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Flashcards in Lesson 1D (Part 1) Deck (29)
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1

What are the most common routes for pyogenic bacteria? (4)

1. Through the biliary tract in patients with suppurative (pus) cholangitis or cholecystitis
2. Goes through the portal venous system
- diverticulitis and appendicitis
3. Goes through the hepatic artery
- osteomyelitis and bacterial endocarditis
4. Occurs as a result of blunt or penetrating trauma to the liver

2

Cholangitis

Inflammation of the bile duct

3

Cholecystitis

Inflammation of the GB

4

Diverticulitis

Inflammation of the diverticulum
- impairing bowel function

5

Appendicitis

Inflammation of the appendix

6

Osteomyelitis

Inflammation of bone/bone marrow

7

Bacterial endocarditis

Inflammation of the endocardium

8

Hepatic abscess

Is a mass filled with pus inside the liver

9

Pyogenic bacteria

Things coming from the bowel and are going into the portal system
- bacteria passing through blood

10

What is hepatic abscesses mainly caused by?

Aanaeurobic (bacterial) infection

11

What are symptoms of pyogenic liver abscess? (6)

1. Fever
2. Malaise
3. Anorexia
4. RUQ pain
5. Jaundice
6. Leukocytosis

12

Is sonography helpful with detection of hepatic absesses?

Yes

13

What are some sonographic signs of liver abscesses? (5)

1. Frankly purulent
- cystic with fluid ranging from echo free to highly echogenic
2. Early supperation
- solid with altered echogenicity, usually hypoechoic due to necrotic hepatocytes
3. Gas producing organisms give rise to echogenic foci with posterior reverberation artifacts ***
4. Fluid/fluid interfaces, internal septations and debris
5. Walls can be thick, irregular or well defined

14

Fluid/filled

Clear fluid on the top and sludgy fluid on the bottom

15

What confirms diagnosis for liver abscesses? (2)

1. Presence of pus
2. Positive gram stain and culture

16

What kind of patients get fungal disease? (3)

1. Immunosuppressed ***
2. Females after pregnancy
3. People after hyperalimentation

17

What is an example of a fungal disease?

Candidiasis

18

How does candidiasis present?

With a persistent fever in a neutropenic patient (low white blood cell count) whose leukocyte count is returning to normal

19

Neoplasm

Any unidentified mass

20

What is the difference between a liver abscess and a hematoma?

A liver abscess needs to be drain, where as a hematoma can resolve on its own

21

What are 9 examples of patients that are immunosuppressed?

1. Transplant pre and post
2. Cancer
3. Chemotherapy/radiation therapy
4. AIDS/HIV
5. Inherited disease
- blood disorders
6. Underlying systemic infection
7. Poor nutrition
8. Shift workers
9. Pregnant

22

What are some sonographic features of candidiasis?

1. Wheel within a wheel
2. Central nidus
3. Hyperechoic foci
4. Bull's eye
5. Uniformly hypoechoic
6. Echogenic

23

Wheel within a wheel

Peripheral hypoechoic zone with an inner echogenic wheel and a central hypoechoic nidus

24

Central nidus

Focal necrosis where fungal elements are found

25

Hyperechoic foci

Multiple small abscesses with air

26

Bull's eye

Hyperechoic center with a hypoechoic rim
- echogenic center contains inflammatory cells

27

Uniformly hypoechoic

Due to progressive fibrosis

28

Echogenic feature of candidiasis

Variable calcification
- scarring

29

What is the most common sonographic feature of candidiasis?

Uniformly hypoechoic