?
RLQ = congenital, solitary, all layers
LLQ = age, multiple sacs, fecal material causes inflammation
131
Read module 5 notes about medical renal disease
...
132
What is the sonographic appearance of fungal balls?
Echogenic, non-shadowing, mobile mass
133
What are the differentials of fungal balls? (3)
Blood clots, tumors, polyps
134
What conditions may be seen in people with AIDS? (8)
- Moderate spleonmegaly
- Candida
- Pneumocystis carinii infections
- Kaposi's sarcoma
- Lymphoma
- Cholangitis
- Acute typhlitis
- Adrenal insufficiency
