abd

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rbeacr
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122338
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abd
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2011-12-10 12:17:52
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14 urinary system
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The urinary system
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  1. urinary system functions
    • secrete waste
    • regulate composition of blood
  2. kidney measurement
    • 9-12 x 4-5 x 2.5-3
    • should be win 1 cm each other
  3. arcuate arteries
    at base of pyramids and separate medulla from cortex
  4. nephrons
    functional unit of kidney
  5. renal hilum
    • where vessles
    • lymphatics
    • and ureter enter and exit
  6. renal vasculature
    • artery most posterior and superior
    • 2 branches of renal vein are anterior
    • ureter inferior to artery
  7. kidney layers
    • 1. perinephric fascia or Gerotas fascia surrounds perinephric fat and encloses adrenal glands
    • 2. perinephric fat sourounds capsule
    • 3. fibrous "true" capsule surrounds kidney
  8. nephron
    • renal corpuscle (glomerulus) and renal tubule
    • filter blood to produce urine
  9. ureter
    • 25 cm tube runs behind peritoneum along psoas enters the lateral angle of bladder
    • not usually seen unless dialated
  10. urinary bladder
    • large muscular bag
    • posterior lateral openings for ureters
    • anterior opening for urethra
    • wall 3-6mm
  11. ureter arterial supply
    renal artery, testicular or ovarian artery, and superior vesical artery
  12. formationof urine
    • glomerular filtration
    • tubular reabsorption
    • tubular secretion
  13. excretion carried out by
    • skin
    • lungs
    • liver
    • large intestine
    • kindeys
  14. metabolic waste products
    • water
    • carbon dioxide
    • nitrogenous waste (urea, uric acid, creatinine)
  15. labs
    • urinalysis- hematuria or pyuria
    • urine ph- renal calculi formation
    • specific gravity- concentration of urine
    • blood- trauma, arf, calculi, neoplasm
    • hematocrit- plasma to cell volume
    • hemoglobin- damage destruction
    • protien-glomerular damage
    • creatine clearance
    • BUN blood urea nitrogen
    • serum creatine- dysfunction
  16. related tests
    • ivp
    • ncct
    • mri- mru
    • vcug
    • renal scan
  17. Types of changes
    • I- echo intensity of cortex equal or greater than liver/spleen
    • and echo intensity on cortex equal to renal sinus

    II- focal disruption of normal anatomy with mass, cyst, tumor, abcess, hematoma
  18. interlobar arteries
    alongside renal pyramids
  19. arcuate vessles
    along base of pyramid
  20. dromedary hump
    cortical bulge usually on lt kidney
  21. junctonal parenchymal defect
    • triangular echogenic area anterior and superior
    • seen best in sag
  22. fetal lobulation
    surface indented btwn calyces
  23. sinus lipomatosis
    • deposition of fat in sinus with parenchymal atrophy
    • fibrous tissue may cause enlargement of sinus with increased echogenicity
  24. extrarenal pelvis
    • central cystic area outside kidney best seen in transverse
    • usually decompress in prone
    • male
  25. bifid
    kidney split into two- normal variant
  26. renal agenesis
    • absense of kidney or failure to form
    • bilateral- (incompatable with life) or unilaters
    • associated with seminal vesicle cyst, vaginal agenesis, bicorn uterus
    • enlargement compensatory of other kidney
  27. renal hypoplasia
    incomplete development of kidney- functins normally
  28. incomplete duplication
    • most frequent congenital anomonly of neonate
    • two collection systems and 2 ureters that join together and enter as 1 in bladder
  29. complete duplication
    double collecting system (bifid kidney)
    • rare
    • two separate collecting systems and two ureters that enter the bladder
    • upper pole ureter more medial than lower
    • demonstrate two ureteral jets in bladder on same side
  30. renal ectopia
    • ectopic kidney
    • kidney not in normal location
    • fails to ascend from true pelvis (sacral kidney)
    • or superior ascending kidney in thorax
  31. crossed renal ectopia
    • fused and nonfused
    • malrotation
    • fused is 8xs more common and on rt. side
    • renal calculi common complication
    • both kidneys on the same side
  32. horse shoe kidney
    • most common renal anomoly
    • fused lower poles
    • malrotation
    • stone formation
    • hydro
    • infection

    isthmus may look like lymphnode or mass anterior to spine
  33. stricture
    • ureteral narrowing due to fibrosis
    • inflammatory disease
    • radiation therapy
    • compression
  34. ureterocele
    • cyst like enlargement of lower end ureter by congenital or acquired stenosis at distal end
    • can cause obstruction and infection
  35. ectopic ureterocele
    • rare
    • female young children
    • assoc w/ complete ureteral dupication
    • ectopic ureter stenotic- obstruction- hydro
  36. bladder
    • cystoscopy better visualization
    • wall- smooth 3-6mm
    • symmetrical

    residual volume less than 20ml normal
  37. simple renal cyst
    • most common renal mass is simple cortical renal cyst
    • aquired
    • 50% older than 50 yrs
    • hematuria- hemorhhage
  38. complex renal cysts
    • consider malignant until proven otherwise
    • septations, thick walls (>1mm), calcification, echos, vascularity
    • kissing cyst may not be a sepatiaon
  39. renal sinus parapelvic cysts
    • originates from sinus and usually lymphatic in origin
    • dont communicate with collecting system

    may cause obstruction
  40. von hippel-lindau
    • genetic disorder
    • variety of abdominal cyst/tumors including renal and panc.cysts/adenomas/adenocarcinoma
  41. tuberous sclerosis
    • genetic disorder
    • mental retardation, seizures
    • renal lesions/cysts/ angiomyolipomas
    • looks like adult ploy cystic kidney
  42. Acquied cystsic kidney disease (ACKD)
    • native pts with renal failure (after 3yrs dialysis)
    • increased cysts, adenomas, carcinoma (tubular obstruction)
    • small echogenic native kidneys with small cysts
  43. Polycystic kidney disease
    • two forms
    • autosomal recessive pkd
    • autosomal dominant pkd
  44. ARPKD
    • autosomal recessive pkd
    • aka Infantile - lungs never mature
    • rare genetic
    • bilaterally
    • dilation of collecting tubules cause renal failure
    • enlarged echogenic kidneys- cant see cysts
    • can be seen inutero
    • associated with hepatic fibrosis- splenomegaly
    • carolis disease (intrahepatic ductal diliation)
  45. ADPKD
    • adults 40-50s
    • genetic disorder
    • bilaterally
    • enlarged kidneys with cysts
    • stone formation, hemorhhage, obstruction
    • cysts may also be on liver, spleen, panc, testes
  46. multicystic dysplastic kidney MCDK
    • dysplatic-means abd development
    • non hereditary
    • unilaterally- (bilateral incompatable with life)
    • most common cystis disease in neonates due to early in utero obstruction
    • atreatic artery, no parenchma or sinus
    • nonfunctioning kidney
    • lungs dont mature if bilateral
  47. meduallary sponge kidney (MSK)
    • developmemt anomoly in pyramids
    • cystic or fusiform diliation of distal collecting ducts- stasis of urine and stone formation
    • assosc with carolis disease (hepatic fibrosis)
    • beckwith-wiefmann (large tounge)
    • echogenic parenchyma
  48. medullary cystic disease (MCKD) and nephronophthisis (NPH)
    • inherited- lead to end stage renal disease
    • cysts in renal medulla
    • fibrosis- scarring of kidney
    • fluid filled cavities
    • excesive unconcentrated urine
    • small echogenic kidney
    • small medullary cysts <2cm
  49. renal cell carcinoma
    • hypernephroma or grawitz tumor
    • Most common renal neoplasm (85% tumors)
    • males
    • 60-70s
    • vonhippel-lindau
    • dialysis patients (acquired cystic disease)
    • Solid mass- vascular
  50. Transitional cell carcinoma
    • 90 % of malignancies that include pelvis, ureter, bladder
    • male- 70s
    • rapid spread
    • hypoechoic 2-3cm
  51. squamous cell carcinoma
    • rare
    • highly invasive
    • hydro, palpable kidney, chronic irritation
    • large mass in renal pelvis
  52. renal lymphoma
    • rare
    • enlarged hypechoic kidneys
    • can be mistaken for renal cysts
    • nonhodgkins more common
    • not primary disease of kidney
  53. renal artery path
    • segmental
    • intralobar- adj to pyramid
    • arcuate- base of pyramid
    • intrelobular- along pyramid
  54. kidney signs malignancy
    • solid mass
    • calcification
    • vascularity
    • contralateral side, liver... mets?
    • >1mm septations
  55. metastisis
    • lung
    • breast
    • RCC from other kidney
  56. nephroblastoma
    • wilms tumor
    • most common abd malignancy in children
    • 2.5-3 yrs
    • more common in horseshoe kidney
    • (neuroblastoms- adrenal gland- neonate to 2yrs)
    • huge tumor that grows rapidly
    • 40% have renal vein thromb/ IVC thromb (budd-chiari)
  57. renal angiomyolipoma (AML)
    • most common benign renal tumor (benign tumors are rare)
    • fat, muscle, and blood vessle
    • female- rt kidney
    • hyperechoic, hemorrhage, organ displacement
    • not vascular
  58. renal adenomatous tumors
    • solid mass
    • benign
    • looks like RC carcinoma
  59. oncocytoma
    • uncommon
    • benign
    • spokewheel pattern with central scar
    • look like rcc
    • (focal nodular hyperplasia cenral scar in liver)
  60. lipomas
    • fat cells
    • benign
    • females
    • echoegenic mass
  61. renal disease
    Group one:increased cortical echos
    from collagen/fibrous tissue
    • interstitial nephritis
    • acute tubular necrosis
    • amyloidosis
    • diabetic neuropathy
    • systemic lupus erythematosus
    • myeloma
  62. renal disease
    Group 2: loss of atomic detail
    cant destinguiosh medu from cortex
    • chronic pyelonephritis
    • renal tubular ectasia
    • acute bacterial nephritis
  63. acute glomerulonephritis
    • necrosis or proliferation of cells in glomeruli
    • enlarged poorly functioning kidney
    • increased cortical echos
  64. acute interstitial nephritis
    • infectious processes
    • or allergetic response to drug
    • enlarged
  65. pararenal fat
    gerotas fascia
  66. lupus nephritis
    • connective tissue disorder from abnormal immune system
    • female
    • 20-40 yrs
    • renal vein thromb, protienuria
    • atrophy of kidney and corical echogenicity
  67. acquired immunodeficency syndroma
    • AIDS
    • usually acute tubular necrisis, nephrocalcinois, interstitial nephritis, focal segmental glomeruloscleroosis
    • echogenic parenchyma
    • normal to enlarged kidneys
  68. sickle cell neropathy
    • sickel cell disease
    • renal vein thrombosis
    • glomerulonephritis
    • papillary necrosis
    • enlarged with decreased echogenicity/edema
    • increased cortical echos
  69. hypertensive neuropathy
    • uncontrolled HTN causes renal damage
    • small kidneys
    • ischema-infarct
  70. papillary necrosis
    • cells at apex of pyramid are destroyed
    • diabetes, obstruction, sickel cell, transplant

    • can happpen after transplant
    • fluid at cortiomed junction of corresponding pyramid
  71. renal atrophy
    • loss of renal tissue
    • enlarged and echogenic- fat filled
  72. acute renal failure
    • prerenal- thrombus of ivc. r vein
    • renal- glomerular dysfunction
    • postrenal- bladder ureter
    • (rad imaging)
    • look for level of obstruction
  73. acute tubular necrosis
    • most commone medical renal disease to produce acute renal failure- can be reversed
    • enlarged kidneys with hyper pyramids
    • medulla or cortex
  74. chronic renal failure
    • loss of renal function from disease (parenchymal)
    • three types
    • nephron, vascular, interstitial
    • eg. glomerularnephristis, renal vasc disease, and diabetes lead to it
    • echogenic kidney with loss of normal anatomy, small kidenys if bilateral
  75. hydronephrosis
    urinary tract obstruction (UTO)
    • acquired (extrinsic) or intrinsic
    • fluid filled calcys
    • 4 grades
    • look for dilated ureter or enlarged prostate
  76. hydro grades
    • 1- small fluid filled separation of pelivs
    • 2- dilitation of some but not all calyces- concave
    • 3- calycs now convex
    • 4- prominent diliatation of collecting system thinning parechyma
  77. conditions that mimic hydro
    • av malformation- rare
    • congenital megacalcys
    • extrarenal pelvis
    • papillary necrosis
    • parapelvic cyst
    • persistent diuresis (urine production)
    • reflux
    • renal artery anyursm
  78. ureteral jet phenomenon
    • color doppler shows jets every 30 seconds
    • obstruction shows absence of jet
    • fills at 2ml per minute
  79. pyonephritis
    • pus in collecting system
    • requires emergency drainage
    • long standing obstruction
  80. emphysematous pyelonephristis
    • air in parenchyma can be from ecoli bacteria
    • emergency nephrectomy
  81. xanthogranulomatous pyelonephritis
    • uncommon disease from chronic obstructiona nd infection
    • destruction of parenchyma and infiltration of yellow lipid laden histocytes
    • staghorn calcuil, large nonfunctioning kidney
    • females
  82. renal calcifications
    most common is renal calcui
  83. medullary sponge kidney calcification
    • intratubular calcification
    • stasis of urine and stone formation
    • hyoerechoic calyces
  84. nephrocalcinosis
    • parenchymal calcification
    • usually in medulla
    • bilateral
    • necrosis, ischema
    • increased cortical echos with spared pyramids
  85. renal artery stenosis
    • most common correctable cause of htn
    • evaluate the segmental and intntraloabr arterties
    • males
    • first 2cm of renal artery
    • fibromusecular dysplasia is common cause
  86. renal infarction
    • part of the tissue undergoes necrosis after loss of blood supply, could be from artery occulsion
    • triangular shape along periphery of renal border
  87. arteriovenous fistulas
    • acquired- biopsy or trauma
    • passage between artery and vein
  88. renal transplant procedure
    • long standing renal failure
    • 16-45 lowest morbidity
    • graft rejectoion is major problem
    • donor kidney rotated and placed in recipients right illiac fossa, renal artery attached to external illiac artery
    • ureter inserted into bladder above normal ureter
  89. renal transplant complications
    • hyperactue- within hrs
    • acute- days to months
    • immunologic- antibodies
    • chronic- months with gradual onset
  90. acute tubular necrosis- transplant
    • #1cause of transplant failure
    • higher in cadaveric kidneys- medical complication after loss of blood supply
    • usually resolves early
    • creatnine elvated
    • swollen kidney
  91. cycosporine toxcicity
    • immunosuppressant used to prevent rejection
    • toxic to kidneys in high doses
    • renal biopsy best way to see
  92. malignancy- transplant
    • delayed complication
    • 55% developed 1 malignancy
    • nonhodgkins lymphoma and skin cancer
    • related to immunosuppressive drug
  93. HAUL
    • order of posoperative occurrence
    • hematoma- immediate bleeding
    • abcess- pyogenic mass around kidney, fever,septa
    • urioma- cystic mass adj tobladder/pelvis
    • lymphocele- build up of lymph fluid 3-6 months post any surgery- just leave it alone
  94. obstructive neuropathy- transplant
    • obstruction- anuria or oliguria
    • necrosis, abcess, fungus ball, retro fibrosis, stricture, ureteral calculi, hemmorage, aids, chemo
    • hydro
  95. graft rupture
    • up to 2 wks after surgery
    • abrupt pain and swelling
  96. color and doppler imaging renal arteries
    RI > .07
  97. kidney stones
    • urolithiasis
    • form in kidney and course down tract
    • usually calcium
    • staghorn calculi- large and fill collecting system
    • men
    • assosciated with renal acidosis
    • lithotripsy- shockwaves break up stone
    • echogenic with posterior shadow

    color doppler twinkle artifact
  98. bladder diverticulum
    • herniation of the bladder wall
    • congential (rare) or acquired (assoc w. stones)
    • neck- no muscular layer so can still have fluid after void- urine stasis infection and stone formation
    • stone can erode wall and fistula btw bowel and bladder
  99. cystitis
    • inflammation of bladder
    • usually secondary to a condition that causes urine stasis
    • bladder wall slough off
    • hypo echoic thickening of wall
    • may become fibrous or scarred
  100. bladder tumors
    • 95% are TCC
    • usually not detected until advanced
    • can be secondary site of malignancy (from colon, uterus or ovaries)
    • most common site is prostate
    • focal bladder wall thickening
    • benign are usually hypoechoic compared to malignant
    • increased vascularity
    • treat as malignant until proven otherwise

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