Module 4 : Metabolic Disease Flashcards
(184 cards)
1
Q
what is a metabolic disease
A
- an abnormality that occurs globally and affects severe organs
2
Q
what is hepatocellular disease and why does it occur
A
- dysfunction of hepatocytes
- normal liver tissue is replaced with fat or fibrosis
3
Q
is hepatocellular disease focal or diffuse
A
- usually diffuse process
4
Q
what lab tests will be abnormal with hepatocellular disease
A
- LFTs
5
Q
what physical aspect of the liver is usually affected by hepatocellular disease
A
- the liver size
6
Q
what are two types of hepatocellular disease
A
- fatty infiltration
- cirrhosis
7
Q
what is fatty infiltration
focal or diffuse?
A
- accumulation triglycerides (fat) in hepatocytes
+ precursor to significant chronic disease - not always uniform throughout the liver
diffuse or focal
8
Q
what is another name for fatty infiltration
A
- steatosis
9
Q
what is steatosis
A
- fat accumulation within hepatocytes
10
Q
is fatty infiltration developmental or acquired, reversible or permanent?
A
- aquired
- reversible
+ life style change required
11
Q
2 most common causes of fatty infiltration
A
- alcohol abuse
- obesity
12
Q
what 4 things do we look for when assessing for fatty infiltration
A
- echogenicity changes
- echo texture changes
- attenuation characteristics
- ability to visualize vessels (paucity)
13
Q
what 3 machine factors are important to consider when assessing fatty infiltration
A
- gains
- TGC
- focus
14
Q
sonographic appearance of mild (grade 1) fatty infiltration
A
- slight increase in liver echogenicity
- diaphragm and vessels clearly defined
15
Q
sonographic appearance of moderate (grade 2) fatty infiltration
A
- increase in liver echogenicity
- vessels and diaphragm not sharply
16
Q
sonographic appearance of severe(grade 3) fatty infiltration
A
- liver echogenicity is increased markedly
- extremely difficulty to define diaphragm and vessel walls
17
Q
what are the two types of focal fatty changes
A
- focal fatty infiltration
- focal fatty sparring
18
Q
what is focal fatty infiltration
A
- focal areas of increased echogenicity
+ fatty deposits - mostly normal liver parenchyma
19
Q
what is focal fatty sparring
A
- majority of liver parenchyma has experienced fatty infiltration
- focal hypo echoic areas (normal liver tissue)
20
Q
what are 4 similarities between fatty sparring and fatty infiltration
A
- both commonly involve the periportal area of the medial LL (segment 4)
- no mass effect
- rapid change with time
- map like boundaries (LINEAR vs round)
21
Q
what 3 lab values could be elevated with fatty infiltration
A
- ALT
- AST
- if related to alcohol abuse then GGT
22
Q
what is cirrhosis and what does it result in
A
- a diffuse process that destroys the liver cells
- resulting in fibrosis with nodule changes
23
Q
what are the underlying causes of cirrhosis
A
- alcohol abuse
- chronic viral hepatitis
- primary sclerosing cholangitis
24
Q
what is the most common underlying cause of cirrhosis
A
- alcohol abuse
25
what is the progressive change that occurs in liver cells with cirrhosis
- cell death>> fibrosis>> regeneration
26
is cirrhosis reversible
- no
27
what are the two types of nodular change
- micronodular
| - macro nodular
28
what causes micro nodular cirrhotic change
- alcohol consumption
29
what causes macro nodular cirrhotic change
- chronic viral hepatits
30
what is the sonographic appearance of acute cirrhosis
- same as severe fatty infiltration
- enlarged liver
- textural changes
31
what is the sonographic appearance of chronic cirrhosis
- small liver (CL/RL >0.65)
- course echo texture
- nodular surface
- paucity of vessels
32
what does paucity mean
- poor ability to see vessels
33
what does chronic cirrhosis eventually lead to
- portal hypertension >> end stage liver failure
34
what associated abnormality is commonly seen with cirrhosis
- ascites quite common
35
what do the lab value levels for cirrhosis depend on
- stage of disease
36
which 6 lab values will be increased with cirrhosis
- AST
- ALT
- LDH
- ALP
- bilirubin (conjugated)
- GGT
37
what lab value will be decreased with cirrhosis
- serum albumin
38
what other organ is affected by liver cirrhosis and why
- the spleen due to portal hypertension
39
what are the 3 classic clinical presentation of patients with cirrhosis
- hepatomegaly
- jaundice
- ascites
40
what are three less common clinical presentations of cirrhosis
- diarrhea
- feeling of fullness
- weight loss
41
what is glycogen storage disease and what causes it
- autosomal recessive disorder
| - excess glycogen deposits in the hepatocytes
42
what is another name for glycogen storage disease
- GSD
| - Von Gierkes disease
43
what 2 other abnormalities is GSD associated with
- benign adenomas and HCC
44
does GSD begin in adults ?
- no begins neonatally
45
how is GSD managed
- controlled and monitored diet
46
sonographic appearance of GSD
- diffuse fatty infiltration (cannot differentiate between causes)
- adenomas = solid masses with variable echogenicity
47
what is the only metabolic disease of the peritoneum
- ascites
48
what is ascites
- accumulation of serous fluid in the peritoneal cavity
49
what are the two types of fluid in ascites
- transudate
| - exudate
50
what is transudate fluid
- contains little protein or cells
| - suggests a non inflammatory response
51
two non inflammatory responses causing ascites
- cirrhosis
| - CHF
52
sonographic appearance of transudate ascites
- anechoic fluid
53
what is exudate fluid
- high protein content
- blood, pus, chylous
- suggests an inflammatory or malignant cause
54
what is chylous
- milky fluid with a high fat content
| - usually from lymphatic system
55
sonographic appearance of exudate ascites
- internal echoes
- echogenic
- locations
56
characteristics of free fluid in peritoneum
- changes with patient position
| - conforms to surrounding organs
57
characteristics of loculated fluid in peritoneum
- no change with movement
- rounded margins
- mass effect
- walled off
58
what are the three most dependant spaces in the peritoneal cavity
- Morrisons pouch (rt kidney and liver)
- pouch of Douglas (uterus and rectum)
- parabolic gutters
59
what is biliary sludge and what is it a precursor to
- a mixture of particulate matter and bile
| - precursor to biliary disease
60
2 other names for biliary sludge
- biliary sand
| - microlithiasis
61
symptoms of biliary sand
- asymptomatic
| - biliary colic and infmallation of GB and panc
62
can biliary sludge resolve on its own
- yes
63
what is the most likely cause of biliary sand
- bile stasis
64
what are 4 causes of bile stasis
- prolonged fasting
- rapid weight loss
- TPN (total parenteral nutrition IV food)
- extra hepatic biliary obstruction
65
what is the sonographic appearance of biliary sand
- no shadowing
- homogeneous low level echoes
- layers in the dependant portion of the gallbladder
+ fluid-fluid levels
- moves with change in patient position
66
what are tumefactive sludge/ sludge balls
- sludge that mimic polypoid tumors
| - to differentiate look at vascularity, mobility, and GB wall thickness
67
what is hepatization
- when sludge has sam echogenicity of liver
| - camouflages the GB
68
what is pseudo sludge
- imaging artifact
- caused by excessive gains, slice thickness or side lobe artifact
- idependent of gravity
69
what is empyema
- presence of pus in bile
70
what is hemobilia
- presence of blood in bile
| - usually due to liver biopsy and percutaneous biliary procedures
71
what is milk of calcium / limey bile
- rare
- separate category from biliary sludge
- GB becomes filled with semi solid substance (calcium carbonate)
72
sonographic appearance of milk of calcium / limey bile
- highly echogenic with posterior shadowing
- changes with patient position
- forms calcium/bile fluid level
73
what is cholelithiasis / gallstones
- most common disease of the gallbladder
74
what 3 factors affect gallstone formation
- abnormal bile composition
- stasis of bile
- infection
75
3 different compositions of stone
- cholesterol (most common)
- bilirubin (pigment stone)
- calcium
76
what are the 5 F risk factors with gallstone
- female
- forty
- fatty
- fertile
- family history
77
what is the clinical presentation of gallstones
- asymptomatic
- RUQ pain (after meals) radiates to back
- nausea and vomitting
- belching
78
sonographic appearance of gallstones
- echogenic focus
- posterior shadowing
- MOBILITY
- may float in the bile
79
what size should stones being to shadow in GB
- > 5mm
80
what is the WES sonographic sign
- Wall > Echo > Shadow
| - seen when gallbladder is filled with multiple stones or one large stone
81
what lab values will be altered with GB stones
- AST
- ALT
- ALP
- BILIRUBIN
82
what 3 things in the gallbladder also cause shadowing
- valves of heister
- fat of portahepatis
- duodenal gas
83
5 complications of gall stones
- biliary colic (MOST COMMON)
- obstruction of cystic duct or CBD
+ leads to GB hydrops
- bacterial infection
- cholecystitis
- ascending cholangitis
84
what 3 questions should an US investigation of biliary obstruction try to answer
- are the bile ducts or GB dilated
- if yes, to what extent
- if no , what is the cause
85
what are the 3 causes of biliary dilation
- obstruction (MOST COMMON)
+ stone, tumor
- loss of duct wall elasticity
- ampulla of vater dysfunction
86
is biliary dilation intra or extrahepatic
both
87
2 clinical presentation of biliary obstruction
- painless jaundice
| - painful jaundice
88
what is painless jaundice indicative of
- neoplastic conditions (panc head)
| - choledochal cysts
89
what is painful jaundice idicitve of
- acute obstruction
| - infection of biliary tree
90
4 signs and symptoms of biliary obstruction
- jaundice
- clay coloured stools
- abnormal LFTs
- pain, nausea
91
what is choledochallithiasis (intra or extra hepatic)
- stones in biliary tree
92
what is the secondary causes to biliary stones
- stones pass from gallbladder to ducts
| + MOST COMMON
93
what are the 4 primary causes to biliary stones
- inflammation
- infection
- carolis disease
- prior surgery
94
what is the most common location for stones in biliary tree
- distal CBD at ampulla of vater
+ difficult to visualize due to bowel gas
+ look for hyperchoic foci with shadowing
+ false positives = air, surgical clips, edge artifact
95
what lab values will be abnormal with biliary obstruction
- ALP
- AST
- ALT
- bilirubin
96
what is treatment of biliary obstruction
- ERCP spincterotomy
- ERCP extraction
- stenting
97
what is ERCP
- endoscopic retrograde cholangiopacreatography
| + put endoscopic through esophagus into duodenum to open up ampulla of vater
98
definition of urolithiasis
- stones in urinary system
99
definition of nephrolithiasis
- stones in the renal collection system
100
defintion of nephrocalcinosis
- calcifications in the renal parenchyma
101
is nephrolithiasis common or uncommon
- very common
| - caucasian males
102
does it increase or decrease with age
- increase with age
103
what are 4 underlying risk factors for getting nephrolithiasis
- hereditary
- limited water intake
- high animal protein diet
- urinary stasis
104
can stones move through the collecting system
- yes
| - can lodge in the natural narrowing of the ureter
105
what are the three natural narrowings of the ureter
- just past UPJ (ureteropelvic junction)
- at the iliac vessels
- at the UVJ (most common) (ureterovesicular junction)
106
what must the size of stone be in order to be able to pass
< 5mm
107
clinical presentation of nephrolithiasis
- asymptomatic
- hematuria (microscopic or gross)
- flank pain
108
what is the sonographic appearance of kidney stones
- echogenic focus
- posterior shadowing
- twinkle artifact
109
what 5 things should you asses for the rad
- number
- size
- location
- complications
110
what is stag horn calculi
- calcification filling the collecting system
| + an entire major or minor calyc
111
what are 5 things that can cause false positives
- intrarenal gas
- renal artery calcification
- calcified sloughed papilla
- calcified tumors
- ureteric jet
112
what are 3 other imaging modalities that can detect urolithiasis
- x ray
- tomography
- CT
113
characteristics of stones in ureter
- location creates imaging problems
- stones lode at narrowest point
- look for dilated tubes
- identify echogenic foci with shadowing at distal end
114
characteristics of bladder calculi
- usually single
- asymptomatic
- may migrate from kidney or be result of urinary stasis (neurogenic bladder or BPH)
- patient may present with hematuria and pain
- check for mobility to dependant portion of bladder
115
what is hydronephrosis
- dilated renal vessels
- due to obstructive or non obstructive causes
- may lead to renal atrophy
116
obstructive causes of hydronephrosis
- intrinsic (stone/mass) or extrinsic (mass/aneurysm) obstruction to flow
* can be diagnosed on ultrasound
117
non obstructive causes of hydronephrosis
- reflux
- infection
- polyuria (to much urine production=diabtetes mellitus)
118
three classifications of hydronephrosis
- grade 1 = mild
- grade 2 = moderate
- grade 3 = severe
119
grade 1 / mild hydro
- slight separation of renal collecting system
| + 2mm seperation
120
grade 2 / moderate hydro
- anechoic separation of entire central renal sinus
- pelvis and calyces are dilated
- clubbed calyces
121
grade 3 / severe hydro
- thinning renal cortex
- extensive enlargement of renal sinus and calyces
- loss of individual calyx definition
122
what should we do when we see hydronephrosis
- look for cause of hydro
123
what 4 things could cause false positives for hydro
- over distended bladder
- extra renal pelvis
- multiple paraplevic cysts
- AV malformation
124
what assessment should you always do when you see hydro
- POST VOID
125
what is another name for renal parenchymal calcium deposits
- nephrocalcinosis
126
can renal parenchymal calcium deposits be bilateral or unilateral, cortical or medullary
- yes they can be both
127
what are 3 things renal parenchymal calcium deposits caused by
- ischemia
- necrosis
- hypercalcemic states
128
what other disease is hard to differentiate between renal parenchymal calcium deposits
- medullary sponge kidneys
129
sonographic appearance of renal parenchymal calcium deposits
- increased cortical echogenicity
- echogenic pyramids or wall of pyramids
- possible shadowing
130
characteristics of Anderson-Carr kidney
- theory of stone progression
- high concentration of calcium in fluid (early development of stone)
- results in deposits of calcium in margins of the medulla
131
sonographic appearance of Anderson-Carr kidney
- non shadowing echogenic rims of renal pyramids
132
what is medical renal disease
- disease affecting renal parenchyma diffusely and bilaterally (always both)
+ cortex
+ medulla
- broad term used to describe renal disorders
- describes poorly functioning but unobstructed kidneys
- can lead to renal failure
133
what is needed to identify cause of medical renal disease
- renal biopsy
134
what is the treatment of medical renal disease
- initially treatable by medication rather than surgery
135
5 areas to evaluate sonographically with medical renal disease
- renal size and contour
- cortical echogenicity
- CM junction distinction
- renal pyramids
- renal sinus
136
what lab value will be increased with medical renal disease and why
- creatinine
- sent for US as initial screening
- purpose of US is to check for a mechanical obstruction.. if there is no obstruction this indicates a renal parenchymal abnormality
137
sonographic appearance of medical renal disease
- depending on underlying cause
| - acute and chronic
138
acute medical renal disease sonographic appearance
- diffuse increase in cortical echogenicity
- prominent CM junction
+ exception = if the pyramids are affected then CM junction will not be defined
- enlarged kidneys
- KIDNEYS MAY APPEAR NORMAL
139
chronic stage medical renal disease sonographic appearance
- small
| - echogenic
140
5 causes of medical renal disease
- acute tubular necrosis
- acute cortical necrosis
- acute glomerulonephritis
- amyloidosis
- diabetes mellitus
141
what is the most common cause of acute reversible renal failure
- acute tubular necrosis
142
what is acute tubular necrosis
- deposits of debris in the renal collecting tubules
- can have hematuria
- can be result of toxic or ischemic insults
+ chemotherapy, antibiotics, antifreeze
143
ultrasound appearance of acute tubular necrosis
- kidneys most often appear normal but may be bilaterally enlarged
- echogenic pyramids
- RI > 0.75 (abnormal resistance to flow)
144
what is acute cortical necrosis
- rare cause of acute renal failure
- ischemic encores of the cortex with sparing of the pyramids
- due to sepsis, burns, severe dehydration PIH (pregnancy induced hypertension)
145
ultrasound appearance of acute cortical necrosis
- initially normal size, hypo echoic cortex and loss of CM junction
- over time kidneys atrophy and cortex calcifies
146
what is acute glomerulnephritis
- autoimmune reaction
- patient presentation
+ hematuria, hypertension, azotemia
147
ultrasound appearance of acute glomerulonephritis in early stage
- may be normal or enlarged
- cortex may be normal , echogenic, or hypo echoic
- EXTREMELY VARIABLE
148
ultrasound appearance of acute glomerulonephritis in lateraled stage
- small
| - echogenic kidneys
149
what is amyloidosis
- systemic metabolic disorder resulting in amyloid (protein) deposits in the kidney
- patient presents with proteinuria
150
ultrasound appearance of amyloidosis
- variable appearance
| + large, normal, or small kidney size = hypo or hyper
151
diabetes mellitus
- MOST COMMON CAUSE OF CHRONIC RENAL FAILURE
- initially kidneys will be enlarged
- end stage = small echogenic, loss of CMJ
152
what is renal failure
- inability of kidneys to remove metabolites from blood
153
what does renal failure result
- azotemia (uremia)
154
what is azotemia
- overload of urea and nitrogenous wastes in the blood
155
three different causes of renal failure
- pre renal
- renal
- post renal
156
pre renal causes of renal failure
- sepsis
| - renal artery stenosis
157
renal cause of renal failure
- parenchymal disease
158
post renal cause of renal failure
- obstruction of collecting system
+ complete obstruction = irreversible damage in 3 weeks
+ incomplete obstruction = irreversible damage in 3 months
159
acute stage of renal failure
- reversible
| - medical renal disease (renal parenchymal disease)
160
sonographic appearance of acute stage renal failure
- most often normal
- may be enlarged or hypo echoic
- check for hydronephrosis, obstruction
- check echogenicity of parenchyma (usually increased)
161
chronic stage of renal failure
- irreversible
| - most common cause is diabetes mellitus
162
sonographic appearance of renal failure
- small kidney
| - echoegenic cortex
163
what lab values increased
- serum creatinine (most common and most important)
- BUN
- Uric acid
- RBC/WBC in urine
- protein uria
164
treatment for renal failure
- dialysis or renal transplant
165
what is dialysis
- removes waste from blood
| - "artificial kidney"
166
what is a renal transplant
- usually on R sides of pelvis and document nature kidney too
167
3 causes of hyperadrenalism
- cushings syndrome
- conns disease
- MEN (multiple endocrine neoplasia)
168
what is cuchsings syndrome a result of
- excess secretion of cortisol
169
what are 4 causes of bushings syndrome
- adrenal hyperplasia
- adrenal adenoma
- adrenal carcinoma
- exogenous corticosteroid administration
170
clinical presentation - of cushings syndrome
- moon face
- buffalo hump (upper neck/lower back)
- truncal obesity (eggs on legs)
- hirsutism
- amenorrhea
- hypertension
171
what is the different between cushings syndrome and cuttings disease
- syndrome = due to adrenal abnormality
| - disease = due to pituitary adenoma producing too much cortisol
172
what causes conns disease
- excess aldosterone secretion
173
what 3 things causes an excess of aldosterone
- ADENOMA (aldosteronoma)
- hyperplasia
- carcinoma (uncommon)
174
clinical presentation of Conns disease
- hypernatremia = increased sodium in blood
- hypokalemia = decreased potassium
- hypertension
- muscle cramps
- altered renal function
175
sonographic appearance of Conns disease
- small
- solid
- round mass
- hypo echoic
176
MEN (multiple endocrine neoplasia)
- 3 types
- tumors develop in several endocrine glands
+ adrenal
+ panc
+ pituitary
+ parathyroid gland
- excessive hormones produced
- benign or malignant
177
MEN type 2
- autosomal dominant
- pheochromocytomas in adrenal (usally benign but with MEN its malignant)
- typically bilateral
- malignant
178
what is hypoadrenalism
- due to primary disorders of the adrenal cortex or disorders of the hypothalamus or pituitary
- may cause adrenal atrophy
179
two types of hypoadrenalism
- Addisons disease
| - Waterhouse-friderichsen syndrome
180
2 types of Addisons disease
- autoimmune (80%)
| - TB (20%)
181
what is Addisons disease
- chronic
| - primary hypoadrenalism
182
autoimmune Addisons disease
- females
| - not typically identified on ultrasound
183
TB Addisons disease
- males
- enlarged, firm, nodular adrenals
- hyperpigmentation
- low blood pressure, muscle weakness, fatigue
- 90% of gland is nonfunctioning
184
what is Waterhouse-friderichsen syndrome
- acute hypoadrenalism
- secondary to hemorrhage, infection
- massive destruction of adrenals
- glucocorticoid therapy necessary
