Urinary System Powerpoint First 1/2

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1

Lateral

Morison's

Posterior

Renal Location:

___ to the vertebrae

  • Retroperitoneal
  • ____ pouch
  • Between the parietal peritoneum and ___ abdominal wall
2

Right; left

Respiration

Renal Location:

___ kidney is lower than the ___

Position varies with changes in posture and ___

Usually lie between T-12 and L-3

3

Calcium

RBC

Renal Function:

Regulates

  • Blood pressure and blood volume
  • Composition and pH of body fluids
  • Absorption of ___
  • Rate of ___ formation
4

Blood

Urine

Renal Function:

Removes metabolic wastes from the ___

Excretes as ____

5

Laterally

70; 30

Posterior; longer

Renal Vasculature:

Renal arteries branch ___ from the aorta

___% of the populations have a single artery and ___% have an accessory artery

Right renal artery passes ___ to the IVC and is ___ than the left

6

Less than

Greater than

Renal Size:

Children by formula

  • ___ 1 year ~ renal length (cm) = 4.98 + [0.155 x age (months)]
  • ___ 1 year ~ renal length (cm)= 6.79 + [0.22 x age (years)]
7

Bean

9-13

6

3

Renal Size:

Reddish brown ___ shaped organ

Average size (adult)

  • ___ cm length
  • ___ cm width
  • ___ cm thickness
8

Below

Between

Gross Renal Structure:

Cortex

  • ___ the capsule or fascia
  • Dips ___ the pyramids (renal columns of Bertin)
  • Arches over pyramids (cortical arches)
9

8-18

Outer

Middle

Gross Renal Structure:

Medulla

  • Internal portion
  • ___ pyramids
  • Base (broader portion) directed toward the ___ surface
  • Apex towards the ___
10
  • Hematuria
  • WBC or protein in urinalysis
  • Trauma
  • Abnormal BUN
  • Flank or back pain
  • History of renal disease
  • Urinary Tract Infection (UTI)
  • Decreased urine output

Renal Exam Indications? (8)

11

Equal

Less

Hypoechoic

Adipose

Renal Ultrasound Appearance:

Renal cortex ___ or less echogenic than the liver

The cortex ___ echogenic than the medulla

____ triangular renal pyramids

Intense central renal sinus echoes caused by ___ tissue

12

Echogenic

Medullary Sponge Kidney: Sonographic appearance -

  • ____ pyramids due to microscopic cysts

Asymptomatic; Patients with hematuira, infection and renal stones should be evaluated for this disease.

13

Bilateral

Collecting

Medullary Sponge Kidney:

____ with normal renal function

Dysplastic cystic dilation of the ____ tubules

14
  • Parathyroid Adenoma
  • Caroli's disease
  • Ehler-Danlos Syndrome
  • Beckwith-Wiedmann syndrome

Medullary Sponge Kidney is associated with what 4 diseases?

15
  • Renal Cyst(s)
  • Polycystic Kidney Disease (PKD)
  • Hydronephrosis
  • Nephrolithiasis (stones)
  • Renal failure (acute or chronic)
  • Abscess
  • Tumors

Common Pathology (7)

16

Benign

Incidental

Complex

Renal Cyst:

___ simple cysts - one or more

_____ finding

Use criteria for cyst

A ___ cyst has irregular walls, septa or internal echoes

17

Infantile

Rare

6

Polycystic Kidney Disease:

Autosomal-recessive polycystic kidney disease (ARPKD)

  • AKA ____ polycystic disease
  • ___ disorder
  • Chromosome ___
18

Adult

Common

Genotype

Polycystic Kidney Disease:

Autosomal-dominant polycystic kidney disease (ADPKD)

  • ____ autosomal-dominant form
  • ____ disorder
  • Severity varies depending upon the _____
19

Enlarged; echogenic

Microscopic

Hepatic

Juvenile ARPKD:

In older children, kidneys are ___ and ____, corticomedullary differentiation is lacking.

May also be ____ or small cysts located in the medulla

Often associated with ___ fibrosis and splenomegaly.

20

NOT; 4th or 5th

60; end-stage

Adult Polycystic Kidney:

Not progressive

Does ___ usually clinically manifest until the ___th or ___th decade

  • hypertension or hematuruia develops

By age ___ years, approximately 50% of patients have ____ renal disease.

21

Bilateral

Enlarged; size

Adult Polycystic Kidney:

___ disease

___ kidneys with multiple asymmetrical cysts varying in ___ and location (renal cortex and medulla)

22

Entire

Unilaterally

Bilateral

Multicystic Dystplastic Kidney:

Dysplastic change usually involves the ___ kidney

Usually occurs ___, with poor function

____ involvements in incompatible with life

23

Nonhereditary

Neonates

Multicystic Displastic Kidney:

Common ____ renal dysplasia

Most common form of cystic disease in ___.

  • Thought to be caused by early in utero urinary tract obstruction
24

Abscence

Small

Ureteral

Nonfunctioning

Multicystic Dysplastic Kidney Sonographic Findings:

Neoates and children - multicystic with the ___ of renal parenchyma, renal sinus and atretic renal artery

Adults - ___ (atrophic and calcified) and echogenic

___ atresia

Contralateral ureteropelvic obstruction

___ kidney

25

Hydronephrosis

Intrinsic; extrinsic

Contralateral

____ - the renal pelvis and calyces become dilated due to the obstructed outflow of urine, which may produce renal atrophy

  • Multiple etiologies
  • ___ vs. ____ causes
  • Evaluate entire kidney
  • Evaluate ____ kidney
  • Can be mild, moderate and severe
26

Pelviectasis

1

False hydronephrosis?

May be a Grade __

Pelvis filled with fluid? Do a post void

27
  • Highest frequency
  • Focal zone placement to provide a high resolution image

Nephrolithiasis (Kidney stone) detection?

It is possible to confuse calculi with calcified vessels in the kidney.

28

Small

Staghorn Calculi

Kidney Stone (Nephrolithiasis)

Most are ___ and can travel through the urinary system with increased hydration without treatment.

Large stones that fill the renal collecting system are called ____.

Some kidney stones may obstruct the ureter in the constricted areas.

29

Kidney

Urine

Echogenic

Kidney Stone (Urolithiasis/Nephrolithasis):

Majority of stones are formed in the ___ and course down the urinary tract

Made up of a combination of chemicals that precipitate out of ___

Very ___ foci with posterior acoustic shadowing

30

3

Attenuation

Kidney Stones (Nephrolithiasis):

Scanning is done along the lines of the renal fat; stones less than __mm may not shadow

Prominent renal sinus fat, mesenteric fat, and bowel have high ___; they may appear as indistinct echogenic focus with questionable posterior acoustic shadowing, making it difficult to differentiate from stones.

31

White

Clinical

Renal Abscess:

___ rim around cystic area can denote infection

Labs, labs, labs - leukocytosis, fever, pain and sweating

_____ presentation is very important

32

Malignant

Pseudotumor

10% and 15%

When a renal mass is detected:

If a cystic renal mass does not meet the sonographic critera for a simple renal cyst, it must be considered ____.

Renal ____ needs to be considered.

Between ___ % and ___% are metastases at the time of diagnosis

33

Solid; malignant

Malignancy

When a renal mass is detected:

If mass is ____, it must be considered ___ unless fat is present

Calcifications in a renal mass are always a sign of ____.

34

Renal; IVC

When a renal mass is detected: Sonographic considerations -

  • Evaluate the ___ vein and ___ into right atrium to look for thrombus and tumor extension
  • Evaluate the contralateral kidney, liver and retroperitoneum for metastases.
35

Renal

Males

6th and 7th

Pain, hematuria, palpable

Renal Cell Carcinoma: AKA Hyernephroma or Grawitz tumor

  • Most common ___ cancer
  • Unilateral
  • More often in ___
  • __th and ___th decades of life
  • Usually symptomatic presenting with ___, ___ and a ____ mass.
36

Solid

Calcifications

Highly

Renal Cell Carcinoma: Sonographic Appearance -

  • Variable - from a ___ mass to a multilocular cyst
  • Complex - (necrosis and hemorrhaging)
  • ____ is a common finding

Masses often have continuous flow, ___ vascular, with a high systolic and diastolic arterial flow.

37

Metastatic

Renal Cell Carcinoma:

___ sites include the liver, nodes, adrenal, opposite kidney, and IVC for tumor extension.

38

Basket

Renal Cell Carcinoma:

Color doppler peripheral vascularity of the tumor called the ____ sign.

39

Hypoechoic

Low

Infiltrating

Transitional Cell Carcinoma: Sonographic appearance -

  • Isoechoic or ___ mass
  • Hydronephrosis in the collecting system with ___ vascularity on color doppler
  • May invade adjacent renal parenchyma and form an ___ mass, which usually preserves the renal contour.
40

Urinary Tract

Transitional Cell Carcinoma:

Affects any portion of the ___ ___

Symptoms - painless hematuria

41

90

Twice; men; 7th

Transitional Cell Carcinoma:

TCC comprises ___% of all the malignancies that involve the renal pelvis, ureter and bladder.

Occurs ___ as often in ___; peak occurrence in the __th decade.

42

Rare

Non-Hodgkin; Hodgkin

Bilateral

Renal Lymphoma:

Primary lymphomatous involvement of the kidneys is ___; the secondary form is more common.

____ lymphoma is more common than ___ lymphoma

Lymphoma is more common as a ___ invasion with multiple nodules.

43

Enlarged

Halo

Hypoechoic; Renal

Renal Lymphoma: Sonographic findings -

  • ___, hypoechoic mass may simulate a renal cyst without acoustic enhancement
  • No sonographic ___ of hypoechoic mass
  • Very ___ renal tumors with poorly defined margins without posterior enhancement may be confused for ___ cysts.
44

Common

Lung cancer, breast and renal cell carcinoma of the contralateral kidney

Secondary Malignancies of the Kidneys:

METS to the kidney is relatively ___

The most common primary malignancies to the kidneys are? (3)