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Abd / SS 2 > Module 1 : Cystic Diseases > Flashcards

Module 1 : Cystic Diseases Flashcards

1
Q

definition of a cyst

A

a walled off collection of fluid

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2
Q

the two types of cysts

A

true cysts vs acquired cysts

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3
Q

characteristics of true cysts

A
  • epithelial wall
  • congenital
    + hereditary or developmental
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4
Q

characteristics of acquired cysts

A
  • no epithelial wall
  • post traumatic
  • infections
  • parasitic
  • inflammatory (abscesses)
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5
Q

can we tell the difference between true and acquired cysts

A
  • NO
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6
Q

common features of true cysts

A
  • multiple cysts in one organ

- multiple organs with cysts

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7
Q

common features of acquired cysts

A
  • history = injury or infection
  • signs
  • symptoms = fever or increased WBC’s
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8
Q

what is the most important thing to determine when scanning cysts and why

A
  • simple or complex
    + helps direct course of treatment
    + simple cyst does not need follow up
    + complex requires further testing or follow up to rule out malignant
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9
Q

the 4 sonographic criteria for a simple cyst

A
  • anechoic
  • strong back wall
  • POSTERIOR ACOUSTIC ENHANCEMENT
  • oval or round = edge shadow
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10
Q

4 characteristics of a complex cyst

A 
- internal echoes
  \+ hemorrhage or infection 
- septations 
   \+ malignancy or hemorrhage or infection or adjacent cysts
- calcifications 
  \+ malignancy or inflammatory or milk of calcium 
- thick wall or mural nodularity 
   \+ malignancy or benign thickening
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11
Q

does age increase or decrease number of cyst

A

increase especially liver and kidney

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12
Q

a genetic abnormality can be indicated by what

A

finding multiple cyst

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13
Q

6 possible effects of cyst on patient (dependant on number size and location)

A
  • asymptomatic
  • pain
  • pressure
  • increased lab values
  • jaundice (pressure on biliary tree)
  • fever
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14
Q

renal cortical cysts are found where

A
  • only in the cortex
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15
Q

renal cortical cysts - simple characteristics

A
  • benign
  • unknown etiology (idiopathic)
  • increase with age (50% of people over 50)
  • mostly asymptomatic
  • no follow up required
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16
Q

renal cortical cysts - complex characteristics

A
  • does not meet the criteria of a simple cyst
  • require further imaging
  • if septations are irregular, >1mm in thickness or solid elements present LESIONS ARE PRESUMED MALIGNANT UNTIL PROVEN OTHERWISE
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17
Q

what are the 2 types of polycystic kidney disease

A
  • autosomal dominant

- autosomal recessive

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18
Q

autosomal dominant polycystic kidney disease (ADPKD)-manifests when?

A
  • in the fourth decade of life (40’s)

- IT IS THE MOST COMMON HEREDITARY RENAL DISORDER

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19
Q

associated anomalies with ADPKD

A
  • liver, pancreas, and splenic cysts

- cerebral berry aneurysms

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20
Q

is ADPKD unilateral or bilateral d

A

BILATERAL ALWAYS

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21
Q

which lab tests will be elevated with ADPKD

A

creatinine and BUN

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22
Q

ADPKD - physical presentation

A
  • palpable mass
  • pain
  • hematuria
  • hypertension (kidney release substance to control blood pressure)
  • UTI’s
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23
Q

ADPKD - sonographic appearance

A
  • renal ENLARGMENT

- multiple cysts bilateral

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24
Q

how does the presentation of ADPKD differ from cortical cysts

A
  • there are multiple cyst but in renal cortical cysts = only in cortex
  • ADPKD = cysts everywhere
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25
Q

autosomal recessive polycystic kidney disorder (ARPKD) - 4 types that are age dependent

A
  • perinatal = in the womb
  • neonatal = new born
  • infantile
  • juvenile
  • ALL CASES MANIFEST IN PEDIATRIC PATIENTS
26
Q

ARPKD - in younger children which organ is most effected

A
  • renal abnormalities more prominent
27
Q

ARPKD - in older children which organ is most effected

A
  • liver abnormalities are more prominent (portal hypertension)
28
Q

ARPKD - associated to what other life threatening disorder

A
  • all cases are associated with congenital hepatic fibrosis

- this will lead to liver failure and transplant will be needed

29
Q

ARPD - sonographic appearance

A
  • massively ENLARGED
  • ECHOGENIC
  • loss of CM differentiation
  • macroscopic cysts noted occasionally but usually to small for us to see
30
Q

parapelvic cysts - characteristics

A
  • lymphatic in origin
  • located in the renal sinus
  • mostly asymptomatic
31
Q

paraplevic cysts - sonographic appearance

A
  • well defined cysts
  • do not collect with collecting system
  • IVP or contrast CT can be used to differentiate between multiple paraplegic cysts and hydronephrosis
32
Q

medullary sponge kidneys - characteristics

A
  • dilated (ectatic) collecting tubules
  • unknown cause
  • 3rd and 4th decade
33
Q

medullary sponge kidneys - sonographic appearance

A
  • bilaterally echogenic pyramids
  • calcifications may be present
    + localized to medullary pyramids
34
Q

medullary cystic disease - characteristics

A
  • result of progressive renal tubular atrophy
  • genetic
    + recessive and dominant forms
35
Q

medullary cystic disease - sonographic appearance

A
  • small echogenic

- cysts at pyramids

36
Q

multi-cystic dysplastic kidney (MCDK) - characteristics

A
  • developmental
    + NOT genetic, obstruction of ureter in utero
  • non hereditary
  • males and females, left and right equally effected
  • MOST COMMON RENAL CYSTIC DISEASE IN CHILDREN
37
Q

MCDK - sonographic appearance

A
  • small, malformed kidney
  • multiple non communicating cysts
  • absence of normal renal architecture
  • UNILATERAL
    + IF BILATERAL = INCOMPATIBLE WITH LIFE - only seen prenataly need one kidney to survive
38
Q

primary congenital cysts - characteristic

A
  • also called EPIDERMOID CYSTS
  • usually of spleen
  • rare
  • asymptomatic
  • solitary
39
Q

primary congenital cysts - sonographic appearance

A
  • echogenic cystic structure

- internal echos

40
Q

choledochal cysts - characteristics

A
  • eastern asian pop
  • females more
  • fusiform dilation of CBD (EXTRAHEPATIC)
  • cause by anomalous (unknown) insertion of CBD into panc duct
  • known association with cholangiocarcinoma (bile duct cancer)
41
Q

fusiform

A
  • dilated in the middle but tapers at each end
42
Q

choledochal cyst - sonographic appearance

A
  • cystic structure
  • may contain sludge, stones or solid neoplasm
  • if cyst large may be difficult to identify connection to CBD
43
Q

what is the most common type of choledocal cyst

A
  • type 1 = fusiform
44
Q

caroli’s disease - characteristics

A
  • rare
  • congenital
  • DILATION OF INTRAHEPATIC BILIARY TREE
  • results in stasis , stones, cholangitis, and sepsis
  • has an association with ARPKD and medullary sponge kidneys
45
Q

caroli’s disease - sonographic appearance

A
  • saccular (out pouching) (MOST COMMON) or fusiform dilation of INTRAHEPATIC DUCTS
  • often diffuse but can be focal
  • dilated ducts may contain stones and sludge
46
Q

cystic fibrosis - characteristics

A
  • genetic

- exocrine dysfunction

47
Q

cystic fibrosis - sonographic appearance

A
  • increased echogenicty of panc
  • atrophy
  • small cyst on pathology report, uncommonly seen
48
Q

peritoneal inclusion cysts

A
  • adhesion trapped ovation fluid
  • ovary encased within lesion fluid leaks out
  • simple to complex
  • trapped by lesions caused by inflammatory disease
49
Q

mesenteric cysts

A
  • rare
  • incidental finding
  • lymphatic or mesothelial in origin
  • variable appearance and size
50
Q

GI duplication cysts

A
  • filled with anechoic fluid
  • well defined double layer wall
    + inner layer = mucosal layer more echogenic
    + outer layer = muscular layer more hypo echoic
51
Q

degenerative prostatic cysts

A
  • most common
  • located in transitional zone (BPH effects here)
  • no clinical significance
52
Q

congenital prostatic cysts

A
  • asymptomatic
  • associated with infertility, hematospermia
  • effect SV and prostate
53
Q

utricle cysts

A
  • unilateral renal agenisis
  • midline tear drop shape
  • usually small but become large
54
Q

mullerian duct cysts

A
  • no spermatozoa
  • tear drop shape
  • lateral to midline
55
Q

ejaculatory duct cysts

A
  • fusiform shape
  • contain spermatozoa
  • associated with infertility
56
Q

seminal vesicle cysts

A
  • ipsilateral renal agenesis with increased size of cysts
57
Q

liver function tests should be abnormal with which types of cysts

A
  • ARPKD, caroli’s, choledocal
58
Q

WBC abnormal in which situations

A
  • infection
59
Q

creatinine or BUN abnormal with which cysts

A

PKD

60
Q

treatments of cystic disease

A
  • cyst aspiration or alcohol ablation
  • surgical removal
  • organ transplant

Abd / SS 2 (7 decks)

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