OB CH 63

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Author:
rbeacr
ID:
150940
Filename:
OB CH 63
Updated:
2012-04-29 19:26:48
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Fetal Urogenital system
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Fetal urogenital system
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  1. increased risk of ug malformations with
    • maternal renal disease
    • drug use
  2. two parts of the urogenital system
    • urinary
    • genital
  3. urinary and genital systems from
    mesoderm
  4. excretory ducts from urinary and genital systems enter the
    cloaca
  5. morphologic indicationi of gender at what week
    9
  6. three sets of excretory organs that develop in embryo
    • pronephros- 1st set of kidneys nonfunctional
    • mesonephros- function for a little but are replaced
    • metanephros - permanant kidneys
  7. when do permanant kidneys begin to develop
    • 5th week
    • mesanephros
  8. when does urine formation begin
    • 11-12th week
    • end of 1st trimester
  9. kidney migration complete at what week
    9
  10. pelvic kidney
    kidney remains in pelvic cavity

    • can be seen with bladder dilitation
    • may look like pelvic mass in females
  11. fetal bladder is derived from the hindgut derivative know as the
    urogenital sinus
  12. genitalia begin to develop at what week?
    complete by what week?
    • 9th
    • complete by 12th
  13. testes produce
    androgens that cause masculinization of external genitalia
  14. scrotal raphe
    • line of fusion of labioscrotal folds
    • in male
  15. urethra and vagina open into
    urogenital sinus
  16. urogenital folds become
    labiosacral swellins become
    phallus becomes
    • labia minora
    • labia majora
    • clitoris
  17. when do you see kidneys and bladder
    14weeks
  18. when do you see stomach
    12 weeks
  19. differentiation of parts of kidney
    18 weeks
  20. renal pelvis size (a/p) up to third trimester
    thrid tri to term
    • 4mm
    • 7m

    normal up to 5, 5-10 possibly normal, >10 anomoly
  21. normal fetal bladder wall
    • 2mm or less
    • measured at level of umb artery
  22. document gender with
    • presense of other anomolies
    • when gentalia is not male or female
  23. testes visable in scrotal sac at what week
    28
  24. kidney urine production contributes to amniotic fluid volume
    14-16 weeks
  25. posterior urethral valve
    • male fetus
    • presence of valve in posterior urethra
  26. ureterocele
    associated with duplication

    anechoic cystic structure in the bladder
  27. large echogenic kideys could mean
    • polycystic disease
    • trisomy 13
    • meckel-gruber syndrome
  28. infantile polycystic kidney
    oligohydraminos
  29. hydroureter
    • dilated ureters
    • oligo
  30. renal agenesis
    • maternal diabetes or cocaine useage
    • unilateral or bilateral
    • bilatera;- hypoplastic lungs

    unilateral more common- good outcome- compensates for the other
  31. potters syndrome
    • bilateral renal agenesis
    • (flat nose, recess chin, wide set eyes)
  32. hypospadias
    testicular agenesis or hypoplasia
  33. horse shoe kidney
    • ingerior poles fuse
    • more common in males
    • 1-4 in 1000
    • associated with other anomolies- tris 18
    • hydro, uti, kidney stones
  34. renal ectopia
    • kidneys lie outside normal position in renal fossa
    • usually area of pelvis
  35. crossed ectopia
    • both on same side of body
    • lies on opposite side of body from ureter insertion into bladder
    • can be fused and on right side of body
    • rarely in thoracic cavity on the left
  36. exstrophy of bladder
    • protrusion of posterior wall of bladder which contains the trigone and ureteric orfices
    • defective closure of inferior abd wall in 4th week
    • if midline think holoprosensencephaly
    • males
    • 1 in 30000

    low cord insertion
  37. cloacal exstrophy
    bladder exstropied but al so large and small intestines
  38. epispadias
    abnormal congenital opening of urethra on top of penis
  39. urachus
    • allantois regresses to become fibrous cord or urachus
    • ligament from apex of bladder to umbilicus
  40. urachal abnormalities
    • lumen of allantois persists while urachus forms and urachal fistula develops which causes urine to drain from bladder to umbilicus
    • usually in teens
    • males
    • assoc with prune belly and post urethral valve syn
  41. urachal cyst
    • aka vesicoallantoic cyst
    • lumen of allantois persists when urachus forms
  42. potters sequence
    • diseases associated with renal failure
    • oligo
  43. infantile polycystic kidney disease
    • autosomal recessive poly cystic kidney disease
    • effects fetal liver and kidneys
    • small cysts in both kidneys and liver cysts
    • tubular malformation and ectasia of distal collecting ducts

    can be in meckle gruber or tris 13

    usually dont survive the first year of life
  44. multicystic dysplastic kidney
    • MCDK
    • multiple noncommunicating cysts of different sizes
    • no normal renal tissue
    • hypoplastic or abset artery
    • atretic ureter and pelvis
    • early obstruction or abnormal development- nonfunctional
    • 1 in 3000 births
    • males
    • maternal diabetes
    • bilatearl- lethal
    • other kidney enlarges to compensate
  45. adult dominant polycystic kidney disease adpkd
    • cystic dilation of nephrons and collecting tubules
    • defective gene for normal epithelial cell devel
    • cysts in cortex and medulla- dont form and impair until adulthood
    • 1 in 1000
    • most common hereditary renal cystic disease recurrance of 50%
    • cysts in liver spleen and panc
  46. meckel gruber synd
    • bilateral renal cysts
    • but also encephalocele polydactly oligo
  47. obstructive cystic dysplasia
    • renal dysplasia second to kidney obstruction in 1-2nd trimester
    • fibrous and cystic replacement of tissue

    • severe bladder outlet obst urethral atresia or post valves
    • 1 in 8000

    hydro or hydroureter

    bilateral hypoplastic lungs
  48. key hole sign
    • bladder outlet obstruction
    • dialted bladder and urethra
  49. UPJ
    • ureteropelvic junction
    • where ureter enters renal pelvis
    • can be from stenotic ureter - male
    • usually unilateral
  50. UVJ
    • ureterovesicle juntion
    • where ureter enters bladder
    • megaureter

    aperistalic segment can contract and pass urine

    • ectopic ureterocele
    • males
    • unilateral
  51. megacystitis
    obstruction at the urethra
  52. pyelectasis
    • dilated pelvis but not calyces
    • associated with downs syndrome
  53. hydronephrosis
    dilated pelvis and calyces inresponse to blockage of urine

    most common fetal anomoly
  54. posterior urethral valve obstruction PUV
    • hydroneph
    • hydrour
    • dilated bladder
    • post urethra
    • abnormal membrane from wolfian duct in post urethra
    • urine cant pass
    • most common in males and most common obstruct
    • can put shunt to drain bladder- lungs can develop

    bladder/kidney can rupture
  55. anterior urethral valves
    • males
    • cong defect obstruction of ant urethral valve
    • abnormal tissue growth causes obstruction?
    • rare
    • hydro and dilated ureters
    • bladder rupture
  56. prune belly syndrome
    aka eagle barrett synd
    • no rectus sheath - hypoplasia of abd wall
    • dilated collecting system
    • cryptorchidism
    • muscle defects from dilated collecting system
    • rare- males

    • large urethra mimicing puv obstruction
    • oligo- distended abdomen- smal thoracic cavity
    • undestended testis
  57. ureterocele
    • cystic dilation of intravesical bladder
    • associated with double collecting system
    • ectopic ureter- medial and caudal
    • lower pole prone to reflux
    • upper pole prone to obstruction

    • females- double collecting
    • males- normal collecting
    • can remove upperpole with surgery in double collect syst
  58. most common renal tumor
    mesoblastic nephroma aka hamartoma (benign)

    • wilms- malignant- female- after 18 months
    • neuroblastoma- first 18mths- adrenal=- right side
    • renal tumors more common in males
    • and are benign
  59. hydrocele
    • common
    • males
    • resolve by itself
    • accumulation of serous fluid around testicle from communication with periotoneal cavity
  60. cryptorchidism
    • undestended testis
    • desend through inguinal canal to enter scrotum before birth
  61. hermaphroditism
    male and female tissue present
  62. hydrometrocolpos
    • obstructed uterus and vagina
    • atresia
    • imperforate hymen
    • double uterus and septate vagina
    • cyst like mass posterior to bladder
  63. fetal ovarian cysts
    • from maternal horomones
    • benign
    • most common cystic mass
    • most regress prenatally
    • may cause torsion, rupture, or intestinal obstruction

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