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DMS 242: Advanced Ob/Gyn > Fetal Genitourinary System > Flashcards

Fetal Genitourinary System Flashcards

1
Q

*When and where should the kidneys be seen in the fetus?

A
  • *by 20 wks, kidneys should be consistently seen adjacent to the fetal spine bilaterally
  • renal cortex, medulla, and sinus can be well differentiated within the fetus
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2
Q

Where do the gonads develop?

A

-in the upper fetal abdomen and descend into the pelvis

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3
Q

When do the testicles move down into the scrotum?

A

-during the 7th month of gestation

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4
Q

When is the earliest the fetal bladder can be seen and when should it be seen by?

A

-can be seen as early as 13 wks and should always be seen by 15 wks

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5
Q

Are normal fetal ureter perceived with sonography?

A

No, so if there is *visualization then it would indicate some pathologic process

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6
Q

What is renal agenesis?

A
  • failure of a kidney to form

- can be unilateral or bilateral

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7
Q

What are the two sonographic finding that help make sonographic diagnosis of renal agenesis?

A
  • First, when kidney is absent in the abdomen, the adrenal gland can be noted in parallel, flattened position, a sonographic finding known as “lying down” adrenal sign
  • Secondly, color doppler can be employed over the renal artery branches of the abdominal aorta- when there is absence of the kidney, there will be no identifiable renal artery branches
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8
Q

*Which type of renal agenesis is the most common?

A

-unilateral renal agenesis

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9
Q

What is the prognosis and amniotic fluid involved with unilateral renal agenesis?

A

-most often, an average amount of amniotic fluid and the prognosis is good

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10
Q

What should the sonographer do before making the conclusion of unilateral renal agenesis?

A

-*always analyze the fetal pelvis for a pelvic kidney, as this is the most common location of an ectopic kidney

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11
Q

What is the most common location for an ectopic kidney?

A

the pelvis

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12
Q

What are the sonographic findings of unilateral renal agenesis?

A
  • absent kidney
  • compensatory hypertrophy of the contralateral kidney
  • visible urinary bladder
  • normal amniotic fluid volume
  • unilateral lying down adrenal sign
  • undetectable renal artery branch with color Doppler (unilateral)
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13
Q

What is compensatory hypertrophy?

A

-when the existing kidney will enlarge taking on the workload of both kidneys

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14
Q

What is another name for bilateral renal agenesis?

A

-*Potter’s syndrome

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15
Q

What is bilateral renal agenesis?

A
  • *a fatal condition

- absence of both of the fetal kidneys

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16
Q

Why is it extremely beneficial to utilize color Doppler to investigate the renal area in bilateral renal agenesis?

A
  • b/c it can be difficult to detect sonographically, secondary to the lack of amniotic fluid surrounding the fetus
  • it can be helpful to determine the location of the renal vessels leading into the kidney or lack of vessels and kidney
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17
Q

What are trustworthy findings consistent with bilateral renal agenesis?

A

non-visualization of the urinary bladder and kidneys; associated with severe oligohydramnios

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18
Q

What are the sonographic findings of bilateral renal agenesis?

A
  • absent kidneys
  • absent urinary bladder
  • severe oligohydramnios
  • bilateral lying down adrenal signs
  • undetectable renal artery branches with color doppler (bilateral)
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19
Q

What is Potter’s sequence?

A
  • deformities with bilateral renal agenesis that are caused by lack of amniotic fluid (causes uterine walls to place pressure on the fetus, not allowing for proper development and growth) :
  • flat nose
  • recessed chin
  • abnormal low set ears
  • wide set eyes (hypertelorism)
  • abnormal or malpositioned limbs)
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20
Q

What is the prognosis for bilateral renal agenesis?

A
  • in most cases, this condition is not compatible with life outside the womb-usually fatal within the first few days of life
  • some newborns can survive IF they have chronic dialysis. Factors such as overall health, and medical support determine the success of this treatment with the goal to sustain the infant until it is strong enough to have a kidney transplant
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21
Q

What is renal hypoplasia?

A
  • congenitally small kidney
  • can be unilateral or bilateral
  • hypoplastic kidney contains a reduced number of nephrons, but has a relatively normal architecture
  • functionality is determined by the severity of the hypoplasia-which may eventually lead to renal failure
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22
Q

Where do the kidneys develop and when is the migration complete?

A

-initially develop close together in the pelvis and gradually migrate into the abdominal cavity by 9th wk of gestation

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23
Q

What is renal ectopia?

A

-when the kidney (most cases only one that remains in the pelvic cavity) fails to migrate to the abdominal cavity

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24
Q

What is crossed ectopia?

A

when both kidney are located on the same side of the body and may be fused together

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25
Q

What is the prognosis of renal ectopia?

A
  • based on possible associated anomalies including:

- gynecologic, gastrointestinal, cardiovascular, skeletal

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26
Q

What are other possible locations for an ectopic kidney?

A

iliac region and thoracic cavity-but these are very uncommon

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27
Q

What is horseshoe kidney?

A

-occurs when there is fusion of the kidneys at the lower poles. The isthmus, typically consists of functional parenchymal renal tissue, (less commonly non-functioning fibrous tissue) which lies anterior to the aorta

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28
Q

What is hydronephrosis/pelvocaliectasis?

A
  • a general term used to describe the dilation of the renal collecting system due to an obstruction of normal urine outflow
  • *most common fetal abnormality noted during an obstetric sonogram
  • may occur as unilateral or bilateral process
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29
Q

Where does the obstruction usually occur with hydronephrosis?

A

in the ureter, bladder or urethra

30
Q

What is the dilation of ureter referred to as?

A

megaureter or hydroureter

31
Q

*What is the most common fetal abnormality noted during an obstetric sonogram?

A

*Hydronephrosis

32
Q

How can fetal pelviectasis be established and measured with sonography?

A

-by taking a renal pelvic diameter

33
Q

What is the typical diameter of the renal pelvis?

A
  • before 33wks gestation, AP diameter should not exceed 4mm

- after 33 wks, normal diameter should not exceed 7mm

34
Q

What is Ureteropelvic junction (UPJ) obstruction?

A
  • most common cause of hydronephrosis in the neonate and most common form of fetal renal obstruction
  • -usually unilateral and more common in males
35
Q

*Where is the UPJ located?

A

*at the junction of the renal pelvis and ureter

36
Q

What is the cause of UPJ obstruction?

A

-may be due to irregular development of the smooth muscle in the area of the UPJ or ureteral stenosis or kinks, adhesions, crossing vessels, or abnormal outlet shapes could be to blame.

37
Q

What are the sonographic findings of UPJ obstruction?

A
  • hydronephrosis (dilation of the renal pelvis and renal calices)
  • normal ureters (non-visualization)
  • normal bladder
38
Q

What is ureterovesical junction obstruction?

A
  • another common cause of hydronephrosis
  • obstruction occurs at the junction of the ureter and urinary bladder
  • initially presents as dilation of the distal portion of the ureter, but quickly leads to hydronephrosis if the obstruction persists
  • more common in males, and almost always unilateral
39
Q

What is the most common urethral anomaly?

A

Posterior urethral valve obstruction

40
Q

What does posterior urethral valve obstruction result in?

A

-hydroureters, hydronephrosis, dilation of the urinary bladder, and oligohydramnios

41
Q

What are PUVs?

A

congenital obstructing flaps of tissue in the male urethra . this flap of tissue prevents normal urine flow from the bladder.

42
Q

What are the types of PUV obstructions?

A
  • complete, partial, or intermittent
  • complete can lead to severe oligohydramnios, Potter’s sequence, and possible renal failure
  • bladder and kidney rupture have occurred in cases where the obstruction was complete and pressure from the obstruction was too high
43
Q

What does the prognosis depend on in PUV obstruction?

A

severity

44
Q

What are the sonographic findings of posterior urethral valve?

A
  • keyhole sign (dilated bladder and urethra)
  • bilateral hydroureter
  • bilateral hydronephrosis
45
Q

*what is the most common cause of fetal bladder rupture?

A

posterior urethral valves

46
Q

What is the keyhole sign?

A
  • seen in males with posterior urethral valves

- refers to the appearance of the proximal urethra, which is dilated, and an associated thick-walled distended bladder

47
Q

What is multicystic dysplastic kidney disease (MCDK)?

A

-characterized by multiple, smooth-walled non-functioning and non-communicating cysts. These cysts are of variable size and number usually found throughout the kidney

48
Q

What happens to functional renal tissue in MCKD?

A

it is replaced by the cysts and thus the affected kidney is non-functional

49
Q

What is the prognosis of MCKD?

A
  • varies based on associated anomalies and whether or not it is unilateral or bilateral
  • bilateral MCKD is fatal outside of the womb, but unilateral isolated MCDK has a favorable prognosis as the disease usually does not progress further than the affected kidney, which can be surgically removed if it is interfering with neighboring organs
50
Q

What are sonographic findings for bilateral multicystic dysplastic renal disease?

A
  • bilateral, smooth-walled non-communicating cysts of variable sizes located within the renal fossae
  • absent urinary bladder
  • oligohydramnios
51
Q

What are the sonographic findings of unilateral MCKD?

A
  • unilateral, smooth-walled non-communicating cysts of variable sizes located within the renal fossae
  • visible urinary bladder
  • normal amniotic fluid volume
  • compensatory hypertrophy of the contralateral kidney
52
Q

What are the categories of fetal renal cystic disease?

A
  • autosomal recessive polycystic kidney disease: both parents must be carriers of the disease
  • autosomal dominant polycystic kidney disease: at least one parent has to be a carrier and the gene must be dominant (as it is capable of overriding the normal gene from parent who isn’t a carrier)
  • multicystic dysplastic kidney disease
  • obstructive cystic dysplasia
53
Q

What is autosomal recessive (infantile) polycystic kidney disease?

A

-cysts with ARPKD are microscopic and not identifiable with sonography

54
Q

What are the categories of ARPKD?

A

Dependent on when symptoms arise:

  • perinatal type-evident in utero-most common
  • neonatal type
  • infantile type
  • juvenile type
55
Q

What are the sonographic findings of ARPKD (infantile)?

A
  • bilateral, enlarged echogenic kidneys. the kidneys may be as large as 3-10X the normal renal size for the gestation
  • absent urinary bladder
  • oligohydramnios
56
Q

What is autosomal dominant (adult) polycystic kidney disease?

A
  • sonographic appearance is similar to that of ARPKD in that both kidneys will appear enlarged and echogenic
  • does not typically manifest until approx. the 5th decade of life, at which time the adult will develop renal cysts and may die from end-stage renal failure
  • associated w/ development of cysts within the liver, pancreas, and spleen
57
Q

What is the distinguishing difference between ADPKD and ARPKD?

A

-the fetus with ADPKD, the urinary bladder is often present and there is a normal amniotic fluid volume, while with ARPKD the bladder is absent and there is oligohydramnios

58
Q

What are the sonographic findings of the ADPKD?

A
  • bilateral, smooth-walled, non communicating cysts of varying sizes located within the renal fossae
  • absent urinary bladder
  • oligohydramnios
59
Q

What is urinary bladder exstrophy?

A

-caused by the defective closure of the inferior part of the anterior abdominal wall during the 4th week of gestation-as a result, the bladder is formed external to the abdominal wall

60
Q

What does urinary bladder exstrophy primarily occur in?

A

-occurs primarily in males and is commonly found with genitalia malformations

61
Q

What genitalia malformations can be commonly found with urinary bladder exstrophy?

A
  • undescended testes
  • displaced scrotum
  • small penis
62
Q

How is the urinary bladder exstrophy seen sonographically?

A

-a small mass is identified outside of the lower abdomen below the umbilical cord insertion

63
Q

What is prune belly syndrome?

A

-describes the result of the abdominal wall musculature being stretched by the extremely enlarged urinary bladder

64
Q

What is prune belly syndrome typically caused by?

A

megacystis-a massively dilated urinary bladder

65
Q

Who is prune belly syndrome mostly seen in?

A

-male fetuses

66
Q
  • What is consistent with the diagnosis of prune belly syndrome?
A

-the triad of absent abdominal musculature, undescended testis, and urinary tract abnormalities

67
Q

What is a hydrocele?

A
  • accumulation of serous fluid around the testicles in the scrotum
  • may occur unilaterally or bilaterally and are generally benign
  • usually resolve after birth
  • larger ones that don’t resolve can be aspirated
68
Q

What is cryptorchidism?

A

-the condition of undescended testicles

69
Q

when do testicles normally descend from the abdomen through the inguinal canals and enter the scrotum?

A

by 28 wks

70
Q

What is VACTERL stand for?

A

vertebral anomalies, anal atresia, cardiac anomalies, tracheoesophageal fistula or esophageal atresia, renal anomalies, and limb anomalies

71
Q

*What is VACTERL association?

A

*When patients are considered to have 3 of the organ system with anomalies listed

DMS 242: Advanced Ob/Gyn (6 decks)

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