Module 5 : Infectious And Inflammatory Disease Flashcards
(307 cards)
1
Q
3 most common clinical presentations of an infection
A
- fever
- pain
- leukocytosis
2
Q
What is leukocytosis
A
- increase number of white blood cells
3
Q
What two things are important when patient presents with fever of unknown origin (FUO) and why
A
- history = immunocomprimised, chemo, chronic disease
- lab tests = can tell you what organs are being affected
4
Q
What should we look for with FUO in relation to organ size
A
- organomegally in acute stage
5
Q
What can infectious processed lead to
A
- abscess
6
Q
What is an abscess and what is it a complication of
A
- localized collection of pus
- complication to infection
7
Q
Which type of patients are more at risk for abscesses
A
- diabetics
- immunosuppressed patients
- cancer patients
- patients with hematoma
- post op
8
Q
What symptom do patients with abscesses present with
A
- localized tenderness
9
Q
Sonographic appearance of an abscess
A
- fluid filled area
- posterior enhancement
- thick irregular walls
- debris
- possible gas (with dirty shadowing)
10
Q
What is hepatitis and what is it caused by
A
- inflammation of the liver
- caused by viruses and toxins (cleaning supplies, Tylenol)
11
Q
What are 4 signs and symptoms of hepatitis
A
- fever
- chills
- nausea and vomitting
- possible jaundice
12
Q
How many types of viral hepatitis are there, and what are the 4 we talk about
A
- 6
- hep A, B, C, D
13
Q
What is the primary mode of spread for hep A
A
- fecal-oral route
14
Q
What is the primary mode of spread for hep B
A
- blood and body fluids
- carrier state
15
Q
What it’s he primary mode of spread for hep C
A
- transfusions
16
Q
What is the primary mode of spread for hep D
A
- dependant on hep B (have to be infected with hep B before hep D)
- IV drug users
17
Q
Three different clinical presentations of hepatitis
A
- acute
- subfulminant/fulminant
- chronic
18
Q
Clinical presentation of acute hepatitis
A
- clinical recovery within 4 months
- usually hep A
19
Q
Clinical presentation of subfulminant/fulminant hepatitis
A
- due to hep B or drug toxicity
- hepatic necrosis
+ death of patient occurs if > 40% of hepatic parenchyma lost
20
Q
Clinical presentation of chronic hepatitis
A
- biochemical markers remain abnormal for > 6 month
21
Q
Sonographic appearance of acute hepatitis
A
- hepatomegaly
- decreased liver echogenicity
- prominent portal vein walls (starry sky appearance)
- GB wall thickening
- MOST OFTEN LIVER IS NORMAL
22
Q
Sonographic appearance of chronic hepatitis
A
- coarse liver parenchyma (heterogenous)
- overall increase in echogenicity
- portal hypertension, cirrhosis (liver decreases in size)
+ splenomegaly
23
Q
Lab values affected with hepatitis
A
- ALT
- AST
- bilirubin
24
Q
4 routes of spread by progenitor bacteria to the liver
A
- biliary tract (cholecystitis)
- portal venous system (diverticulitis, appendicitis)
- hepatic artery (endocarditis from heart)
- trauma (blunt or penetrated)
25
What is pyogenic bacteria
- produces pus
26
Clinical presentation of bacterial infection
- fever
- RUQ pain
- malaise (general feeling of unwell ness)
- anorexia (loss of appetite results in weight loss and muscle deterioration)
27
Sonographic appearance of bacterial liver infection
- simple to complex cyst
- shaggy wall
- internal separations
- echogenic foci with posterior reverberation ( gas = dirty shadow)
28
Two types of fungal disease
- candida
| - pneumocystis
29
What is candida and who does it usually affect
- yeast infection
| - typically infects immunocompromised patients
30
Clinical presentation of candida
- persistent fever
| - WBC count returning to normal
31
Sonographic appearance of candida
- UNIFORMLY HYPOECHOIC (MOST COMMON)
- hyperechoic
- bulls eye appearance
- wheel within a wheel appearance
- liver kidney and spleen involvement
32
What is the bulls eye appearance
- focal areas of hypoechoic rim with hyperechoic center
33
What is the wheel within a wheel appearance
- hypoechoic rim with hyperechoic center, and hypoechoic nidus (dot) in very center
34
What is pneumocystis carinii and who does it commonly affect
- an opportunistic infection
| - affects immune compromised patients (aids)
35
What is an opportunistic infection
- wont effect people with normal immune system
| - goes after weak immune system people
36
What other structures are involved with pneumocystis carinii
- LIVER (most common)
- spleen
- renal cortex
- pancreas
- lymph nodes
37
Sonographic appearance of pneumocystis
- DIFFUSE, tiny non shadowing, echogenic foci
| - progresses to shadowing clumps of calcification
38
Three parasitic diseases
- amebiasis
- hydatid (echinococcal) disease
- schistosomiasis
39
What is the primary route of spread to the liver with amebiasis
- fecal-oral route
40
Route of travel to the liver with amebiasis
- travels from colon, through PORTAL VEINS, to teh liver
41
Which lobe of the liver is most commonly affected by amebiasis and why
- right lobe is more commonly affected
| - may be due to a gravity thing
42
Sonographic appearance of amebiasis
- round/oval in shape
- hypoechoic
- fine internal echoes
43
What is the most common clinical presentation of amebiasis
- PAIN
| - diarrhea
44
What is hydatid (echinococcal) disease
- parasitic infection (tapeworm)
45
What type of countries are hydatid disease more common in
- sheep and cattle raising countries
46
What structures can be affected of hydatid disease
- LIVER (MOST COMMON)
- spleen
- ureter
- bladder
- kidneys
47
What is the definitive host of a hydatid tape worm
- dogs
48
What is the definitive host
- the host in which the parasite reaches maturity
49
Who is the intermediate host of a hydatid tapeworm
- humans
50
What is the intermediate host
- a host in which the parasite undergoes development but does not reach maturity
51
How does the hydatid tapeworm spread to humans
- fecal-oral route
52
How does the parasite travel to the liver adn what lobe is most affected
- via the portal venous system
| - right lobe is more commonly affected
53
What are the three layers of the embryo cyst of the parasite
- ectocyst
- pericyst
- endocyst
54
What is the ectocyst
- external membrane (1mm)
55
What is the pericyst
- dense connective tissue capsule around the cyst
| - body tries to protect itself by walling off the cyst
56
What is the endocyst
- inner germinal layer
57
What is the order of the layers of the embryo parasitic cyst (outer to inner)
- pericyst
- ectocyst
- endocyst
58
What are the 4 sonographic appearances of the parasitic embryo
- hydatid sand (cyst full of low level echoes)
- simple cyst
- daughter cyst (multiple cysts within a cyst)
- calcified walls
59
5 signs and symptoms of hydatid disease
- dependant on stage
- pain/discomfort
- jaundice
- vascular thrombosis/ infarction (cysts compress veins of the liver)
- anaphylactic shock (from cyst rupture allergic reaction)
60
What is the treatment of hydatid parasitic disease
- surgery
| - only safe option so rupture does not occur
61
what type of infection is schistosomiasis
- parasitic infection
62
how do the worms travel to infected organs in schistosomiasis
- worms penetrate the skin and trace to the mesenteric veins via lymph and blood vessels
63
what organs do worms invade in schistosomiasis
- liver
- spleen
- bowel
- bladder
64
how can schistosomiasis lead to cirrhosis
- ova penetrate portal vein wall and connective tissue
- this leads to a granulomatous reaction (inflammatory response) and periportal fibrosis
- this leads to portal hypertension and cirrhosis
65
sonographic appearance of schistosomiasis
- thickening/increased echogenicity of the periportal wall
- initially liver is enlarged
- then liver shrinks due to hypertension
- splenomegaly
- thickened bladder wall (only if bladder affected)
66
what type of infection is tuberculosis (TB)
- opportunistic infection
67
where does TB start and what organs does it infect
- lungs
| - spleen, adrenal glands, urinary tract
68
sonographic appearance of spleen with TB
- tiny echogenic foci with or without shadowing
69
sonographic appearance of adrenal gland with TB
- acute = bilateral diffuse enlargement
| - chronic = atrophied and calcified (may not see adrenals themselves just calc)
70
what other disease of adrenal could result from TB
- Addisons disease
| - TB lead to adrenal atrophy and hypoadrenalism
71
what is peritonitis
- inflammation of the peritoneum
72
what are the types of the cases of peritonitis
- infectious
| - non infectious
73
what are the 4 infectious causes of peritonitis
- bacteria
- viruses
- fungi
- parasites
74
what are the 2 non infectious causes of peritonitis
- pancreatitis
| - foreign bodies (TALC)
75
what do patients with peritonitis present with
- severe pain
76
what group of people does tuberculosis peritonitis target
- immunocompromised
| + aids, cirrhosis, alcoholics
77
what is the sonographic appearance of tuberculosis peritonitis
- exudate fluid
| - lymphadenopathy
78
what are the 2 types of cholecystitis
- acute
| - chronic
79
what is the most common cause of acute cholecystitis
- impacted stone
+ interference in blood supply leads to an inflammatory reaction
+ predisposes the patient to infection
80
is acute cholecystitis more common in females or males
- females
81
what is the clinical presentation of acute cholecystitis
- RUQ pain, fever, leukocytosis
- nausea and vomiting
- jaundice
82
what are the 7 sonographic signs of acute cholecystitis
- GB wall > 3mm
- hyperaemia
- gallstones
- impaction at neck
- GB hydrops (dilated GB)
- pericholecystic fluid (fluid around GB)
- postive Murphys sign
83
what lab values will be affected with acute cholecystitis
- bilirubin
- ALP
- leukocytosis
- AST
- ALT
84
what are the 5 complications of acute cholecystitis
- empyema (pus in bile)
- gangrenous cholecystitis
- emphysematous cholecystitis
- perforation
- abscess
85
what is gangrenous cholecystitis and what is the patient presenting with
- necrosis of the gall bladder
| - no pain
86
ultrasound appearance of gangrenous cholecystitis
- no layering bands of echogenic tissue within the GB lumen
87
where does perforation occur in the gall bladder and why
- occur at fundus
| - most distal from where the blood supply is
88
ultrasound appearance of perforation
- free fluid in peritoneal cavity
- low level collection adjacent to the GB
- ill defined hypo echoic mass surrounding the GB
- may identify perforation
89
what is emphysematous cholecystitis caused by and is it common or rare
- caused by gas forming bodies
- progress rapidly
- diabetes
- rare
90
who is more effected by emphysematous cholecystitis men or women
- men
91
what is acalculous cholecystitis
- inflamed gallbladder without stoned
92
who is most commonly affected by acalculous cholecystitis
- critically ill patients
93
4 predisposing factors to aclaculous cholecystitis
- trauma
- previous unrelated surgery
- burn victims
- hyperalimentation (IV nutrition)
94
will patients with aclalculous cholecystitis experience pain usually
- won't have pain because ill patients in hospital hopped up on pain meds
95
ultrasound appearance of acalculous cholecystitis
- similar to acute cholecystitis nut without stoned
96
what is the most common form of symptomatic gallbladder disease
- chronic cholecystitis
97
what are the 4 clinical presentations of chronic cholecystitis
- intolerance to fatty foods
- belching/indigestion
- postprandial RUQ pain
- N&V
98
ultrasound appearance of chronic cholecystitis
- thick heterogeneous wall
- contracted GB wall with gallstones
- WES signs
99
what lab values will be effected with chronic cholecystitis
- ALT
- bilirubin
- AST
- ALP
100
3 complications from chronic cholecystitis
- bouveret syndrome
- gallstone illeus
- mirizzis syndrome
101
what is bouveret syndrome
- gastric outlet obstruction
| - gallstones lodge in duodenum and block stomach contents
102
what is gallstone ileus
- distal bowel obstruction
| - gallstones lodge at ileocecal valve
103
what is chronic cholecystitis associated with
- gallbladder carcinoma
104
what is mirizzi syndrome
- impacted stone in the cystic duct, GB neck, or Hartmanns pouch
- the CHD becomes compressed (extrinsic) by the stone or inflammatory reaction and results in jaundice
105
what abnormality will form between the cystic duct and CHD with mirizzi syndrome
- fistula
106
3 clinical symptoms of mirizzi syndrome
- fever
- pain
- jaundice
107
ultrasound appearance of mirizzi syndrome
- dilated bile ducts above the level of obstruction
| - CBD normal
108
what is xanthogranulomatous cholecystitis
- rare form of chronic inflammation
109
ultrasound appearance of xanthogranulomatous cholecystitis
- hypo echoic nodule/bands in a thick GB wall
| - represents fatty granulomatous nodules
110
in what age group and gender is porcelain gallbladder most common in
- older women
| - 6th decade of life
111
is porcelain gallbladder common or rare
- rare
112
what is the cause of porcelain gallbladder
- idiopathic
| - unknown
113
what disease has a high association with porcelain gallbladder
- GB carcinoma
114
what is associated with porcelain gallbladder
- stones
| - may be a form of chronic cholecystitis
115
ultrasound appearance of porcelain gallbladder
- calcified GB wall
116
is cholangitis common or rare
- rare
117
what is cholangitis
- inflammatory and fibrosing disorder of the biliary tree
118
what are the 5 types of cholangitis
- acute (bacterial)
- recurrent pyogenic
- AIDS
- biliary ascariasis
- primary sclerosing
119
what is acute (bacterial) cholangitis caused by
- due to biliary obstruction (choledochalithiasis)
120
what is the clinical presentation of acute cholangitis
- fever
- RUQ pain
- jaundice
121
sonographic findings of acute cholangitis
- dilated biliary tree with thickened walls
- stones in biliary tree
- liver abscess
122
what lab values are increased acute cholangitis
- WBC
- ALP
- bilirubin
123
in what countries is recurrent pyogenic cholangitis most common in
- SE
| - east Asia
124
what is the etiology of recurrent pyogenic cholangitis and what does chronic obstruction lead to
- unknown
| - chronic obstruction leads to stasis and stone formation
125
which lobe of the liver is most commonly affected with recurrent pyogenic cholangitis
- lateral left lobe
126
what are 2 possible long term complications to recurrent pyogenic choalngitis
- biliary cirrhosis
| - choleangiocarcinoma
127
ultrasound look of recurrent pyogenic cholangitis
- dilated ducts with stone and sludge in one segment of the liver
128
what is AIDS cholangitis due to
- opportunistic infection
| - advanced stages of AIDS
129
what is ultrasound look of AIDS cholangitis
- thickened bile duct and GB walls
- focal strictures
- intra and extra hepatic duct dilatation
- CBD dilated
130
what lab values will be elevated and normal with AIDS cholangitis
- ALP elevated
| - bilirubin normal
131
what is biliary ascariasis caused by
- roundworm infestation
132
what is ultrasound look of biliary ascariasis
- echogenic non shadowing parallel lines/tubes in the ducts and GB
- look for movement
133
how do the roundworms get to the bile ducts and gallbladder
- start in intestinal tract then move retrogradely through ampulla of vater into the GB and bile ducts
134
what is primary sclerosing cholangitis
- chronic inflammatory process
| - bile ducts fibrose and inflame
135
what is the cause of primary sclerosing cholangitis
- unknown
| - maybe autoimmune
136
what does primary sclerosing cholangitis can lead to what 3 things
- biliary cirrhosis
- portal hypertension
- hepatic failure
137
does primary sclerosing cholangitis affect women or men more
- men
138
do patients tend to have symptoms with primary sclerosis cholangitis
- no
| - until leads to other larger conditions
139
what other condition will 80% of patients with primary sclerosis cholangitis have
- ulcerative colitis
| + autoimmune disorder
140
what is pancreatitis
- inflammation of the pancreas
141
can pancreatitis be acute or chronic, mild moderate and severe, and focal or diffuse
- yes
142
how is acute pancreatitis diagnosed
- based on lab or clinical findings
143
what is the clinical presentation of acute pancreatitis
- severe, constant, intense pain radiating to the back
- relief by sitting up or bending at the waist
- N&V
- possible fever
144
what are the 3 roles of ultrasound with acute pancreatitis
- identify stones in GB or duct
- detect fluid collections
- monitor the inflammatory process
145
what are 2 possible etiologies for acute pancreatitis
- alcohol abuse (binge drinking benders)
| - biliary stones
146
sonographic appearance of diffuse acute pancreatitis
- normal
- decreased echogenicity
- heterogeneous
- edematous
- smooth contour
- increased size
- possible fluid collections
147
sonographic appearance of focal acute pancreatitis
- focal hypo echoic area
- panc head most common
- mimics a neoplasm
- alcohol abusers
148
what are 6 complications of acute pancreatitis
- fluid accumulations
- pseudocysts and phlegmons
- hemorrhage
- necrotizing pancreatitis
- peritonitis
- abscess formation
149
what is a pseudocyst
- walled off collection of inflammatory fluid and debris
150
what is a phlegmon
- inflammatory fat
151
what are 3 main characteristics of chronic pancreatitis
- progressive
- IRREVERSIBLE DAMAGE
- fibrous scarring
152
what is the predominant cause of chronic pancreatitis
- alcohol abuse
153
sonographic appearance of chronic pancreatitis
- heterogeneous
- dilated panc ducts
- calcifications
- irregular contour
- decreased size
154
what are the 2 hallmark appearance of chronic pancreatitis
- dilated panc duct
| - calcifications
155
2 complications of chronic pancreatitis
- pseudocysts
| - portosplenic thrombosis
156
what 2 lab values will be changed and how with acute pancreatitis
- increased amylase
| - increased lipase
157
what 2 lab values will be affected and how with chronic pancreatitis
- normal amylase
| - increased lipase
158
what are the 2 inflammatory bowel diseases
- crohns diease
| - ulcerative colitis
159
what are the 2 most common methods of assessment for inflammatory bowel disease
- barium studies
| - endoscopy
160
what is crohns disease
- chronic granulomatous inflammation
161
what portion of the bowel does crohns disease affect most commonly
- terminal ileum
| - colon
162
what layers of the bowel does Crohns disease affect
- all layers of the wall
163
what is the cause of crohns disease
- etiology unkown
164
sonographic appearance of crohns disease
- MARKEDLY THICKENED HYPOECHOIC WALL (concentric)
- narrowed lumen
- peristalsis of affected portion
- rigidity to pressure
- creeping fat (echogenic halo)
- hyperemia and mesenteric lymphadenopathy
165
4 complications of crohns disease
- abscess formation
- fistula formation
+ linear bands of variable echogenicity
- inflamed fat
+ poorly defined hypo echoic areas
- appendicitis
166
what is ulcerative colitis
- ulceration of colon and rectum
167
what layers of the wall are affected with ulcerative colitis
- mucosal and submucosal layers of colon
168
what other disease has an increase chance of occurring with ulcerative colitis
- colon cancer
169
clinical presentation of ulcerative colitis
- rectal bleeding
| - abscesses
170
ultrasound appearance of ulcerative colitis
- possibly normal or hypoechoic bowel
| - thickened wall
171
what is pseudomembranous colitis
- a necrotizing inflammation (infection with c difficile)
172
what causes pseudomembranous colitis
- patients become susceptible to infection when oral antibiotics wipe out the normal intestinal flora
173
what is the clinical presentation of pseudomembranous colitis
- diarrhea
| - fever and pain
174
what are the sonographic markers of pseudomembranous colitis
- rare
- massive edema
- thickened hypo echoic bowel wall
- prominent haustral markings
175
is pneumatosis intestinal common or rare
- rare
176
what is pneumatosis inestinalis associated with
- underlying condition s
+ COPD
+ traumatic endoscopy
177
are patents usually asymptomatic or symptomatic with pneumatosis intestinalis
- asymptomatic
178
sonographic appearance of pneumatosis intestinalis
- thick hypo echoic wall
- hyperechoic areas in the wall with ring down artifact
+ packets of gas
- look for air in portal venous system
179
what is the most common cause of acute abdominal pain
- acute appendicitis
180
which age group usually presents with acute appendicitis
- younger people
181
what gender has atypical presentation of acute appendicitis and why
- women
| - could be related to pelvic issue instead
182
what are 3 causes fo acute appendicitis
- obstruction of appendiceal lumen
- venous return is compromised
- leads to bacterial overgrowth leading to inflammation
183
signs and symptoms of acute appendicitis
- starts with crampy peri-umbilical pain
- nausea
- vomitting
- classic presentation
- peritoneal irritation
- guarding over mcburneys point
184
what is the classic presentation of acute presentation
- RLQ pain
- tenderness
- leukocytosis
185
how can we determine if a patient has peritoneal irritation
- rebound tenderness
186
what mcburneys point
- 2/3 from umbilicus 1/3 from iliac crest
187
when should ultrasound be used in acute appendicitis
- slim adult patient
- children
- symptoms less than 48 hours in duration
- differentiating between gynaecological symptoms
188
when should CT be used in acute appendicitis
- normal - obese adult patients
- chronic appendicits
- complication to appendicits
- equivocal ultrasound
189
what are the landmarks for the appendix
- ascending colon, cecum/cecal tip, terminal ileum
- iliopsoas
- external iliac vessels
190
sonographic appearance of acute appendicitis
- blind ended no peristalsis tube
- non compressible
- >6mm in AP diameter or single wall thickness of >3mm
- appendix with fecalith is positive
- hypervascularity
- prominent fat around cecum
- perforation - loculated fluid collection
191
three complications of acute appendicitis
- rupture
- abscess
- diffuse peritonitis
192
what is mesenteric adenitis
- symptoms mimic appendicitis
- RLQ lymphadenopathy without appendicitis
- seen as enlarged lymphnodes with a thick walled ileum
193
what is mucocele
- distension of appendix with mucous
194
is mucocele common and who does it affect the most
- rare
| - females
195
benign causes of mucocele
- fecaliths
- inflammatory scarring
- polyps
196
malignant causes of mucocele
- primary mucous cyst adenoma
| - primary mucous cystadenocarcinoma
197
are patients with mucocele usually symptomatic
- asymptomatic
198
sonographic presentation of mucocele
- large cystic/ hypo echoic mass in RLQ
- enhancement
- wall calcs
- rupture of malignant form can cause pseuomyxoma peritonei
199
what is a diverticula
- outpouching of bowel wall
200
what is diverticulosis
- multiple diverticula
201
what is diverticulitis
- can lead to inflammation
202
clinical presentation of bowel diverticular disease
- fiver
- leukocytosis
- pain
203
in what gender and culture is RLQ diverticulitis more common in
- women
- asian population
- young adults
204
is RLQ diverticulitis congenital or acquired and bilateral or solitary
- congenital
| - solitary
205
which portion of the GI tract does RLQ diverticulitis most commonly affect and what layers of the wall
- cecum and ascending colon
| - all layers of the gut wall
206
sonographic appearance of RLQ diverticulitis
- sac like structure protruding from wall
- hyperaemia
- fecalith
- inflamed fat
- focal wall thickening
207
what is the most common form of diverticulitis
- LLQ diveriticulitis
208
what increases incidence of LLQ diverticulitis
- increased with age
| - low bulk diet (low fibre)
209
what causes LLQ diverticulitis
- defect in muscular layer that causes the mucosal layer to protrude out
- multiple saccular outpouchings
- fecal material incites inflammation
210
which portion of the colon is affected by LLQ diverticulitis
- sigmoid
| - left colon
211
sonographic appearance of LLQ diverticulitis
- hypo echoic concentric thickening of bowel
- echogenic foci with posterior shadowing or ring down
- abscess
- mesenteric thickening
212
what is bladder diverticula and what are the two types
- out pouching of bladder wall (lateral)
| - congenital or acquired
213
what is congenital bladder diverticula
- all 3 layers of the wall involved
| - located near ureteral orifice
214
what is acquired bladder diverticula
- inner 2 layers of wall involved
| - high occurrence with neurogenic bladder (cannot empty bladder fully)
215
can bladder diverticula disappear
- yes post void
216
what can bladder diverticula lead to
- urinary stasis which can lead to infection or stone formation
217
what is mechanical bowel obstruction (MBP) and what can it be caused by
- physical obstruction
- GI mass
- impinging external mass
218
where would the bowel be dilated with mechanical bowel disease
- bowel loops dilated proximal to the site of the blockage
219
how will peristalsis change with time in mechanical bowel obstruction
- hyperparitstalis = earlier stages
| - no peristalsis = later stage
220
signs and symptoms of mechanical bowel obstruction
- abdominal pain and distension
| - committing and diarrhea
221
what is intussusception
- invagination (telescoping) of bowel segments
222
what is the most common cause of small bowel obstruction in children
- intussusception
223
signs and symptoms of intussusception
- pain
- vomitting
- currant jelly stools
224
ultrasound appearance of intussusception
- multiple concentric rings
+ donuts
- target appearance / pseudo kidney
225
what is volvulus
- close looped obstruction (kink in bowel)
- U or C shaped loop of bowel
- not an ultrasound diagnosis
226
what is paralytic ileus
- bowel obstruction related to lack of function
- paralyzed muscle wall
- +++ gas with no peristalsis
227
How does the infection travel in a urinary tract infection (UTI)
- infection travels from bladder to the kidneys
228
Which gender has a higher incidence of getting a UTI
Women
229
What type of patients have increased incidence of getting a UTI
- diabetics
| - immunocompromised
230
Signs and symptoms of UTI
- flank pain
- fever
- frequency (needing to go a lot)
- urgency (needing to go right away)
231
What will the lab test changes be with a UTI
- increase WBC
- pyuria
- bacteremia
- microscopic hematuria
232
What are the 2 types of pyelonephritis
- acute
| - chronic
233
What is acute pyelonephritis and what is it caused by
- inflamed renal tubules
| - caused by E. Coli
234
What patient group is usually affected by acute pyelonephritis
- young women
| - 15-35
235
Can acute pyelonephritis be focal or diffuse
- both
236
How is acute pyelonephritis usually diagnosed
- diagnosed clinically with lab work
237
When is imaging done with acute pyelonephritis
- symptoms or lab abnormalities persist
238
Ultrasound appearance of acute pyelonephritis
- normal
- loss of CM junction
- enlargements
- compression of sinus
- change in echotexture
- focal masses (abscess)
- gas
239
What is chronic pyelonephritis and what is it caused by
- interstitial (intercellular connective tissue) nephritis
| - caused by vesicoureteric refluxfrom congenital ureteric problems
240
When does chronic pyelonephritis start and who is most commonly affected
- starts at young age
| - women
241
Ultrasound appearance of chronic pyelonephritis
- cortical scarring
- asymmetric changes between right and left
- atrophy
- dilated, blunted calyces
242
What is a possible complication of pyelonephritis
- abscess
| - may decompress (rupture) in to the collection system or perinephric space
243
What is the usual initial screening test for abscesses when is ultrasound used
- CT
| - follow resolving abscess
244
Ultrasound appearance of abscess
- solitary
- round
- thick walled
- complex cyst
- gas bubbles
245
What is pyonephrosis
- pus in the collecting system
246
What is the cause of pyonephrosis in young adults
- UPJ obstruction/stones
247
What is the cause of pyonephrosis in elderly
- malignant obstruction
248
Ultrasound appearance of pyonephrosis
- hydronephrosis
- multiple low level echoes within hydro
- mobile debris
249
What are the 2 rare forms of pyelonephritis
- emphysematous
| - xanthogranulomatous
250
What is emphysematous pyelonephritis and who is most commonly effected adn what is the preferred method of evaluation
- gas forms in kidney parenchyma
- diabetic older women
- CT
251
Ultrasound appearance of emphysematous pyelonephritis
- linear echogenic areas with dirty shadowing
252
What is xanthogranulomatous pyelonephritis
- chronic pus formin g
- unilateral
- focal or diffuse
253
What kind of calculus is associated with xanthogranulomatous pyelonephritis
- staghorn calculi
254
Ultrasound appearance of xanthogranulomatous pyelonephritis
- destruction of parenchyma
- loss of CM junction
- dilated calyces
- inflammatory mass
+ cannot be distinguished betweenabscess
255
What si glomeruonephritis
- autoimmune reaction which causes inflammation at the level of the glomerulus
- presents as medical renal disease
256
What patients are usually affected by fungal infections of the urinary tract and what is it associated with
- diabetics
- immunocompromised
- indwelling catheters
257
What kind of fungal infection is most common in the urinary tract
Candida albicans
258
Ultrasound appearance of fungal infection of urinary tract
```
- hypoechoic parenchymal masses
+ abscesses
- fungal balls
+ echogenic, non shadowing, ,mobile mass
+ DDX blood clot, tumor, polyp
```
259
What are the two parasitic infections of the urinary tract
- schistosomiasis
| - hydatid disease
260
what is cystitis
- inflammation of the bladder
261
what causes infectious cystitis in women
- E coli
262
what causes infectious cystitis in men
- caused by prostatitis or bladder outlet obstruction
263
what does infectious cystitis result in and what can patients present with
- results in mucosa edema and decreased bladder capacity
| - present with hematuria
264
ultrasound appearance of infectious cystitis
- thick bladder
265
what is chronic cystitis and who does it most commonly affect
- chronic inflammation of bladder
| - more commonly affects middle aged women
266
signs and symptoms of chronic cystitis
- frequency
- urgency
- hematuria
267
ultrasound appearance of chronic cystitis
- thick walled bladder
| - possible TCC appearance
268
what is interstitial cystitis and what is the cause
- chronic bladder inflammation
| - unknown cause
269
what is interstitial cystitis associated with
- systemic disease
| + lupus
270
what is the sonographic appearance of interstitial cystitis
- mimic bladder cancer
271
what is neurogenic bladder
- loss of voluntary control of voiding
- have lots of urinary stasis
- have to self catheterize
272
ultrasound appearance of neurogenic bladder
- trebeculated bladder
- possible debris or stones in the bladder
- hydronephrosis
273
what is the etiology of retroperitoneal fibrosis
- unknown etiology
274
what is retroperitoneal fibrosis
- sheets of fibrosis tissue form in retroperitoneum
| - fibrous sheets drape over the great vessels and surround the ureters
275
what is the modality of choice for assessing retroperitoneal fibrosis
- CT
276
ultrasound appearance of retroperitoneal fibrosis
- hypo echoic homogeneous masses
| - envelope and obstruct retroperitoneal structures
277
what is benign prostatic hyperplasia (BPH)
- enlargement of the prostate in older men (over 50)
| - 40g / 40cc upper limit of normal
278
what zone of the prostate changes with BPH
- transition zone becomes enlarged and nodular
279
does the size of the prostate vary to the amount of symptoms
- not directly correlated to severity of the symptoms
280
signs and symptoms of BPH
- nocturia
- difficulty voiding
+ prostate compress urethra
281
ultrasound appearance of BPH
- hypo echoic enlargement of the inner gland
- calc
- degenerative cysts
- nodules
- heterogeneous
282
what is a TURP
- transurethral resection of the prostate
- endoscope is inserted into penile urethra and the prostate is resected
+ electrocautery and laser
- done to relieve symptoms
283
what is prostatitis
- inflammation of prostrate and seminal vesicles
284
what causes prostatitis and what are the two forms
- infectious organisms from lower urethra invade the ducts in the peripheral zone
- acute and chronic
285
signs and symptoms of prostatitis
- lower back pain
- dysuria
- perineal pressure
286
what lab value will be increased with prostatitis
- increased PSA
287
who is usually effected by acute prostatitis
- younger and have increased pain
288
ultrasound appearance of acute prostatitis
- hypo echoic areas
- hypervascularity
- possible abscess
289
what is chronic prostatitis caused by
- E coli
290
ultrasound appearance sonographic appearance
- focal masses of varying echogenicity
- calcification
- periurethral glad irregularity
- dilated SV
291
what is pleura
- serous membrane
| - enfolds in both lungs (visceral layer) and reflected upon walls of thorax and diaphragm (parietal)
292
what is a pleura effusion
- fluid in thoracic cavity between the visceral and parietal pleura
293
what are the 2 types of pleura effusion
- transudative
| - exudative
294
what is transudative fluid and what is it seen with
- anechoic fluid
| - CHF and cirrhosis
295
what is exudative fluid and what is it seen with
- echogenic fluid
- septations
- pleural thickening
- infection and neoplasm
296
what is the most common cause of ? LUQ mass
- splenomegaly
297
what are 3 symptoms of splenomegaly
- LUQ fullness
- pain
- palpable
298
what are 6 causes of splenomegaly
- infection
- inflammation
- hematologic disorders
- neoplasia
- connection
- infiltration
299
what 3 things can lead to mild to moderate splenomegaly
- portal hypertension
- infection
- AIDS
300
what are 2 causes of marked splenomegaly
- leukaemia
| - lymphoma
301
what is a complication of splenomegaly
- spontaneous rupture
302
is splenomegaly a true infectious or inflammatory response
- no but a part of the immense system and plays a role in immunity
303
what is acquired immune deficiency syndrome AIDS
- a syndrome of opportunistic infections
| - final stage of infection by HIV
304
what other things are associated with AIDS
- moderate splenomegaly
- candida infection
- pneumocystis carinii infection
- kaposis sarcoma
- lymphoma
- cholangitis
- acute typhlitits
- adrenal insufficiency
305
what is kaposis sarcoma on ultrasound
- difficult to identify sonographically
- hyperechoic liver nodules
- non specific solid mass in the adrenal gland
306
what is lymphoma on ultrasound
- hypo echoic liver nodules or adrenal gland or GI tract
307
what is acute typhlitis on ultrasound
- hypo echoic uniform thickening of the colon
| + cecum and ascending colon
