Infectious and Inflammatory Flashcards
1
Q
What is the most common clinical presentation of infection? (3)
A
- Fever
- Pain
- Leukocytosis
2
Q
What complication can infection lead to?
A
An abscess
3
Q
Who is at risk of getting an abscess? (4)
A
- Diabetics
- Immunosuppressed patients
- Patients with hematomas
- Post-operative patients
4
Q
What may hepatitis be caused by?
A
Viruses or toxins
5
Q
How many types of hepatitis are there and what are the 4 most common types of hepatitis?
A
6 Types
Hepatitis A, B, C, and D are the most common
6
Q
What is the primary mode of spread for Hepatitis A?
A
Fecal-oral route
7
Q
What is the primary mode of spread for Hepatitis B?
A
Blood and body fluids, carrier state
8
Q
What is the primary mode of spread for Hepatitis C?
A
Transfusions
9
Q
What is the primary mode of spread for Hepatitis D?
A
Dependent on Hep B/IV drug users (cannot get Hep D unless you have already contracted Hep B)
10
Q
What percentage of Hepatitis A cases are acute and what is the prognosis?
A
99%
Clinical recovery with 4 months
11
Q
What is a rare and severe form of hepatitis and what does it cause?
A
Subfulminant/fulminant
Causes hepatic necrosis
12
Q
What is subfulminant/fulminant hepatitis due to?
A
Hepatitis B or drug toxicity
13
Q
Death will occur with subfulminant/fulminant hepatitis after what percentage of hepatic parenchyma is lost?
A
> 40%
14
Q
When would you consider hepatitis to be chronic?
A
If biochemical markers remain abnormal for >6 months
15
Q
How will the liver appear sonographically with acute hepatitis? (5)
A
- Hepatomegaly
- Decreased liver echogenicity
- Prominant portal vein walls
- Gallbladder wall thickening
- More often, liver usually appears normal
16
Q
What is the prominent portal vein walls in acute stage hepatitis referred to as?
A
Starry sky appearance
17
Q
What is the sonographic appearance of chronic hepatitis? (4)
A
- Coarse liver parenchyma
- Overall increase in echogenicity
- Portal hypertension
- Cirrhosis
18
Q
What lab values are typically increased with hepatitis?
A
ALT, AST bilirubin
19
Q
What are the 4 routes of spread by pyogenic bacteria to the liver?
A
- Biliary tract
- Portal venous system
- Hepatic artery
- Trauma
20
Q
What is the sonographic appearance of a bacterial liver infection? (4)
A
- Simple to complex cyst
- “Shaggy wall”
- Internal septations
- Echogenic foci with posterior reverb (gas)
21
Q
What are fungal diseases that can affect the liver?
A
Candida and pneumocystis carinii
22
Q
What is sonographic presentation of candida fungal liver disease and what is the most common? (4)
A
- Hyperechoic
- Bulls eye appearance
- Wheel within a wheel appearance
Most common = Uniformly hypoechoic
23
Q
Which fungal disease of the liver is an opportunistic infection?
A
Pneumocystis carinii
24
Q
Which group of people contract pneumocystis carinii?
A
Immunocompromised (AIDS)
25
What is the sonographic appearance of pneumocystis carinii?
Tiny non-shadowing echogenic foci that could progress to shadowing clumps of calcifications
26
How do amoeba travel with amebiasis and what other disease travels the same route?
Fecal-oral route
(Colon -> Portal vein -> Liver)
Hydatid disease has the same route
27
Which lobe of the liver is more commonly affected by amebiasis and hydatid disease?
Right
28
What is the most common clinical presentation of amebiasis?
PAIN
29
What is hydatid disease also called?
Echinococcal
30
What is hydatid disease and what are the most common structures affected? (5)
It is a parasitic infection (tapeworm) common in sheep and cattle raising countries.
Affects the liver most commonly but also:
- Spleen
- Ureter
- Bladder
- Kidneys
31
Which hosts are "definitive" and "intermediate" in hydatid disease?
Dogs = definitive host (tapeworm matures)
Humans = intermediate (parasite undergoes development but doesn't mature)
32
What is the "embryo" in hydatid disease and what are it's layers?
The embryo of the parasite is a slow growing cyst with three layers:
Ectocyst, pericyst, endocyst
33
Define ectocyst in terms of the embryo parasite in hydatid disease:
External membrane (~1mm thick)
34
Define pericyst in terms of the embryo parasite in hydatid disease:
Dense connective tissue capsule around cyst
35
Define endocyst in terms of the embryo parasite in hydatid disease:
Inner germinal layer
36
What are 4 sonographic appearances that represent the embryo in hydatid disease?
- Hydatid sand
- Simple cyst
- Daughter cysts
- Calcified walls
37
What is a rare result that could happen due to the embyronic cyst rupturing in hydatid disease and what are 3 other signs of Hydatid?
Rare due to rupture = Anaphylactic shock
- Pain/discomfort
- Jaundice
- Vascular thrombosis/infarction
38
What is shistosomiasis?
A parasitic infection where worms penetrate the skin and travel to mesenteric veins via lymph and blood vessels
39
What structures are invaded with schistosomiasis?
Liver, spleen, bowel, and bladder
40
What affects does schistosomiasis have and how do they occur?
- Granulomatous reaction ("walling off" inflammation)
- Periportal fibrosis
Occurs from the ova penetrating the portal vein wall and connective tissue
41
What is the sonographic appearance of schistosomiasis? (6)
- Thickening/increased echogenicity of the periportal walls
- Hepatomegaly (initially)
- Shrunken liver (over time due to portal hypertension)
- Splenomegaly
- Thickened bladder wall
- "Turtle back appearance"
42
What can periportal fibrosis lead to over time?
Portal hypertension and cirrhosis
43
What is another name to the thickening and brightened appearance of the granulomatous reaction?
Turtle back appearance
44
What is tuberculosis?
Opportunistic infection that starts in the lungs and may spread to the spleen, adrenals, urinary tract/
45
What is the sonographic appearance of TB in the spleen?
Tiny echogenic foci with or without shadowing
46
What is the sonographic appearance of acute TB in the adrenal glands?
Bilateral diffuse enlargement
47
What is the sonographic appearance of chronic TB in the adrenal glands?
Atrophied and calcified
48
What can TB lead to?
Atrophy of the adrenals and hypoadrenalism (Addison's disease)
49
What is peritonitis?
Inflammation of the peritoneum
50
What is peritonitis caused by and what is the main symptom?
Infectious or non-infectious factors
Main symptom = severe pain
51
What are examples of infectious causes of peritonitis?
Bacteria, viruses, fungi, and parasites
52
What are examples of non-infectious causes of peritonitis?
Pancreatitis, foreign bodies
53
What is a type of peritonitis that affects immunocompromised patients?
Tuberculosis peritonitis
54
What would you see sonographically in a patient with tuberculosis peritonitis?
Exudative fluid, lymphadenopathy
55
What is acute cholecystitis most often due to?
Impacted stones (most often in the GB neck) which interfere with blood supply leading to inflammation and infection
56
Who does acute cholecystitis affect more?
Females
57
What are things you may see sonographically with acute cholecystitis? (7)
- GB wall >3mm
- Hyperemia
- Gallstones
- Impaction at neck
- GB hydrops
- Pericholecystic fluid
- Postitive murphy's sign
58
What lab values would you expect to see altered in acute cholecystitis?(5)
- Bilirubin
- ALP
- Leukocytosis
- AST
- ALT
59
What are the complications of acute cholecystitis?(6)
- Empyema
- Gangrenous
- Cholecystitis
- Emphysematous cholecystitis
- Perforation
- Abscess
60
Where does perforation typically occur in the gallbladder?
Fundus
61
What is gangrenous cholecystitis?
Necrosis of the gallbladder (typically no pain due to dead nerves)
62
What is a rare form of cholecystitis that is caused by gas forming bacteria?
Emphysematous cholecystitis
63
Emphysematous cholecystitis affects who more? (3)
Men, diabetics and immunocompromised people
64
What is acalculous cholecystitis?
Inflamed gallbladder without stones that typically affects critically ill patients.
65
What are predisposing factors for acalculous cholecystitis? (4)
- Trauma
- Previous unrelated surgery
- Burn victims
- Hyperalimentation (prolonged sickness w/IV nutrition)
66
What is the sonographic appearance of acalculous cholecystitis?
Same as acute cholecystitis, but without stones
67
What is the most common form of symptomatic gallbladder disease?
Chronic cholecystitis
68
What is the sonographic appearance of chronic cholecystitis? (3)
- Thick heterogeneous wall
- Contracted GB with stones
- WES sign
69
What lab values would you expect to see altered with chronic cholecystitis?
AST, ALT, ALP, and Bilirubin
70
What are complications of chronic cholecystitis? (3)
- Bouveret syndrome
- Gallstone ileus
- Mirizzi's syndrome
71
What is Bouveret syndrome?
A gastric outlet obstruction due to a fistula between the cystic duct and duodenum allowing a stone to pass into the duodenum and lodge there
72
What is gallstone ileus?
Distal bowel obstruction due to a gall stone passing into the intestinal tract and lodging distally
73
What is chronic cholecystitis associated with?
Gallbladder carcinoma
74
What is a rare complication of chronic cholecystitis?
Mirizzi syndrome
75
What happens in Mirizzi syndrome?
CHD is compressed by an impacted stone in GB neck, cystic duct, Hartmann's pouch, or inflammatory reaction which results in obstructive jaundice
76
What may form in Mirizzi syndrome?
Fistula between the cystic duct and CHD
77
What is xanthogranulomatous cholecystitis?
Rare form of chronic inflammation
78
What is the term for "The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body"?
Infection
79
What is the term for " A localized reaction that produces redness, warmth, swelling, and pain as a result of infection"?
Inflammation
80
What are the two terms for "the abnormal enlargement of organs"?
- Organomegaly
| - Visceromegaly
81
What is the term for "A local accumulation of pus anywhere in the body"?
Abscess
82
What is the term for "The red streaking and lymph node swelling in the area of an injury usually caused by a bacterial infection with Streptococcus"?
Lymphangitis
83
What is the term for "inflammation of a gland"?
Adenitis
84
What is the term for "the swelling of soft tissues as a result of excess fluid accumulation"?
Edema
85
What are the two terms for "Large or swollen lymph nodes"?
- Adenopathy
| - Lymphadenopathy
86
What is the term for "a mosquito-borne parasitic disease caused by tiny thread-like worms that live in the human lymph system causing blockage and enlargement of limbs"?
Elephantiasis
87
What is the term for "an above normal range of white blood cells in the blood"?
Leukocytosis
88
What is the term for "a below normal range of white blood cells in the blood"?
Leukopenia
89
What is the term for "a clump or wad of swallowed food or hair that blocks the digestive system"?
Bezoars
90
What is the term for "an infection of the kidneys' collecting system causing pus to collect in the renal pelvis and distension of the kidney"?
Pyonephrosis
91
What is the term for "a region of normally compressible lung tissue that has filled with liquid and become swollen and hard"?
Lung consolidation
92
What is the term for "a complete or partial collapse of a lung or lobe of a lung"?
Atelectasis
93
What is the term for "a collection of air or gas in the chest or pleural space that causes part or all of a lung to collapse"?
Pneumothorax
94
What is FUO?
Fever of Unknown Origin
95
What is the sonographic appearance of an abscess?
A fluid filled area with posterior enhancement, debris and thick, irregular walls. Possible gas as well.
96
What is hepatitis and what are the signs/symptoms? (5)
An inflammation of the liver
- Fever
- Chills
- Nausea
- Vomiting
- Jaundice
97
What determines chronic hepatitis?
Biochemical markers remain abnormal for > that 6 months
98
The classical presentation of fever, RUQ pain, malaise and anorexia indicates what?
Bacterial liver infections
99
What is the clinical presentation of candida infection?
A persistent fever with a WBC count returning to normal
100
What organs are involved in a candida infection?
Liver, kidney and spleen
101
What organs are involved with Pneumocystis Carinii? (5)
Liver, Spleen, renal cortex, pancreas, lymph nodes
102
What is the sonographic appearance of amebiasis? (3)
- Round/oval shape
- Hypoechoic
- Fine internal echoes
103
What is the clinical presentation of acute cholecystitis? (5)
- RUQ pain
- Fever
- Leukocytosis
- Nausea and Vomitting (N&V)
- Jaundice (25%)
104
How does gangrenous cholecystisitis appear on U/S?
Non-layering bands of echogenic tissue within the GBB (image page 186)
105
How does gallbladder perforation appear on U/S? (4)
- Free fluid in the peritoneal cavity
- Low level collection adjacent to the GB
- Ill-defined hypoechoic mass surrounding GB
- May see perforation in wall
106
How does emphysematous cholecystitis appear on Ultrasound?
Dirty shadowing (due to gas forming bacteria)
107
What is the clinical presentation of chronic cholecystitis? (4)
- Intolerance to fatty foods
- Belching/indigestion
- Postprandial RUQ pain
- N&V
108
What is the WES sign most commonly associated with?
Chronic cholecystitis
109
What are the clinical symptoms of Mirizzi Syndome? (3)
Fever, pain, jaundice
110
What is the sonographic appearance of Mirizzi syndrome?
- Dilated bile ducts above level of obstruction (CHD)
| - Normal CBD
111
What is the sonographic appearance of xanthogranulomatous cholecystitis?
Hypoechoic nodules/bands in a thick GB wall that represent fatty granulomatous nodules (abnormal, fibrous tissue).
112
How to remember ALT, AST and ALP?
ALT = "a liver transplant" - specific indicator of liver damage
AST = "a serious trauma" - injury to cells
ALP = "a lith problem" - stones or biliary issue
