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MIDS 187 > Ch 11 Genitourinary System > Flashcards

Ch 11 Genitourinary System Flashcards

1
Q

Urinary tract anomalies are m/c in males or females?

A

Males (such as horseshoe + polycystic kidneys)

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2
Q

U/s evaluation of kidneys is most optimal at what week?

A

Week 20 (they appear isoechoic to surrounding tissues)

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3
Q

By what week can the kidneys be identified?

A

Week 22

(can use CD and/or power doppler to aid in documenting renal arteries)

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4
Q

Kidney length?

A

20 weeks: 2 cm
Term: 4cm

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5
Q

When is the bladder seen?

A

As early as 11 weeks, but definitely by 13 weeks

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6
Q

The fetal bladder fills + voids about how many times per hour?

A

Once

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7
Q

If the bladder is filling, how many kidneys are functioning?

A

At least 1 - it would not fill if there were none

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8
Q

Fetal urinary production begins at what week?

A

9 weeks - increases after 16 weeks + makes up 90% of amniotic fluid by 20 weeks

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9
Q

The presence of oligohydramnios after 16 weeks indicates what?

A

-Suspicious of malfunctioning genitourinary (GU) system due to lack of urine production
-Suspicion of bilateral renal agenesis

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10
Q

Is renal agenesis common?

A

Unilateral: yes (can live normal lifespan)
Bilateral: no (associated with UPJ obstruction + VUR + incompatible with life)

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11
Q

Where to search for ectopic kidney?

A

Abdomen, pelvis + renal fossa

(unilateral agenesis will have 1 very large kidney to compensate for missing the other)

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12
Q

Does unilateral agenesis cause a change in amniotic fluid levels?

A

No, bladder filling remains normal

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13
Q

Where will the adrenal gland be if there is renal agenesis?

A

In the renal fossa

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14
Q

Differential diagnoses for empty renal fossa?

A

Renal aplasia, dysplasia, multicystic dysplastic kidney + renal ectopia

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15
Q

What is the m/c location for an ectopic kidney?

A

Pelvis

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16
Q

SF of an ectopic kidney?

A

-Smaller, malrotated + irregular shape
-Similar echogenicity to surrounding bowel
-Many are dysplastic or hypoplastic with decreased function

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17
Q

Where is a pelvic kidney located?

A

Inferior to renal fossa + superior to bladder (either midline or off midline)

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18
Q

What is crossed renal ectopia?

A

-When a kidney is located on the opposite side from where its ureter inserts into the bladder
-Is fused with the opposite kidney in 90% of cases

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19
Q

What type of cross over is m/c with crossed renal ectopia?

A

Left to right crossover is m/c

(UP of crossed ectopic kidney m/c fuses to LP of normal kidney)

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20
Q

List 2 u/s findings with crossed renal ectopia?

A

-Calyceal dilation
-Hydronephrosis

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21
Q

What is the m/c renal fusion anomaly?

A

Horseshoe kidneys

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22
Q

What is a horseshoe kidney?

A

-When kidneys fuse at LPs (m/c) creating a U shape
-The ishmus is the connection b/w the 2 renal masses

(best seen in TRV or coronal)

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23
Q

Are horseshoe kidneys m/c lower or higher than normal kidneys?

A

Lower

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24
Q

What is an obstructive uropathy?

A

Any blockage of urine flow (m/c in males)

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25
Q

What is one of the m/c fetal anomalies detected on prenatal sonography?

A

Obstruction

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26
Q

List the measurements for mild, moderate + severe hydronephrosis?

A

Mild:
-2nd tri: 4-7mm
-3rd tri: 7-9mm

Moderate:
-2nd tri: 7-10mm
-3rd tri: 9-15mm

Severe:
-2nd tri: >10mm
-3rd tri: >15mm

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27
Q

When hydronephrosis is detected in 2nd tri, a follow up u/s must be done at how many weeks?

A

32 weeks - to determine presence of urinary tract dilation

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28
Q

What is the anterior-posterior renal pelvis diameter that is considered abnormal?

A

> 5mm

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29
Q

What is the m/c cause of congenital obstructive hydronephrosis?

A

UPJ obstruction (m/c males + unilateral)

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30
Q

Where does UPJ obstruction occur?

A

At junction of renal pelvis + ureter

(can be functional (m/c) or anatomic)

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31
Q

SF of UPJ obstruction?

A

Unilateral hydronephrosis w/o ureter dilation + normal bladder

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32
Q

SF of UVJ obstruction?

A

Hydronephrosis with dilation of ureter to bladder but w/o dilated bladder

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33
Q

Does unilateral or bilateral UVJ obstruction result in oligohydramnios?

A

Bilateral

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34
Q

What is a megaureter?

A

Ureter >7mm from 30 weeks onward

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35
Q

What is VUR (vesicoureteral reflux)?

A

Permanent or intermittent retrograde flow of urine from bladder into upper urinary tract

(m/c seen during voiding of bladder)

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36
Q

What is a ureterocele?

A

-Cystic dilation of distal ureter within bladder
-M/c associated with duplicated collecting system + an ectopic ureter insertion
-M/c in females

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37
Q

What is renal duplication?

A

2 renal collecting systems with or w/o separate ureters (m/c unilateral)

38
Q

In a duplex kidney, the UP is m/c obstructed due to what?

A

An ectopic ureter insertion or ureterocele

39
Q

Urethral atresia is characterized by what 2 things?

A

-Anhydramnios (absence of fluid)
-Largely distended bladder that fills the entire fetal abdomen + pelvis

(image in slide shows massive bladder taking up whole baby)

40
Q

What is lower urinary tract obstruction (LUTO)?

A

-Any condition that blocks urinary flow from the bladder
-Characterized by an enlarged bladder (megacystis) + bilateral hydronephrosis

(high mortality due to oligo + pulm hypoplasia)

41
Q

What are the 2 m/c causes of LUTO?

A

PUV (posterior urethral valves - m/c) + urethral atresia

42
Q

What is the keyhole sign associated with?

A

Posterior urethral valves

43
Q

What is a PUV?

A

An obstructing membrane in the posterior urethra due to redundant membranous folds

(causes bladder to not empty + gets enlarged extending into entire pelvis/abdomen)

44
Q

SF of PUVs?

A

-Keyhole sign (point of obstruction)
-Thick walls + dilated bladder
-Dilated prostatic urethra

45
Q

How many types of PUVs are there?

A

3 : type 1 is m/c, type 2 is l/c

46
Q

What is prune belly syndrome?

A

-Cause of urinary tract dilation
-Is the distention of the anterior abdominal wall
-4x m/c in twin pregnancies
-M/c in males

(image in slide shows massive bladder on baby)

47
Q

How can prune belly syndrome be resolved?

A

Place a bladder shunt to drain excess urine + reduce pressure

48
Q

What is the leading cause of perinatal death?

A

Pulmonary hypoplasia + is related to oligohydramnios

49
Q

List the types of polycystic kidney disease (PKD)?

A

Hereditary:
-ARPKD (recessive)
-ADPKD (dominant)

Nonhereditary:
-MCDK (multicystic dysplastic kidney disease)
-Obstructive cystic dysplasia
-Simple renal cysts

50
Q

What is ARPKD?

A

-Bilateral + known as infantile PKD
-M/c cystic disease in pregnancy
-4 types (perinatal, neonatal, juvenile + infantile which is m/c)

51
Q

SF of ARPKD?

A

-Multiple small cysts 1-2mm
-Bilaterally enlarged, homogenous + echogenic kidneys with poor corticomedullary differentiation

52
Q

What is ADPKD?

A

-M/c inherited kidney disease
-AKA adult PKD (APKD) b/c rare in antenatal life

53
Q

SF of ADPKD?

A

-Similar to ARPKD as small cysts are seen
-Can result in enlarged + echogenic kidneys

(can be seen in childhood + utero)

54
Q

Is ADPKD + ARPKD easy to differentiate?

A

NO! Must use other form of analysis

55
Q

What is MDKD?

A

-Multiple noncommunicating cysts varying in size, separated by dysplastic parenchyma/tissue
-M/c unilateral
-VUR is m/c finding with this

56
Q

SF of MCDK?

A

-Multiple large anechoic cysts varying in size
-Increased echogenicity b/w cysts + connective tissue
-Renal pelvis + prox ureter is absent

(image in slide shows kidney full of cysts)

57
Q

What is commonly seen in the contralateral kidney with MCDK?

A

Compensatory hypertrophy

58
Q

What is the m/c cause of nonhereditary fetal renal cystic dysplasia + hyperechoic kidneys?

A

Obstructive cystic dysplasia

59
Q

SF of a simple renal cyst?

A

Single, nonseptated cyst with well defined borders + no communication with renal pelvis

(not common finding)

60
Q

M/c renal tumor?

A

Congenital mesoblastic nephroma - only occur in 3rd trimester

(they are large + take up at least half the kidney)

61
Q

Are kidney tumors common?

A

No, unusual

62
Q

What are adrenal glands?

A

Ovoid, triangular or heart shaped structures m/c in suprarenal region of fetus

63
Q

What trimester are the adrenals best seen?

A

3rd trimester (in SAG)

64
Q

SF of adrenals?

A

Hyperechoic central medulla with hypoechoic thick outer cortex

(are large in a fetus compared to adults)

65
Q

Fetal neuroblastomas develop where?

A

In adrenals

66
Q

What is the only visualized pelvic organ?

A

Pelvis

67
Q

The pelvis consists of what?

A

Echogenic iliac crests, separated from echogenic sacrum by the hypoechoic sacroiliac joints

68
Q

What are the 2 m/c abnormalities in the pelvis?

A

Female reproductive ones:
-internal pelvic masses
-sacrococcygeal teratomas (m/c)

69
Q

What is the urachus?

A

Normal embryonic remnant that exists as a fibrous cord that connects the bladder to the allantois

70
Q

The urachus becomes what ligament?

A

The median umbilical liagament

(has no function)

71
Q

What are the 2 m/c types of urachal anomalies?

A

Urachal sinus + cyst

(fully patent urachus is l/c)

72
Q

What is the m/c complication associated with urachal anomalies?

A

Infection

73
Q

Do cancers have an association with urachal anomalies?

A

Yes - adenocarcinoma + trasitional cell carcinoma

74
Q

What is bladder exstrophy?

A

Severe congenital anomaly that results from failure of mesenchymal cells to migrate b/w ectoderm of abdomen + cloaca, causing eversion of bladder onto abdominal surface

75
Q

Bladder exstrophy can simulate what other anomalies?

A

Omphalocele or gastroschisis

76
Q

What is the cloaca?

A

Common sinus in embryonic development, which it divides to form the rectum, bladder + genitalia

77
Q

What is cloacal exstrophy?

A

Rare congenital disorder due to anomalous development of cloacal membrane

(is most severe anomaly in the spectrum)

78
Q

At what week is it accurate to identify fetal sex?

A

After week 20

(from 12-14 weeks the genital tubercle in M/F is indistinguishable)

79
Q

How to tell the sex of a fetus?

A

Female: downward angle of tubercle
Male: upward angle of tubercle

80
Q

What can make it hard to tell if a baby is a male?

A

-Umbilical cord can look like a penis
-Thighs can hide scrotum

81
Q

How to tell if the sex is a female?

A

3 echogenic lines will be seen representing the labia majora + minora

82
Q

Which trimester is most accurate for evaluating fetal sex?

A

2nd trimester

83
Q

What is hypospadias?

A

Abnormal development of corpus spongiosum + cavernosa urethra due to incomplete fusion of urogenital folds

84
Q

When does testicular descent occur?

A

Adbominally: 10-15 weeks
Inguinally: 26-35 weeks

85
Q

Inguinoscrotal hernias are quite common + most common on which side?

A

Right

86
Q

What is the m/c intraabdominal tumor in female fetuses + neonates?

A

Fetal ovarian cysts

87
Q

Any ovarian cyst over what size is m/c to experience torsion?

A

> 5cm

88
Q

When would ovarian torsion occur?

A

In large, complex ovarian cysts m/c during or right after the antenatal period

89
Q

What is disorders of sex development?

A

A congenital condition where the development of chromosomal, gonadal or anatomical sex is atypical

90
Q

What is androgen insensitivity syndrome (AIS)?

A

-Results in a normal female phenotype (46, XY)
-Amenorrhea presents at puberty + testes may be found (bilateral orchiectomy is done)

MIDS 187 (19 decks)

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