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Metabolic Diseases Flashcards

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1
Q

A metabolic disease is an abnormality that occurs

A

Globally in the body

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2
Q

A metabolic disease affects ____ and is dependant on

A

Several organs

The stage of the disease

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3
Q

What makes the underlying cause of a metabolic numerous

A

Many substances metabolized in the body

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4
Q

What are the different metabolic diseases of the liver

A

Hepatocellular disease

Glycogen storage disease

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5
Q

What are the different types of hepatocellular disease

A

Fatty infiltration

Cirrhosis

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6
Q

What is hepatocellular disease

A

A diffuse process what is caused by the dysfunction of hepatocytes

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7
Q

What is normal liver tissue replaced with in hepatocellular disease

A

Fat or fibrosis

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8
Q

Hepatocellular disease ranges from

A

Simple fatty changes to cirrhosis

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9
Q

What does hepatocellular disease often result in

A

Abnormal LFT’s

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10
Q

Hepatocellular disease often affects the

A

Liver size

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11
Q

What is Fatty infiltration

A

Steatosis

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12
Q

Define steatosis

A

Accumulation of triglycerides within hepatocytes

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13
Q

Is fatty infiltration uniform throughout the liver

A

No, not always

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14
Q

Fatty infiltration can be what kind of processes

A

Focal or diffuse

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15
Q

Fatty infiltration is

A

Acquired and reversible

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16
Q

What are the 2 most common causes of fatty infiltration

A

Alcohol abuse

Obesity

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17
Q

Fatty infiltration is the precursor to

A

Significant chronic disease

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18
Q

What is assessed when evaluating the liver for fatty infiltration

A

Echogenicity changes
Echotexture changes
Attenuation characteristics
Ability to visualize vessels

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19
Q

What is imperative when assessing for fatty infiltration

A

Appropriate gains, TGC’s and focus

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20
Q

What is the sonographic characteristics for mild fatty infiltration

A

Slight increase in liver echogencity

Diaphragm and vessels clearly defined

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21
Q

What is the sonographic characteristics for moderate fatty infiltration

A

Increase in liver echogencity

Vessels and diagram not sharply defined

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22
Q

What is the sonographic characteristics for severe fatty infiltration

A

Liver echogencity is markedly increased

Extremely difficult to define diaphragm and vessel walls

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23
Q

What are the different types of focal fatty changes

A

Infiltration

Sparing

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24
Q

What is the sonographic characteristics of infiltration

A

Focal areas of increased echogencity (fatty deposits)

Mostly normal liver parenchyma

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25
What is the sonographic characteristics of sparing
Focal hyperechoic areas (normal liver tissue) | Majority if liver parenchyma has fatty infiltration
26
What lab values could potentially be elevated with fatty infiltration
ALT AST BBT is associated with alcohol abuse
27
What is cirrhosis
A diffuse process that destroys the liver cells
28
What does cirrhosis result in
Fibrosis of the liver parenchyma with nodular changes
29
What are the underlying causes for cirrhosis
Alcohol abuse Chronic viral hepatitis Primary sclerosing cholangitis
30
What is the progressive change of cirrhosis
Cell death Fibrosis Regeneration
31
Is cirrhosis reversible
No
32
What are the 2 types of nodular changes with cirrhosis
Micro nodular | Marco nodular
33
What is mirco nodular changes in cirrhosis caused by
Alcohol consumption
34
What is macro nodular changes in cirrhosis caused by
Chronic viral hepatitis
35
What does the acute stage of cirrhosis look like
Some appearance of severe fatty infiltration Enlarged liver Textural changes
36
What does the chronic stage of cirrhosis look like
Small liver (CL/RL >0.65) Course echotexture Nodular surface Paucity of vessels
37
What is quite common with liver cirrhosis
Ascites
38
Cirrhosis has the potential to progress to what
End stage liver failure
39
What do the lab values for cirrhosis depend on
The stage of the disease
40
What are the increased lab values for cirrhosis
``` AST ALT LDH ALK PHOS (ALP) Bilirubin (conjugated) Gamma globulins (BBT) ```
41
What lab value is decreased with liver cirrhosis
Serum albumin
42
Which other organ is affected by liver cirrhosis and why
Spleen and because of portal hypertension
43
What is the classic clinical presentation of liver cirrhosis
Hepatomegaly Jaundice Ascites
44
What are the other clinical presentations for liver cirrhosis
Diarrhea Feeling of fullness Weight loss
45
What is glycogen storage disease
Autosomal recessive disorder
46
What is another name for glycogen storage disease
Von Gierke’s disease
47
Glycogen storage disease is cause by what
An enzyme deficiency (G6P) which leads to excess glycogen deposits in hepatocytes
48
What is the most common disease of the gallbladder
Cholelithiasis
49
What are the factors affecting gallstone formation
Abnormal bile composition Stasis of bile Infection
50
What is the compulsion of gallstones
Cholesterol Bilirubin Calcium
51
What is the most common composition of gallstones
Cholesterol
52
What is the stone called when it is composed of bilirubin
Pigment stone
53
What are the risk factors for cholelithiasis
``` Female Fat Fertile Forty Family history ```
54
What is the clinical presentation of cholelithiasis
Can be asymptomatic RUQ pain (after meals) Nausea and vomiting Belching
55
If a patient is found to have cholelithiasis and has RUQ pain how does the pain radiate
Towards the back
56
What is the sonographic appearance of cholelithiasis
``` Echogenic focus Posterior shadowing Mobility May float in the bile WES sign ```
57
If a cholelithiasis stone is <5mm what may it not have
A shadow
58
When is the WES sign seen
When the gallbladder is filled with multiple stones or one large stone
59
What does WES stand for
Wall Echo Shadow
60
What lab values will be altered with cholelithiasis
ASTT ALT ALP Bilirubin
61
What are the complications of gallstones
``` Biliary colic Obstruction of the cystic duct or CBD Bacterial infection Cholecystitis Ascending cholangitis ```
62
What is the most common complication of gallstones and what does it cause
Biliary colic; causes severe pain
63
What does the obstruction of the cystic duct or CBD lead to
GB hydrops
64
An US examination to investigate possible obstruction of the biliary tree tree should focus on which 3 questions
1. Is the bile duct or GB dilated 2. If yes, to what level 3. If yes, what is the cause
65
What are the 2 different types of biliary tree obstruction
Biliary dilation | Choledocholiathiasis
66
Biliary dilation can be
Intra-hepatic or extra-hepatic | Mild, moderate or severe
67
What causes the ducts to dilate
Obstruction Loss of duct elasticity Ampulla of vaster dysfunction
68
What is the most common cause of duct dilation
Obstruction
69
What is the typical cause of biliary obstruction
Stone | Tumor
70
What is the clinical presentation of obstruction
Painless jaundice | Painful jaundice
71
What causes painless jaundice
Neoplastic conditions | Choledochal cysts
72
When is painful jaundice seen
With acute obstruction (stones) And/Or Infection of the biliary tree
73
What are the signs and symptoms of obstruction
``` Jaundice Clay coloured stool Abnormal LFT’s Pain Nausea ```
74
Can choledocholiathiasis be intrahepatic or extrahepatic
Yes
75
What is choledocholiathiasis
Stones in the biliary tree
76
Are there primary and secondary causes of choledocholiathiasis
Yes
77
What is the secondary cause of choledocholiathiasis
Stones that pass from the gallbladder to ducts
78
What is the primary cause of choledocholiathiasis
Stones that form in the ducts
79
What is the most common cause of choledocholiathiasis
Secondary
80
What causes the primary cause of choledocholiathiasis
Inflammation Infection Caroli’s disease Prior surgery
81
What kind of infection will lead to the primary cause of choledocholiathiasis
Parasitic
82
What is the most common location for stones in the biliary tree
Distal CBD at the ampulla of Vater
83
when does glycogen storage disease begin
neonatally
84
what is associated with glycogen storage disease
begin adenomas | HCC
85
how is glycogen storage disease managed
through controlled and monitored diet
86
what is the sonographic appearance of glycogen storage disease
presents as diffuse fatty infiltration | adenomas
87
what is the metabolic disease that affects the peritoneum
ascites
88
define ascites
accumulation of free serous fluid in the peritoneal cavity
89
what are the 2 different types of ascites fluid
transudate | exudate
90
what does transudate fluid contain
little protein or cells
91
what does transudate fluid suggest
a non-inflammatory process
92
what kind of non-inflammatory processes does transudate fluid typically indicate
cirrhosis | CHF
93
why does cirrhosis cause transudate fluid to be leaked
because pressures in the liver increases which causes fluid to leak out of the hepatocytes or hypoalbuminemia
94
what is the sonographic appearance of transudate fluid
anechoic fluid
95
what does exudate fluid contain
high protein blood (hemoperitoneum) pus chylous
96
define chylous
milky fluid with a high fat content
97
where is chyous from
lympathic system
98
what does exudate fluid suggest
an inflammatory or malignant cause
99
what is the sonographic appearance of exudate fluid
internal echoes echogenic loculations
100
what are the 2 different ways fluid in the perioneal cavty can present
free | loculated
101
how does free fluid in the perioteum change
with patient position
102
does free fluid in the perioteum confrom to the surrounding organs
yes, with acute angles with organ contact
103
how does loculated fluid in the peritoeum change with movement
it doesn't
104
what is the appearance of loculated fluid in the peritoneum
``` rounded margins mass effect (walled off) ```
105
what are the 3 most dependant spaces in the perioneal cavity
morrison's pouch pouch of douglas paragolic gutter
106
what are the different metabolic diseases of the gallbladder and biliary tree
biliary sludge gallstones biliary tree obstruction
107
what is biliary sludge
a mixture of particulate matter and bile
108
what are the different names for biliary sludge
biliary sand | microlithiasis
109
what is biliary sludge a potential presursor for
gallbladder disease
110
if a patient has biliary sludge how do they present
may or may not have symptoms
111
if a patient is asymptomatic and has biliary sludge, what does it typically indicate
biliary colic | inflammation of the gallbladder and pancreas
112
can biliary sludge resolve spontaneously
yes
113
what is the most likely cause of biliary sludge
bile stasis
114
what are the causes of bile stasis
prolanged fasting rapid weight loss TPN extrahepatic biliary obstruction
115
what is the sonographic appearance of biliary sludge
``` non-shadowing homogeneous low level echoes layers in the dependant portion of the gallbladder -fluid-fluid level moves with patient position ```
116
what are the different types of biliary sludge
``` tumefactive sludge/sludge balls hepatization pseudo sludge empyema hemobila milk of calcium ```
117
what is tumefactive sludge/sludge ball
sludge that mimics polypoid tumors
118
how do you differiciate tumefactive sludge from polypoid tumor
look at vascularity mobility and GB wall thickness
119
what is hepatization sludge
sludge that has the same echogenicity as the liver | camouflages the GB
120
what is pseudo sludge
an imaging artifact that is independant of gravity | caused by excessive gains, slice thickness or side lobe artifact
121
what is empyema sludge
presence of pus in bile
122
what is hemobilia sludge
the presence of blood in bile
123
what is hemobila usually due to
liver biopsy | percutaneous biliary procedures
124
what is another term for milk of calcium
limey bile
125
What is milk of calcium
Rare, semi solid substance that fills the GB that is in a separate category from biliary sludge
126
What is milk of calcium composed of
Calcium carbonate
127
What is the sonographic appearance of milk of calcium
Highly echogenic material with posterior shadowing that changes with patient position and it forms a calcium/bile fluid level
128
Stones in the distal CBD can be difficult to visualize due to what
Bowel gas
129
What do you look for in the distal CBD if there is bowel gas blocking the stone
Hyperechoic focus with posterior shadowing
130
What are scanning techniques to resolve the distal CBD
Changing patient position Compression of bowel Change windows Use the pancreatic head as a reference
131
What can cause false positives of stones in the distal CBD
Surgical clips; post cholecystectomy Air Edge artifact
132
What lab values will change with choledocholiathiasis
Alkaline phosphatase (ALP) AST ALT Bilirubin
133
what is the treatment for choledocholiathiasis
ERCP spincterotomy ERCP extraction stenting
134
what does ERCP stand for
endoscopic retrograde cholangiopanreatography
135
what are the metabolic diseases that affect the urinary tract
calculi in the urinary collecting system medical renal disease renal failure
136
what are the different types of stones in the urinary system
``` nephrolithiasis bladder calculi hydronephrosis renal parenchymal calcium deposits Anderson-Carr kidney ```
137
define urolithiasis
stones in the urinary system
138
define nephrolithiasis
stones in the renal collecting system
139
define nephrocalcinosis
calcifications in the renal parenchyma
140
is nephrolithiasis very common
yes
141
who is more commonly affected by nephrolithiasis
caucasian males
142
the incidence of nephrolithiasis increases with what
age
143
what is the etiology of nephrolithiasis
unknown
144
what are the underlying risk factors for developing nephrolithiasis
hereditary limited water intake high animal protein diet urinary stasis
145
stones that form in the kidneys can move through what
the collecting system
146
stones can become lodged in the natural narrowings of the ureter where
just past the UPJ at the iliac vessels at the UVJ
147
what is the most common place for a stone to become lodged in the ureter
the UVJ
148
stones < what can be passed
5mm
149
what is the clinical presentation of nephrolithiasis
often asymptomatic heamturia flank pain
150
hematuria in cases of nephrolithiasis can be what
microscopic or gross
151
what is the sonographic appearance of nephrolithiasis
echogenic focus | posterior shadowing
152
what information of nephrolithiasis should be gathered for the radiologist
number size location compilcations
153
what complications are being assessed for in cases of nephrolithiasis
hydronephrosis | jets in the bladder
154
tiny stones can be difficult to identify, so what should be looked for
twinkle artifact
155
define staghorn calculi
calcifications in the collecting system
156
what can cause false postives for nephrolithiasis
``` intrarenal gas renal artery calcifcations calcified sloughed papilla calcified tumors ureteric stent ```
157
whaat are the 3 other imaging modalities that can detect urolithiasis
xray tomagraphy CT
158
bladder calculi are
usually single | asymptomatic
159
bladder calculi can be the result of
a stone migrating from the kidney | urinary stasis
160
what can the patient present with if they have bladder calculi
hematuria | pain
161
what is checked for in cases of bladder calculi and how is it done
mobility of the stone to the dependant portion of the bladder by changing patient position
162
what is hydronephrosis
dilated renal collecting system
163
hydronephrosis can be a
incidental finding, asymptomatic patient
164
hydronephrosis can be due to what causes
obstructive | non-obstructive
165
what are the obstructive causes of hydronephrosis
intrinsic/extrinsic obstruction of flow
166
what should be assessed for in obstructive cases of hydronephrosis
jets
167
what are the non-obstructive causes of hydronephrosis
reflux infection polyuria
168
what may hydronephrosis lead to
renal atrophy
169
classifications for hydronephrosis are based on what
sonographic appearance
170
how many grades of hydrone[hrosis are there
3
171
what is grade 1 hydronephrosis
mild | slight seperation of the renal collecting system
172
what is grade 2 hydronephrosis
moderate anechoic seperation of the entire central renal sinus pelvis and calcyes (major and minor) are dilated clubbed calcyes
173
what is degree of separation of the renal collecting system when there is mild hydronephrosis
2mm
174
what is grade 3 hydronephrosis
severe thinning of the renal cortex extensive enlargement of the renal sinus and calyces loss of individual calyx definition
175
why are the ureters and bladder assessed in cases of hydronephrosis
looking for the cause
176
what can lead to false positives of hydronephrosis
over distened bladder extra-renal pelvis multiple parapelvic cysts AV malformation
177
in cases of hydronephrosis what must always be performed
a post-void assessment
178
what is another term for renal parenchymal calcium deposits
nephrocalcinosis
179
renal parenchymal calcium deposits occur ___ and are
bilateral and diffuse
180
renal parenchymal calcium deposits are either
cortical or medullary
181
renal parenchymal calcium deposits can be caused by
ischemia necrosis wall of pyramids
182
what is the sonographic appearance of renal parenchymal calcium deposits
increased cortical echogenicity echogenic pyramids or wall of pyramids possible shadowing
183
what is Anderson-Carr kidney
theory of stone progression
184
what causes Anderson-Carr kidney
high concetration of calcium in fluid around tubules
185
what does Anderson-Carr kidney result in
deposits of calcium in the margins of the medulla
186
what is the sonographic appearance Anderson-Carr kidney
non-shadowing echogenic rims of renal pyramids
187
medical renal disease affects what
renal parenchyma bilaterally and diffusly in the cortex and medulla
188
medical renal disease is a broad term to describe what
renal disorders
189
medical renal disease describes what
poorly functioning but unobstructed kidneys
190
what needs to be doen to identify the cause of medical renal disease
renal biopsy
191
medical renal disease is intially treated by what rather than what
medication rather than surgery
192
what can medical renal disease lead to
renal failure
193
in cases of medical renal disease what are the areas to evaulate
``` renal size and conture cortical echogencity CM junction distinction renal pyramids renal sinus ```
194
what may the sonographic appearance of medical renal disease depend on
the varying underlying cause
195
what is the sonographic appearance of the acute stages of medical renal disease
diffuse increase in cortical echogencity prominent CM junction enlarged kidneys can also appear normal
196
what is the exception in acute stages of medical renal disease if the pyramids are affected
the CM junction will not be defined
197
what is the sonographic appearance of the chronic stage of medical renal disease
small echogenic kidneys
198
what are the causes of medical renal disease
``` acute tubular necrosis acute cortical necrosis acute glomerulonephritis amyloidosis diabetes mellitus ```
199
what is the most common cause of acute reversible renal failure
acute tubular necrosis
200
what is acute tubular necrosis
deposits of debris in the renal collecting tubules
201
what can acute tubular necrosis be the result of
toxic or ischemic insults
202
what is the appearance of acute tubular necrosis on ultrasound
kidneys most often appear normal but maybe bilateral enlarged with echogenic pyramids RI >0.75
203
acute cortical necrosis is a rare cause of what
acute renal failure
204
what is acute cortical necrosis
ischemic necrosis of the cortex with sparing of the pyramids
205
what is acute cortical necrosis due to
sepsis burns severe dehyrdations PIH
206
what is the sonographic appearance of acute cortical necrosis
initally normal size, hypoechoic cortex and loss of CM junction over time, kidneys atrophy and cortex calcifies
207
acute glomerulonephritis is a
autoimmune reaction
208
what does the patient present with when they have acute glomerulonephritis
hematuria hypertension azotemia
209
what is the early appearance of acute glomerulonephritis on US
kindey may be normal size or enlarged | cortex may be normal echogenic ot hypoechoic
210
what is the appearance of the later stages of acute glomerulonephritis
small, echogenic kidneys
211
what is amyloidosis
systemic metabolic disorder resulting in amyloid deposits in the kidneys
212
what will the patient present with when they have amyloidosis
proteinuria
213
what is the appearance of amylodosis on US
variable; large, normal or small kidney size | hypo or hperechoic
214
what is the most common cause of chronic renal failure
diabetes mellitus
215
initally what happens to the kidneys when a patient has diabetes mellitus
kidneys will be enlarged
216
at end-stage of diabetes mellitus what is the appearance of the kidneys
small echogenic loss of CMJ
217
renal failure is
the inability of kidneys to remove metabolites from blood
218
what is azotemia
overload of urea and nitrogenous wastes in the blood
219
what does renal failure result in
azotemia
220
what are the 3 different causes of renal failure
pre-renal renal post-renal
221
what leads to the cause of pre-renal, renal failure
sepsis | renal artery stenosis
222
what leads to renal, renal failure
parenchymal disease
223
what leads to post-renal renal failure
obstruction of collecting system
224
if there is complete obtruction how long does it take for the renal damage to be irreversible
3 weeks
225
if there is incomplete obstruction how long will it take for the renal damage to be irreversible
3 months
226
acute stage renal failure is
reversible | typically due to medical renal disease
227
what is the sonographic appearance of acute stage renal failure
most normal, possible enlargeme hypoechoic assess for hydronephrosis, obstruction check echogencity of parenchyma
228
chronic stage renal failure is
irreversible | most common caused by diabetes mellitus
229
what is the sonographic appearance of chronic stage renal failure
small kidney | echogenic cortex
230
what lab vaules are increased with renal failure
``` serum creatinine BUN uric acid RBC/WBC in urine proteinuria ```
231
what is the treatment for renal failure
dialysis | renal transplant
232
what are the different metabolic diseases of the adrenal glands
hyperadrenalism | hypoadrenalism
233
what can cause hyperadrenalism
cushing's syndrome conn's disease MEN
234
what does cushing's syndrome result from
excess secretion of cortisol
235
cushing's sydrome can occur as the result of
adrenal hyperplasia adrenal adenoma adrenal carcinoma exogenous corticosteriod administration
236
what is the clinical presentation of cushing's disease
``` moon face buffalo hump truncal obesity hirsutisim amenorrhea HTN ```
237
what is the difference between cushing's syndrome and cushing's disease
snydrome is cause by adreanal dysfunction | disease is caused by a pitutary disorder
238
what is Conn's disease
excess aldosterone secreation
239
what can Conn's disease occur as a result of
adenoma (aldosteronoma) hyperplasia carcinoma
240
is carcinoma causing Conn's disease common or uncommon
uncommon
241
what is the clincial presentation of Conn's disease
``` hypernatemia hypokalemia HTN muscle cramps altered renal function ```
242
what is the sonographic appearance of Conn's disease
small,solid, round mass | hypoechoic
243
what does MEN stand for
multiple endocrine neoplasia
244
how many types of MEN are there
3
245
MEN tumores develop in several endocrine glands, like
adrenal pancreas pituitary parathyroid gland
246
MEN causes excess what to be produced
hormones
247
MEN can be either
benign or malignant
248
is type 2 MEN malignant or benign
malignant
249
MEN type 2 is and occurs
autosomal dominant and occurs typically bilaterally in the phenochromocytomas in adrenal
250
hypoadrenalism is due to
primary disorders of the adrenal cortex or disorders of the hypothalamus or pituitary
251
hypoadrenalism may cause what
adrenal atrophy
252
what can cause hypoadrenalism
Addison's disease | waterhouse-friderichsen syndrome
253
what are the 2 types of addison's disease
autoimmune | TB
254
what % of addison's disease is autoimmune
80
255
autoimmune addison's disease is
found in females | not typically identified sonographically
256
what % of addison's disease is TB
20
257
TB addison's disease is found in
males
258
TB addison's disease causes
``` enlarged, firm, nodular adrenals hyperpigmentation low blood pressure muscle weakness fatigue ```
259
what % of the gland is nonfunction when the patient has TB addison's disease
90
260
what is waterhouse-frederichsen syndrome
acute hypoadrenlism
261
waterhouse-frederichsen syndrome is from
massive destruction of adrenals
262
waterhouse-frederichsen syndrome is secondary to
hemorrhage | infection
263
what is necessary with waterhouse-frederichsen syndrome
glucocorticoid therapy

Abdomen 2 (6 decks)

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