Metabolic Disease

Question 1

Diffuse process that is dysfunction of hepatocytes and normal tissue is replaced with fat or fibrosis

Answer 1

Hepatocellular disease

Question 2

Fat accumulation within the hepatocytes that is acquired and reversible

Answer 2

Fatty infiltration (steatosis)

Question 3

The liver becomes more hyperechoic and heterogenous with a change in the ability to visualize vessels

Answer 3

Fatty infiltration

Question 4

The grades of fatty infiltration

Answer 4

Grade 1: Mild: slight increase in echogenicity, diaphragm and vessels clearly visible
Grade 2: Moderate: increased echogenicity, diaphragm and vessels not well defined
Grade 3: Severe: markedly increased echogenicity, very difficult to see diaphragm and vessels

Question 5

Focal areas of increased echogenicity (fat deposits) within mostly normal liver tissue

Answer 5

Focal fatty infiltration

Question 6

Focal hypoechoic areas (normal liver tissue) within a mostly fatty liver

Answer 6

Focal fatty sparing

Question 7

Which area is mostly involved in focal fatty changes? What are some characteristics?

Answer 7

Medial left lobe. Map like boundaries and rapid change over time

Question 8

A diffuse process that destroys liver cells and is not reversible

Answer 8

Cirrhosis

Question 9

Appears as severe fatty infiltration and enlarged liver

Answer 9

Acute cirrhosis

Question 10

Small liver, coarse echotexture, nodular surface, small vessel sizes

Answer 10

Chronic cirrhosis

Question 11

What are some lab values associated with cirrhosis?

Answer 11

AST, ALT, LDH, ALP, bilirubin (conjugated)

Question 12

What are the 3 main clinical presentations of cirrhosis?

Answer 12

Hepatomegaly, jaundice, ascites

Question 13

Autosomal recessive disorder that causes excess glycogen deposits in hepatocytes

Answer 13

Glycogen storage disease/ Von Gierke’s

Question 14

GSD sonographic appearance

Answer 14

Diffuse fatty infiltration and adenomas

Question 15

2 types of ascites

Answer 15

Transudate: anechoic (little/no protein or cells), suggests non-inflammatory process
Exudate: echogenic, high protein content (blood, pus, chylous), inflammatory or malignant cause

Question 16

Free vs loculated fluid

Answer 16

Free fluid: changes with patient position, conforms to organs
Loculated: no change with movement, round/mass like effect

Question 17

The 3 most dependent spaces in the abdominopelvic cavity?

Answer 17

Morison’s Pouch, paracolic gutters, Pouch of Douglas

Question 18

A mixture of particulate matter and bile that can be a precursor to GB disease, most commonly caused by bile stasis

Answer 18

Biliary sludge

Question 19

When sludge becomes the same echogenicity as the liver and camouflages the GB

Answer 19

GB hepatization

Question 20

Pseudo sludge

Answer 20

Artifact due to excessive gains

Question 21

The presence of pus in bile

Answer 21

Empyema

Question 22

Blood in the bile

Answer 22

Hemobilia

Question 23

GB filled with semi solid deposits

Answer 23

Milk of calcium (limey bile)

Question 24

Most common disease of the GB

Answer 24

Cholelithiasis (gallstones)

Question 25

Three factors that affect gallstone formation

Answer 25

- abnormal bile composition - biliary stasis - infection

Question 26

3 different types of GB stones

Answer 26

1. Cholesterol 2. Bilirubin 3. Calcium

Question 27

Who’s most at risk for GB stones? (5 f’s)

Answer 27

Female, fat, fertile, forty, family history

Question 28

What are some of the clinical presentations for gallstones?

Answer 28

Asymptomatic, RUQ pain, N&V, belching

Question 29

What is the WES sign?

Answer 29

Wall, echo, shadow. | When the GB is completely filled with stones

Question 30

What lab values may indicate stones?

Answer 30

AST, ALT, ALP, BILI

Question 31

What are 3 complications associated with gallstones?

Answer 31

Biliary colic (most common), obstruction of cystic duct or CBD, bacterial infection, cholecystitis, ascending cholangitis

Question 32

Differentiate painful/painless jaundice

Answer 32

Painless: neoplastic condition, choledochal cysts Painful: acute obstruction or infection of the biliary tree

Question 33

What are some S/S of biliary obstruction

Answer 33

- jaundice - clay coloured stool - abnormal LFT’s - pain - nausea

Question 34

Stones in the biliary tree

Answer 34

Choledocholithiasis

Question 35

Most common location for choledocholithiasis

Answer 35

Distal CBD at Ampulla of Vater

Question 36

Stones in the urinary system

Answer 36

Urolithiasis

Question 37

Stones in the renal collecting system

Answer 37

Nephrolithiasis

Question 38

Calcifications in the renal parenchyma

Answer 38

Nephrocalcinosis

Question 39

Where are the narrowings in the ureter that are common for stones to get lodged? What size stones can be passed?

Answer 39

1.UPJ 2. Iliac vessels 3. UVJ (most common) stones <5mm can pass

Question 40

What artifact is associated with stones?

Answer 40

Twinkling artifact

Question 41

Dilatation of the renal collecting system

Answer 41

Hydronephrosis

Question 42

Obstructive vs non obstructive hydro

Answer 42

Obstructive: intrinsic/extrinsic obstruction of flow. Look for jets Non-obstructive: reflux, infection, polyuria

Question 43

Grade hydronephrosis

Answer 43

Grade 1: slight separation of the renal sinus Grade 2: separation of the entire central sinus, clubbed calyces Grade 3: severe, cortical thinning, loss of individual calyx definition

Question 44

Anderson-Carr Kidney on U/S

Answer 44

Non-shadowing echogenic rims of pyramids

Question 45

Poorly functioning but unobstructed kidneys

Answer 45

Medical renal disease

Question 46

Diffuse increase in cortical echogenicity with prominent CM junction, enlarged kidneys

Answer 46

Acute medical renal disease

Question 47

Chronic medical renal disease

Answer 47

Small, echogenic kidney

Question 48

Most common cause of ARF and is reversible

Answer 48

Acute tubular necrosis

Question 49

Necrosis of the cortex with sparing of the pyramids

Answer 49

Acute cortical necrosis

Question 50

Acute glomerulonephritis

Answer 50

Autoimmune reaction

Question 51

Amyloid deposits in the kidneys

Answer 51

Amyloidosis

Question 52

Most common cause of chronic renal failure

Answer 52

Diabetes mellitus

Question 53

Inability of kidneys to remove waste from blood and results in azotemia

Answer 53

Renal failure

Question 54

What are the 3 causes of renal failure?

Answer 54

1. Pre-renal: sepsis, stenosis 2. Renal: tissue 3. Post renal: obstruction of collecting system

Question 55

What lab values may be abnormal with renal disease?

Answer 55

- Creatinine ** - BUN - Uric acid - RBC/WBC in urine - proteinuria

Question 56

Excessive cortisol secretion

Answer 56

Cushing’s syndrome

Question 57

Cushing’s disease

Answer 57

Due to malfunctioning pituitary (too much ACTH)

Question 58

Hyperadrenalism vs hypoadrenalism

Answer 58

Hyper: too much hormone Hypo: not enough hormone

Question 59

Excessive aldosterone secretion

Answer 59

Conn’s Disease

Question 60

MEN type 2

Answer 60

Bilateral, autosomal dominant, malignant

Question 61

Tumours developing in several endocrine glands

Answer 61

MEN

Question 62

Chronic primary hypoadrenalism that is usually autoimmune & affects mostly females

Answer 62

Addison’s disease

Question 63

Acute hypoadrenalism

Answer 63

Waterhouse-Friderichsen Syndrome

Question 64

Which enzyme is most sensitive indicator of biliary obstruction

Answer 64

ALP