Abdomen Test #3
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A fibrous sheath that surrounds kidneys, perinephric fat & the adrenal glands
True capsule that covers kidney
Fat around kidney
- Highly echogenic central area of the kidney
- Calyces, Fat, Nerves, Lymph nodes
- Urine reservoir (collecting system)
- Expanded Superior (prox) portion of ureter
Column of Bertin
- Prominent cortical tissue
- Separates Medullary Pyramids
- Can mimic a mass
Albumin/Protein in urine
Increased/Excessive urine output
Decreased urine output
Normal size of kidney? How do they develop
- 9-12 cm (sag)
- 2-4 cm A/P
- 5-7 cm TRV
- Develop in the Pelvis w/pelvic organ
- Migrate into the flank area
Is Kidney Intra or retroperitoneal?
Which kidney is higher/larger in the body?
Lt kidney is higher by 0.5-1 cm longer than right
Parenchyma is made up of what?
Cortex/Medulla (functional unit)
Entrance to Renal sinus is referred to as?
What structures pass through the hilum?
- Renal arteries
- Lymphatic vessels
What are the Kidney functions?
- Dispose metabolic waste through urine
- Maintain bl pressure thu regulation of fl. vol.
- Regulate Ph balance (base/acid)
- Regulate Serum electrolytes
Kidney Lab Values
- Creatinine (most Specific)
- BUN (Blood Urea Nitrogen Waste)
Normal USA of Kidney
- Renal Cortex: Homogenous low-level echoes
- Hypoechoic to liver
- Renal Pyramids: Triangular shaped, hypoechoic surround sinus
- Renal Sinus: Highly echogenic central area
- Smooth Contour & Jelly Bean shaped
Blood flow pathway TO Kidney
- Renal A
- Segmental A
- Interlobar A
- Arcuate A (smallest can be seen)
- Interlobular A
Blood flow pathway FR Kidney
- Interlobular V
- Arcuate V
- Interlobar V
- Renal V
Which is longer? (Rt/Lt Renal Art) (Rt/Lt Renal Vn)
- Right Renal A is longer (AO)
- Left Renal Vn is longer (IVC)
How does each course around the AO or IVC? (Rt/Lt Renal A) (Rt/Lt Renal Vn)
- Rt Renal A courses Post to IVC
- Lt Renal Vn courses Ant to AO & Post to SMA
Diffuse Renal Parenchymal Disease
Poorly functioning kidneys w/o obstruction (all over)
USA of Diffuse Renal Parenchymal Disease
- Echogenic Parenchyma (cortex/medulla)
- Acute: Enlarged kidneys
- Chronic: Small, contracted Kidneys
- End Stage: Atrophy, small w/thin cortex
Bulge in Capsule of Lt Kidney due to compression by spleen
Kidney in pelvis
Most common, usually fused @ lower poles
Junctional Parenchymal Defect
Echogenic Triangle on renal capsule (around periphery of kidney)
Dual Collecting System
- More common anomaly
- 2 collecting sys.
- Complete or incomplete
- Has upper/lower sinus area
Renal arteries flow (high/low)
Low resistance bec. it feeds major organs
Where is a transplanted kidney placed?
- Iliac Fossa on Rt side connected to Iliac A
Name the Fl collections that may occur after a Renal transplant
- Post transplant hydronephrosis
3 causes of Post-transplant kidney failure
- Acute Tubular Necrosis (common cause) Degeneration of tissue
- Renal Infarct
- Cyclosporine Toxicity
What is the drug cyclosporine use to prevent in a transplanted kidney?
Possible Post-biopsy complications
- AVM: Arterio Venous Malformation (Fistula)
What is Resistive Index (RI) used for?
Test Kidney Function
Normal RI for the Kidney
- Area of the bladder that is triangular in shape
- Located on Posterior/Inferior wall
- Benign polyps
- Superficial neoplasms of bladder wall
Outpouching of UB wall
- aka Nephroblastoma
- Most common solid tumor in Children
- Man made circle in UB
- Mechanical way to drain urine
Inflammation of the renal parenchyma & pelvis
Benign Renal Hamartoma composed of bl vessels, muscle & fat
- Vascular tumor that can happen in other places of the body
- A focal growth that resembles a neoplasm but results fr faulty development in an organ
- Ureteropelvic Junction obstruction (ureter/pelvis)
- Congenital narrowing of the ureter just below the kidney
- Ureterovesicle Junction obstruction
- Congenital narrowing of the ureter @ the UB
- Posterior Urethral Valves
- Membrane obstructs post urethra causing dilation of UB, ureters and Pelvis
Prune Belly Syndrome
- AKA: Eagle Bartlett Syndrome
- Lax Syndrome
- Keyhole bladder
- AKA: Nephrocalcinosis
- Calcium deposits in Medullary pyramids
- Becomes echogenic
Non-surgical U/S vibration treatment of kidney stones
Extracorporeal Shockwave Lithotripsy
Non-surgical water-therapy treatment of Kidney stones
Transitional Cell Carcinoma (TCC)
Secondary Cancer from the urinary tract
Where does TCC originate?
Transitional Cells of Urinary bladder
Renal Cell Carcinoma (RCC)
Malignant cancer of the kidney
Where does RCC originate?
Where does RCC go?
- Renal V
- Contralateral Kidney
- Paraaortic nodes
- Long Bones
Parapelvic Cyst (not a true cyst, so where are they derived from)?
Renal Cyst located in the Sinus Hilum region
What can parapelvic cyst be confused with?
- or Extra Renal Pelvis
- Autosomal Dominant Polycystic Kidney Disease or Adult Polycystic Kidney Disease
- Inherited and Progressive
- Latent until 50's
APKD is associated with?
Cyst in Spleen, Liver and Pancrease
Renal Parenchymal Disease
Poorly functioning kidneys w/o obstruction
- Form of chronic pyelonephritis
- Renal pelvis contracts around a stone
- Shadowing fr stone
USA of Nephrolithiasis
- Echogenic foci
- Possible Post shadowing (anechoic)
- Stones in ureter may not be seen
How to prove stones?
- Use color doppler to see if stone displays "Twinkle artifact"
- Change to a higher frequency tx
- Type of Infective Stone
- Fills entire Renal pelvis w/ post. shadowing
- Oddly shaped
USA of Hydronephrosis
Fluid in Renal Sinus/Calyces
USA of Mild Hydro
Slight separation of collecting system
USA of Moderate Hydro
Further dilation of calyces (paw print)
USA of Severe Hydro
Large anechoic area w/ thinning cortex
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