Unit 3 (Urinary, Hepatobiliary, GI)

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Unit 3 (Urinary, Hepatobiliary, GI)
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Unit 3: Urinary System, Hepatobiliary System, GI
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  1. an instrument that is inserted percutaneously through the renal cortex and medulla into the renal pelvis to allow the urine to drain outside of the body directly from the renal pelvis:
    nephrostomy tube
  2. name a possible complication to watch for with placement of a nephrostomy tube:
    pneumothorax
  3. an instrument that is placed surgically or via cystoscopy, with the upper portion in the renal pelvis and the lower portion with the urinary bladder, enabling urine to flow normally:
    ureteral stent
  4. the most common indwelling urinary catheter:
    foley catheter
  5. describe how a foley catheter is placed and its function:
    • placed within the bladder using sterile technique and a small balloon is inflated to keep it in place
    • to obtain specimens, relieve urinary retention, monitor renal function, and manage urinary incontinence
  6. when performing an IVU on a patient with a urinary catheter, name two things that should be done:
    • don’t forget to clamp catheter bag so contrast doesn’t drain into the bag
    • don’t forget to unclamp after procedure
  7. a relatively rare anomoly in which one kidney is absent from the body and the other kidney is unusually large:
    renal agenesis
  8. condition of enlargement of the kidney because of absence of the other kidney:
    compensatory hypertrophy
  9. consists of the presence of a third, small, rudimentary kidney:
    supernumerary kidney
  10. a rare anomaly of size involving a kidney that is developed less than normal and usually is associated with hyperplasia of the other kidney:
    hypoplasia
  11. an overdeveloped kidney, often associated with renal agenesis or hypoplasia of the other kidney:
    hyperplasia
  12. an anomaly where the lower poles of the kidneys are joined across midline by a band of soft tissues, causing a rotation anomaly on one or both sides:
    horseshoe kidney
  13. an anomaly that exists when one kidney lies across the midline and is fused to the other kidney, and both kidneys demonstrate various anomalies of position, shape, fusion, and rotation:
    crossed ectopy (both kidneys on same side)
  14. an anomaly that consists of incomplete or excessive rotation of the kidneys as they ascend from the pelvis in utero:
    malrotation
  15. a kidney that is out of its normal position, usually lower in position and most are asymptomatic:
    • ectopic kidney
    • (a transported kidney is placed in the pelvis)
  16. distinguished from a pelvic kidney by the length of the ureter; if the ureter is short, it is a:
    congenital pelvic kidney
  17. "prolapse" of the kidney:
    nephroptosis
  18. name problems that can be caused by nephroptosis:
    • urinary problems
    • kinks in ureter
    • (why upright images are taken)
  19. name different ways in which renal pelvis and ureter anomalies may possibly occur:
    • frequent
    • may be unilateral or bilateralm
    • may occur as double renal pelvis
    • either isolated or in combination with a double ureter
  20. a cystlike dilation of a ureter near its opening into the bladder:
    ureterocele
  21. what does a ureterocele usually result from?
    from congenital stenosis of the ureteral orifice
  22. how does a ureterocele appear radiographically?
    as a filling defect in the bladder with a  characteristic “cobra head” appearance
  23. a condition that is probably a congenital anomaly and may actually represent a dilated, branched ureteric remnant:
    ureteral diverticula
  24. a condition that may occur as a congenital
    anomaly or be caused by chronic bladder obstruction and resultant infection:
    bladder diverticula
  25. mucosal folds that protrude into the posterior urethra as a congenital condition and can cause significant obstruction to urine flow:
    urethral valves
  26. a familial kidney disorder that, though congenital in origin, usually presents in adults in their thirties and presents as innumerable tiny cysts that are present at birth gradually enlarge as the patient ages, sometimes becoming so large that normal tissue is compressed and damaged:
    polycystic kidney disease
  27. a congenital anomaly usually not diagnosed until the fourth or fifth decade of life, when infective complications occur and in which the only visible abnormality is the dilatation of the medullary and papillary portion of the collecting ducts, usually bilaterally:
    medullary sponge kidney
  28. how does medullary sponge kidney appear radiographically?
    an IVU reveals linear markings in the papillae or cystic collections of contrast mediain the enlarged collecting ducts
  29. a condition of the kidney that looks like “clubbing” and enlargement of the calices:
    medullary sponge kidney
  30. the most common of all bacterial infections:
    urinary tract infection (UTI)
  31. a bacterial infection of the calices and renal pelvis and thought to represent the most common renal disease:
    • pyelonephritis
    • can result in renal failure (very painful)
    • in the acute stage, kidney becomes very enlarged
    • in chronic stage, kidney is often smaller than normal
  32. a condition where a urinalysis demonstrates a presence of pus (white cells) created by the body’s reaction to the infection:
    pyuria
  33. an inflammatory reaction of the renal parenchyma caused by an antigen-antibody reaction in the glomeruli:
    • acute glomerulonephritis
    • often occurs following streptococcal infection of the upper respiratory tract or the middle ear
  34. inflammation of the bladder, caused by bacteria that may be either actue or chronic:
    cystitis
  35. the backward flow of urine out of the bladder and into the ureters, may be seen in cases of cystitis:
    vesicoureteral reflux
  36. a bladder dysfunction caused by interference with the nerve impulses concerned with urination:
    neurogenic bladder
  37. how can neurogenic bladder occur, and name something to be remembered when dealing with it:
    • can occur from damaged nerves (like a paraplegic)
    • must be drained slowly. too fast, could put pt into shock
  38. intimal thickening of predominantly the small
    vessels of the kidney and may occur as part of the normal aging process as well as in younger patients in association with hypertension and diabetes:
    nephrosclerosis (hardening/scarring of kidneys)
  39. disturbances of calcium metabolism that is characterized by tiny deposits of calcium dispersed thoughout the renal parenchyma:
    nephrocalcinosis (in the renal pyramids)
  40. usually represents the end result of a chronic process such as chronic glomerulonephritis or polycystic kidney disease that gradually
    results in diminished kidney function, but can arise acutely:
    renal failure
  41. a characteristic of renal failure, consisting of retention of urea in the blood and is not toxic, but its blood level correlates with retention of other waste products and is thus a measure of the severity of renal failure:
    uremia (too many waste products in blood)
  42. stones that develop from urine, which can precipitate crystalline materials, especially calcium and its salts:
    renal calculi
  43. a large calculus that assumes the shape of the pelvicaliceal junction:
    staghorn calculus
  44. severe pain resulting from movement of stones or acute obstruction that refers along the course of the ureter toward the flank or genital regions:
    renal colic
  45. an obstructive disease of the urinary system that causes a dilation of the renal pelvis and calices with urine:
    hydronephrosis
  46. an acquired abnormality common in adults that may be solitary or multiple and bilateral and is usually asymptomatic and not an impairment to renal function, but can cause symptoms like rupture, hemorrhage, infection or obstruction:
    renal cysts
  47. the most common malignant tumor of the kidney arising from the proximal convoluted tubule:
    adenocarcinoma
  48. a malignant renal tumor found in children that usually develops before five years of age:
    nephroblastoma/wilm's tumor
  49. a condition in which painless hematuria is the chief symptom and is common in men and its etiology is related to cigarette smoking and certain industrial chemicals, and a link to excessive coffee drinking is being investigated:
    • bladder carcinoma
    • radiographic appearance: filling defect in bladder
  50. name the three main parts of the hepatobiliary system:
    • liver
    • gallbladder
    • biliary tree
  51. the largest organ in the body, located in the RUQ, held in position by peritoneal ligaments and muscles:
    liver
  52. name several of the functions of the liver:
    • portal circulation helps with substance metabolism
    • synthesis of substances – blood clotting, storage of vitamin B and other materials
    • detoxification and excretion of various substances
  53. describe the liver's blood supply:
    • has a double blood supply:
    • hepatic artery
    • portal vein
  54. list the parts of the biliary tree:
    • many small bile ducts
    • rt and lft hepatic ducts
    • common hepatic duct
    • cystic duct
    • common bile duct
  55. the common bile duct descends posterior to the ________________ to enter at its _________________.
    • descending duodenum
    • posterior medial aspect
    • A. gallbladder
    • B. head of spleen
    • C. intestine (duodenum)
    • D. pancreatic duct
    • E. body of spleen
    • F. tail of spleen
    • G. pancreas
    • H. common duct
    • I. liver
    • J. dorsal pancreatic duct
    • K. bile duct
    • L. ventral pancreatic duct
    • M. pancreas
    • N. duodenum
    • O. major papilla
    • P. minor papilla
  56. visualized on a plain radiograph as a hazy radiopacity in the gallbladder:
    milk of calcium
  57. a semiliquid sludge composed of calcium carbonate mixed with bile in the gallbladder and isž caused from the settling of bile as a result of an obstruction at the neck of the gallbladder:
    milk of calcium
  58. what are these?
    OCG
    PTC
    Chiba
    • žOCG: oral cholecystogram
    • žPTC: percutaneous transhepatic cholangiogram
    • chiba: skinny needle
    • žERCP: endoscopic retrograde cholangiopancreatography
  59. a chronic condition of the liver in which the liver parenchyma and architecture are destroyed:
    cirrhosis
  60. the accumulation of fluid within the peritoneal cavity, most commonly due to cirrhosis and severe liver disease:
    ascites
  61. a common liver condition in which a virus causes acute inflammation of the liver and interferes with the liver’s impaired ability to excrete bilirubin:
    hepatitis
  62. žinfectious hepatitis that is excreted in the GI tract in fecal material and is spread by contact with an infected individual, normally through ingestion of contaminated food or water:
    hepatitis A
  63. a serum hepatitis that is transmitted parenterally in infected serum or blood products:
    hepatitis B
  64. žviral hepatitis that is caused by a parenterally transmitted RNA virus and accounts for 90% of
    the cases of hepatitis that develop after bloood transfusions:
    hepatitis C
  65. gallstones (about 10% of the population develop them at some point):
    cholelithiasis
  66. small stones that tend to travel into the biliary tree and may result in obstruction:
    gravel
  67. an acute inflammation of the gallbladder:
    • cholecystitis
    • clinically, sudden onset of pain fever, nausea, vomiting in individuals with chronically symptomatic cases
  68. žwhen a stone becomes impacted in the small bowel and causes an obstruction and is characterized by air in the biliary ductal system which can be seen on a plain radiograph:
    gallstone ileus
  69. an acute or chronic inflammation of the pancreatic tissue:
    pancreatitis
  70. a fluid collection caused by pancreatitis:
    pseudocyst
  71. a žcondition in which an accumulation of excess bile pigments (bilirubin) in the body tissues stains the skin and eyes a yellowish color:
    jaundice
  72. occurs because of hemolytic disease in which too many red blood cells are destroyed or because of liver damage from cirrhosis or hepatitis:
    medical jaundice or "nonobstructive"
  73. occurs when the biliary system is obstructed and prevents bile form entering the duodenum with a common cause being blockage of the common bile duct caused by stones or masses:
    surgical jaundice or "obstructive"
  74. ža benign neoplasm of the liver composed of newly formed blood vessels, and these neoplasms can form in other places within the body, like the brain:
    hemangioma
  75. the most common tumor of the liver:
    hemangioma
  76. ža primary carcinoma of the liver that is uncommon in the US and in which an association between cirrhosis and hepatoma exists, with alcoholism and poor nutrition associated with each:
    hepatoma "hepatocarcinoma"
  77. žoccurs infrequently, but most neoplasms within the GB are malignant:
    carcinoma of the gallbladder
  78. results from chronic cholecystitis and is a risk factor for gallbladder carcinoma:
    "porcelain" gallbladder
  79. the fifth most common cause of cancer death within the US. that spreads before symptoms occur and is usually rapidly fatal:
    carcinoma of the pancreas
  80. know the regions:
    • know the quadrants:
  81. though there is a low frequency of positive findings, KUBs are performed to:
    • rule out perforations
    • assess catheter and tube placements
    • show outlines of liver, kidney, spleen, psoas muscle shadow
    • properitoneal fat stripes
    • demonstrate calcified structures
  82. describe a few basic positions of structures in a routine KUB:
    • lower liver margin is at or above the level of the right twelfth rib
    • left kidney is higher
    • kidneys are the length of three vertebrae at one year of age and above
    • kidneys later are the length of two and a half vertebrae
  83. describe gas/air being viewed in a routine abdomen radiograph:
    • in erect position few, if any air-fluid levels
    • in infants & children gas is seen throughout
    • in adults gas is normally seen only in the stomach and colon
    • erect films need to include the diaphragm
    • with the inability to stand, do left lateral decubitus
  84. a procedure that visualizes the internal surfaces of both ends of GI system with the use of lighted instruments with optics to visualize disease of the esophagus, stomach and duodenum, rectum and distal colon, and occasionally the terminal ileum:
    endoscopy
  85. name some common functions of gastric tubes:
    • aspiration of gastric contents to control N/v
    • for decompression and removal of gastric contents because of bowel dysfunction or surgery
    • for nutritional support tube feedings (gastric gavage)
    • medication administration
  86. the most common gastric tube:
    levin tube
  87. an instrument placed through the mouth to combat an emergent condition that requires large amounts of gatric contents to be aspirated:
    ewald or edlich tube (gastric lavage)
  88. an instrument used for removal of gasric contents (other than a gastric tube):
    levacuator tube
  89. an instrument that delivers a liquid diet directly to the duodenum or jejunum:
    enteral tube
  90. a common radiopaque enteral tube:
    dobhoff tube
  91. two common types of prolonged enteral tube:
    • corpak
    • entriflex
  92. an instrument used to remove gas and fluids in the prevention and treatment of abdominal distention:
    nasoenteric decompression tube
  93. three types of nasoenteric decompression tubes:
    • miller-abbott tube (common double lumen tube)
    • harris
    • cantor
  94. ____________ or ____________ may also be
    surgically placed in any portion of the GI system.
    • levin tubes
    • foley catheters
  95. indicates the tube is placed in the stomach:
    indicates the tube is placed in the duodenum:
    indicates the tube is placed in the jejunum:
    • gastrostomy tube
    • duodenostomy tube
    • jejunostomy tube
  96. an instrument that is frequently placed endoscopically and provides a direct route for feeding:
    percutaneous endoscopic gastostomy tube
  97. a congenital absence or closure of a normal body orifice or tubular organ:
    atresia
  98. a congenital condition in which the esophagus fails to develop past same point:
    esophageal atresia
  99. describe symptoms and occurrences involved with an esophageal atresia:
    • symptoms: excessive salivation, choking, gagging, dyspnea, and cyanosis
    • immediate surgery is required
    • patient is prone to aspiration
    • tracheoesophageal fistulas often occur
  100. black tarry stools:
    melena
  101. passage of bright red blood in stool:
    hematachezia
  102. coughing up blood:
    hemoptysis
  103. vomiting up blood:
    hematemesis
  104. blood in the urine:
    hematuria
  105. nose bleed:
    epistaxis
  106. congenital anomaly in which the lumen of the duodenum does not exist and in which a radiograph shows the “double bubble sign”:
    duodenal atresia (2nd most common form of bowel atresia)
  107. a congenital discontinuation of the ileum:
    ileal atresia (most common form of bowel atresia)
  108. symptoms of ileal atresia:
    abdominal distension and the inability of the infant to pass stool
  109. the congenital failure of development of the distal rectum and anus:
    colonic atresia (form of bowel atresia)
  110. fistulas frequently occur in the _____________ system.
    genitourinary system
  111. congenital disorder in which there is no anal opening to the exterior:
    imperforate anus
  112. where is a fistula accompanying an imperforate anus most commonly present in boys vs. girls and in what radiographic position is it best visualized?
    • boys: between the perineum and urethra
    • girls: between the vagina and colon
    • visualized: cross-table lateral rectum with patient prone
  113. a congenital anomaly of the stomach where the pyloric canal leading out of the stomach is narrowed because of hypertrophy of the pyloric sphincter:
    hypertrophic pyloric stenosis
  114. name the most common indication for surgery in infants, its symptoms, and a radiographic appearance:
    • hypertrophic pyloric stenosis
    • projectile vomiting, weight loss, dehydration
    • demonstrates the string sign
  115. a condition in which the intestines are not in their normal location, involving the  large and small intestines:
    malrotation
  116. malrotation of the intestines predisposes the patient to:
    • internal hernias
    • volvulus
  117. a congenital condition in which there is a complete reversal of all abdominal organs:
    situs inversus
  118. a condition in which there is an absence of neurons in the bowel's wall, typically in the sigmoid colon:
    • hirschsprung’s disease  “congenital megacolon” 
    • toxic megacolon can result if untreated
  119. a sac-like defect located within six feet of the ileocecal valve and is a remnant of a duct connecting the small bowel to the umbilicus in the fetus:
    • meckel's diverticulum
    • (a congenital diverticulum of the distal ileum)
  120. name some symptoms, occurrences, and radiographic appearance for meckel's diverticulum:
    • symptoms can mimic appendicitis
    • children often develop ulcer in adjacent bowel
    • adults have cramping, vomiting, and bowel obstruction
    • may not be seen on small bowel film, but can be demonstrated on a nuclear scan
  121. a narrowing of the esophagus that causes obstruction to varying degrees depending on the amount of stricture:
    esophageal stricture
  122. name causes and treatment for esophageal stricture:
    • causes: ingestion of material that inflames the mucosa, such as those that contain strong acids or alkalines; malignant or benign processes
    • treatment: dilation of esophagus with special mercury-filled tube of varying sizes
  123. incompetent cardiac sphincter allowing the backward flow of gastric acid and contents into the esophagus:
    • GERD "esophageal reflux disease"
    • primary cause of esophageal inflammation
    • not always evident on barium swallow
  124. areas of mucosal erythema of the esophagus:
    barrett's esophagus
  125. areas of esophageal mucosal erythema that extends to less than 2 cm above the normal squamocolumnar junction:
    short segment barrett's esophagus
  126. name various treatments and preventative measures taken against esophageal reflux disease (GERD):
    • elevate the head of the individual's bed
    • avoid drinks such as coffee or alcohol
    • avoid chocolate
    • avoid smoking
    • antacids can wash gastric acids out of esophagus
    • medicines like H2 blockers inhibit acid production
    • prokinetic agents enhance motility
    • surgery is the last option
  127. an erosion of the mucous membrane of the lower end of the esophagus, stomach, or duodenum:
    • peptic ulcer
    • adults of all ages, mostly people over 40
    • almost always benign
    • most commonly on bulb and/or lesser curvature
  128. inflammation of the mucosal lining of the stomach and small bowel:
    gastroenteritis
  129. a group of diseases of various causes in which there is interference with normal digestion and absorption of food through the small bowel:
    malabsorption syndrome
  130. a condition that occurs as a result of sensitivity to the gliadin fraction of gluten, an agent found in wheat and rye products such as bread:
    • celiac disease
    • (the best known small-bowel malabsorption disorder)
  131. a form of malabsorption syndrome in which the small bowel lacks enough of the enzyme lactase, which is used to digest lactose into simple sugars that can be absorbed:
    lactose insufficiency
  132. a chronic inflammatory disease of unknown etiology that is typically located in the lower ileum but may be seen anywhere throughout the bowel:
    regional enteritis "chrohn's disease"
  133. inflammation of the vermiform appendix, resulting from an obstruction caused usually by a fecalith or rarely by a neoplasm:
    appendicitis
  134. an inflammatory lesion of the colon mucosa:
    ulcerative colitis
  135. abnormally lengthened, dilated superficial veins occurring in the esophagus because of portal hypertension:
    • esophageal varices
    • (pts at risk of hemorrhage)
  136. describe contrast and position used to best demonstrate esophageal varices:
    • best demonstrated in the recumbent position
    • use thin barium
    • appearance of wormlike defects within the column of barium
  137. a protrusion of a loop of bowel through a small opening, usually in the abdominal wall:
    • hernia
    • (ex. inguinal, femoral, umbilical)
  138. a condition that occurs when a bowel loop protrudes through a weakness in the inguinal ring and may descend downward into the scrotum:
    inguinal hernia
  139. a type of hernia that can be pushed back into the abdominal wall:
    reducible hernia
  140. a herniated loop of bowel that is stuck and cannot be reduced:
    incarcerated hernia
  141. a type of hernia where the constriction through which the bowel loop has passed is tight and cuts off blood supply to the bowel:
    strangulated hernia
  142. a weakness of the esophageal hiatus, which permits some portions of the stomach to herniate into the thoracic cavity:
    • hiatal hernia
    • (most are asymptomatic, some have reflux)
  143. a portion of the stomach and gastro esophageal junction are both situation above the diaphragm and schatzki’s ring is often visible:
    direct or sliding hiatal hernia
  144. a condition that consists of a mucosal ring that protrudes into the lumen:
    • schatzki's ring
    • not significant unless less than 13 mm in diameter
  145. a condition in which a portion of the stomach or adjacent viscera herniates above the diaphragm while the gastro esophageal junction remains below the diaphragm:
    • rolling or paraesophaeal hiatal hernia
    • less common
    • can be life-threatening because of potential volvulus, incarceration, or strangulation
  146. a condition in which the entire stomach is located above the diaphragm:
    intrathoracic stomach
  147. bowel obstructions can involve the large or the small intestine and are classified as (2):
    • mechanical bowel obstruction
    • paralytic ileus or “adynamic ileus”
  148. give some aspects of mechanical bowel obstruction:
    • occurs from a blockage of the bowel lumen
    • gas confined to the small bowel with multiple air fluid levels visible on erect radiographs
    • bowel sounds are hyperactive and high pitched
    • emesis contains bile
  149. give some aspects of paralytic ileus or “adynamic ileus”:
    • paralytic ileus or “adynamic ileus”
    • failure of peristalsis to occur
    • gas can be visualized in the large and small intestine
    • absence of bowel sounds
    • generally lasts no longer than three days
  150. causes of paralytic ileus or “adynamic ileus”:
    • surgery
    • intra-peritoneal or retroperitoneal infection
    • medications
    • illnesses
    • bowel ischemia
    • electrolyte imbalance
  151. a condition in which a gallstone erodes from the gallbladder and creates a fistula to the small bowel leading to an obstruction, usually when the gallstone reaches the ileocecal valve:
    gallstone ileus
  152. a twisting of a bowel loop about its mesenteric base, usually at either the sigmoid or ileocecal
    junction:
    vovulus
  153. give some aspects of a vovulus:
    • most common in the elderly
    • radiographically seen as a collection of air conforming to the shape of the affected, dilated bowel
    • may resolve on its own, but surgery is required if it twists more than 360°
  154. a condition that occurs when a segment of bowel, constricted by peristalsis, telescopes into a distal segment and is driven further into the distal bowel by peristalsis:
    • intussusception
    • (radiographically looks like a coiled spring)
  155. a neuromuscular abnormality of the esophagus that results in failure of the lower esophageal sphincter of the distal esophagus to relax, leading to dysphagia:
    achalsia
  156. a condition that occurs when mucosal outpouchings penetrate through the muscular layer of the esophagus:
    esophageal diverticula
  157. an esophageal diverticulm that involves the mucosa only and results from a motility disorder of the esophagus that allows the mucosa to herniate outward:
    pulsion diverticulum
  158. a pulsion type of diverticulum found at the pharyngoesophageal junction at the upper end of the esophagus:
    zenkers diverticulum
  159. a pulsion type diverticulum found in the distal esophagus just above the hemi-diaphragm:
    epiphrenic diverticulum
  160. a type of diverticulum that involves all layers of the esophagus and results form adjacent scar tissue that pulls the esophagus toward the area of involvement:
    traction diverticulum
  161. the presence of diverticula without inflammation, is seen in all parts of the colon, most frequently in the sigmoid colon, and particularly among the elderly:
    diverticulosis
  162. inflammation of a diverticulum:
    diverticulitis
  163. benign smooth muscle tumor of the esophagus:
    leiomyoma
  164. small masses of tissue arising from the bowel wall to project inward into the lumen:
    • colonic polyps
    • (adenomatous polyp: has neoplastic potential)
    • (hyperplasia)
  165. the second most common cause of cancer mortality:
    colon cancer
  166. the most common type of colorectal cancer and is derived from the glandular epithelium of the colon:
    adenocarcinoma
  167. a tumor of benign neoplastic epithelium that consists of a saccular projection into the bowel lumen and is either sessile or pedunculated:
    adenomatous polyp
  168. attached directly to the bowel wall with a wide base:
    sessile
  169. attached directly to the bowel by a narrow stalk:
    pedunculated

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