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OB Pathology > chpt 63 fetal uriogenital > Flashcards

chpt 63 fetal uriogenital Flashcards

1
Q

what are the three set of excretory organs that develop in the embryo

A
  1. pronephrous2. mesonephrous 3. metanephrous
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2
Q

permanent kidney

A

metanephros

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3
Q

The permanent kidney develops ?

A

early in the 5th week

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4
Q

When does urine formation begin?

A

early in the first timester, around the 11th and 12th week

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5
Q

urine is excreted into the _______ and forms major part of ____________.

A

amniotic cavity, amniotic fluid

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6
Q

T or F; The kidney does not need to filtrate in utero? Why

A

True; because the placenta elimates waste from fetal blood

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7
Q

T or F; The kidney lie far apart in the pelvis

A

false; kidney lie close together

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8
Q

The kidneys migrate into the abdomen and seperate from one another around ______ week of gestation.

A

9th

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9
Q

T or F; in some cases one kidney can stay in the pelvic cavity while the other migrates into the posterior flank of the abdomen

A

True

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10
Q

pelvic kidney may appear in females as?

A

pelvic masses

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11
Q

arterial supply to the kidney comes from?

A

arteries that arise from the aorta

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12
Q

At least ______% of adult kidneys have two or four renal arteries

A

25%

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13
Q

The female urinary bladder derives from?

A

hindgut

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14
Q

hindgut is know as?

A

urogenital sinus

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15
Q

the caudal end of the mesonephretic ducts opens into the?

A

cloaca; and parts are absorbed into the urinary bladder wall

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16
Q

distingushing sexual characteristics begin during the _____ week and external genital organs are fully developed by the _____ week

A

9th week; 12th week

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17
Q

fetal testis produce ? and cause?

A

they produce androgens; and cause masculinization of the external genitalia

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18
Q

what elongates to form the penis?

A

phallus

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19
Q

the ______ swelling grow toward the median plane and fuse to form the _______.

A

labioscrotal; scrotum

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20
Q

The testis remain near the deep inguinal rings until ____ weeks

A

28th

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21
Q

failure to complete the descend of the gonads is?

A

cryptorchidism

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22
Q

the gonads descend through the ____ and enter the scrotum before birth.

A

ingunal canal

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23
Q

uretha and vagina both open into the ____?

A

ureogenital sinus/ vestibule of the vagina

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24
Q

the uerogenital folds become the ?

A

labia minora

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25
Q

the labioscrotal folds become the ?

A

labia majora

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26
Q

the phallus becomes the ?

A

clitoris

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27
Q

the formation of the uterus is dependent on?

A

the fusion of two paramesonephreic ducts (mullerian ducts)

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28
Q

what happens if fusion of the paramesonephrenic ducts is incomplete? compete failure of this fusion will cause?

A

1.duplication of the uterus or vagina may occur 2. duplication of the entire femal tract or bicornuate uterus(duplicaton of uterus and one vagina)

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29
Q

what is uterus didelphys?

A

double uterus and double vagina

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30
Q

If only one paramesanephric duct develops this will cause?

A

unicornuate uterus (single uterine tube and horn)

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31
Q

At least 86% of fetal kidneys may be image at ____ weeks

A

12th

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32
Q

kidneys should be documented in all fetuses songraphically at ____weeks.

A

18

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33
Q

When kidney appear enlarged and echogenic ?

A

infantile polycystic diseast (with oligohydraminos), adult polycystic disease (normal amniotic fluid volume), Meckel-Greuber, trisomy 13

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34
Q

The kidneys are hyperechoic with regard to surrounding tissues at ____weeks.

A

18-20

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35
Q

describe the kidneys songraphically at 25 weeks.

A

relatively homogeneous renal cortex and parenchyma, hypoechoic pyramids and calyces, and anechoic renal pelvis

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36
Q

Where should the kidneys be visualized?

A

adjacent to the spine

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37
Q

If kidney is not well seen the fetal pelvis should be scanned to rule out?

A

ectopic kidney

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38
Q

Is it possible to have a unilateral kidney agensis?

A

yes; the contralateral kidney will be enlarged to compensate

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39
Q

on transverse image the renal pelvis is measured? and

A

anterior to posterior diameter when the fetal spine is toward the maternal anterior wall

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40
Q

What is the upper normal limit for transverse scan of the kidney?

A

_ 4mm up to 33 wks gestation and 7mm from 33 weeks of gestation until term_

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41
Q

The ureters usually measure____ in diameter and are filled with fluid.

A

less than 1 to 2 mm

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42
Q

T OR F; NORMAL URETER ARE ALWAYS SEEN

A

FALSE

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43
Q

DILATION OF THE POSTERIOR URETHRA IS HIGHLY SUSPICIOUS FOR ?

A

OBSTRUCTIVE PROCESS CALLED POSTERIOR URETHRAL VALVE SYNDROM (KEYHOLE BLADDER SIGN)

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44
Q

POSTERIOR URETHRAL VALVE SYNDROME OCCURS IN _______ AND IS MANIFESTED BY THE PRESENCE OF __________?

A

MALE FETUSES; A VALVE IN THE POSTERIOR URETHRA

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45
Q

WHAT IS A ROUND ECHO FREE AREA LOCATED CENTRALLY IN THE PELVIS?

A

BLADDER

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46
Q

HOW LONG DOES IT TAKE THE BLADDER TO FILL AND EMPTY?

A

30 MINUTES

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47
Q

EXTERNAL GENITALIA IS DIFFERENTIATED IN THE ______ TRIMESTER?

A

SECOND

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48
Q

In second trimester, identification of the female should only be documented when?

A

major and minor labia is seen

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49
Q

Abnormal congenital opening of the male urethra on the undersurface of the penis

A

Hypospadias

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50
Q

accumulation of serous fluid around the testicle, resulting from communication with the peroneal cavity and are generally benign

A

hydrocele

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51
Q

what is the critial marker in the assessment of renal function?

A

amniotic fluid

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52
Q

the fetal kidneys begin to excrete urine after the _____ week and do not become the major contributor of fetal urine until_____?

A

11th; 14-16 weeks

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53
Q

Name the two categories of Renal malformations?

A

1.congenital malformation 2. resulting from obstruction process

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54
Q

complete absence of the kidney

A

renal agenesis

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55
Q

letal disorder because of renal insuffiency and hypoplasia of the lungs

A

bilateral renal agensis

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56
Q

the presence of at leat one functioning kidney

A

unilateral renal agensis

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57
Q

what makes it difficult to image the kidneys

A

oligohydraminos

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58
Q

what determines if the kidneys are present or not?

A

presence or absence of the urinary bladder

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59
Q

unilateral renal agensis is estimated to occur in?

A

1 in 600-1000 births

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60
Q

bilateral renal agensis is referred to as?

A

Potters syndrome

61
Q

what diseases are associated with potter’s syndrome?

A

diesease associated with renal failure, oligohydraminos, pulmonary hypoplasia, abnormal facies, malformed hands and feet

62
Q

T or F; Potter’s syndrome can be uni or bilateral?

A

True

63
Q

Potter’s Type 1

A

autosomal recessive infantile polycystic kidney disease

64
Q

Potter’s type 2

A

Renal agensis; multicystic dyplastic kidney, renal dysplasia

65
Q

Potter’s type 3

A

autosomal dominate polycystic kidney disease

66
Q

Potter’s type 4

A

renal dysplasia; obstructive kidney disease

67
Q

autosomal recessive disorder that affects the fetal kidneys and liver

A

infantile polycystic kidney disease

68
Q

IPKD is characterized by?

A

development of small cyst on both kidneys and liver

69
Q

most sever IKPD is associated with?

A

renal failure, oligohydraminos, and absent urinary bladder

70
Q
A
71
Q

What is a characteristic finding of Potter’s syndrome 1?

A

symmetric enlargement of both kidneys secondary to renal collecting tube dilation

72
Q

What occurs in most severe cases of IPKD?

A

renal failure

73
Q
A
74
Q

Intrauterine diagnosis of IPKD should only be considered when the following characteristics are found:

A
  • family history of IPKD
  • bilateral enlarged kidneys
  • highly echogenic kidney texture
  • significant oligohydramnios
  • inability to ID the fetal bladder
75
Q

When may enlargement of kidneys from Potter’s syndrome 1 occur?

A

24th week, so serial studies are recomended

76
Q

With Potters syndrome 1, why are kidneys so massively enlarged?

A

hundreds of dilated tubules

77
Q

Multicystic Dysplastic Kidney Disease (MCKD) is characterized by:

A
78
Q

What is the most common form of renal cystic disease in childhood and represents one of the most common abdominal masses in the neonate?

A

multicystic dysplastic kidney disease

79
Q

T/F: Incidence of MCKD is found more often in females than males.

A

False, males

80
Q

Although most cases of MCKD are unilateral, nearly ______ of cases are bilateral

A

1/4

81
Q

Associated abnormalities of Potters syndrome 2 / MCKD may involve:

A

the contralateral kidney, heart, central nervous system, extremities, and GI syndromes

82
Q

The prognosis for infants with MCKD varies based on

A

prenatal findings

83
Q

When both kidneys are found to be multicystic, oligohydramnios and an absent bladder are expected;

A

a lethal condition exists for the neonate

84
Q

If only one kidney is affected the other may enlarge as a result of:

A

compensatory hypertrophy

85
Q

Describe the multicystic dysplastic kidney:

A
  • composed of multiple smooth walled, non functioning, non communicating cysts of variable size and number
  • kidney borders are difficult to define
  • ureter and renal pelvis may be atretic and the renal artery is hypoplastic or absent
86
Q

Adult dominant polycystic kidney disease (ADPKD) is associated with:

A

-cystic dilation of the nephrons and of the collecting tubule walls in both kidneys

87
Q

What is the most common of the heredditary diseases?

A

Adult dominant polycystic disease

88
Q

Prognosis of prenatal diagnosis of APKD depends on the progression of

A

cyst development leading to renal failure

89
Q

The sonographic appearance of ADPKD is similar to what?

A

autosomal recessive polycystic renal diease (kidneys are symmetrically enlarged and echogenic)

90
Q

T/F: ADPKD (potters syndrome 3) is nearly always bilateral

A

True

91
Q

When does renal dysplasia occur secondary to renal obstruction?

A

in the 1st or early second trimester of pregnancy

92
Q

Unilateral obstructive cystic disease can be caused by:

A

a uteropelvic or ureterovesical junction obstruction

93
Q

bilateral obstructive dysplasia is caused by:

A

severe bladder outlet obstruction, usually urethral atresia or posterior urethral valves

94
Q

Prognosis of Potter’s syndrome Type 4 (obstructive cystic disease) depends on

A

unillateral or bilateral involvement

95
Q

Bilateral involvement of PS4/ obstructive cystic disease indicates

A

a poor outcome resulting from renal failure and lung hypoplasia

96
Q

Early son. findings of PS4/ obstructive cystic disease:

A

hydronephrosis or hydroureter..but as kidney stops functioning, the cortex becomes completely dysplastic and replaced with the multiple cortical cysts

97
Q

How do dsyplastic kidneys appear?

A

small and echogenic with cortical peripheral cysts

98
Q

If obstructive cystic disease is bilateral, look for

A
  • early bladder outlet obstruction (keyhole bladder)
  • bilateral hydronephrosis
  • thick-walled bladder
  • sever oligohydramnios
99
Q

When does renal ectopia occur?

A

when the kidney lies outside of its normal position in the renal fossa..usually in pelvis

100
Q

What is crossed renal ectopia?

A
  • when the ectopic kidney lies on the opposite side of the abdomen relative to its utereral insertion into the bladder
  • kidneys are usually fused together and found on right side of abdomen
101
Q

Is crossed renal ectopia found more in males or females?

A

males

102
Q

With horseshoe kidneys, if the spine is down;

A

the connecting isthmus may be seen anterior to Aorta

103
Q

Where may the urinary tract by obstructed?

A
  • ureteropelvic junction
  • ureterovesical junction
  • level of urethra (megacystistis)
104
Q

Amount and degree of urinary tract obstruction depends on

A

the gestational age at which the obstruction began

105
Q

If urinarytract obstruction occurs early,

A

a multicystic kidney may develop

106
Q

If the obstruction occurs in the late first trimester or second trimester:

A

cystic dysplasia may result

107
Q

Late obstruction produces:

A

hydronephrosis

108
Q

What is the most common fetal anomaly?

A

fetal hydronephrosis

109
Q

Up to 22 weeks, hydronephrosis looks

A

the measurements of the renal pelvis are uniform

110
Q

After 22 weeks, how does hydronephrosis look?

A

the obstructed kidneys produce increased renal pelvic diameters and true hydronephrosis

111
Q

Describe son appearance of hydronephrosis

A
  • dilated renal pelvis, which often communicates with the calyces, is centrallly located and distended with urine
  • remaining renal tissue may be ID’d in all but the most severe cases of hydronephrosis
112
Q

Renal pelvis measurements in 2nd trimester:

A

4-10 mm

113
Q

Renal pelvis measurements in 3rd trimester:

A

7-10 mm

114
Q

What is an abnormal renal pelvis measeurment?

A

exceeding 10-15 mm in the AP direction in the transverse plane

115
Q

What is the most common reason for hydronephrosis in neonates?

A

ureteropelvic junction obstruction

116
Q

HOw many obstruction disorders are found during early childhood?

A

1/2, so early prenatal detection may improve long-term renal function

117
Q

What are the causes of ureteropelvic junction obstructions?

A
  • abnormal bends or kinks in ureter
  • adhesions
  • abnormal valves in ureter
  • abnormal outlet shape at the ureteropelvic junction
  • absence of the long muscle that is imperitive to the normal excretion of urine from kidney
118
Q

UPJ obstruction is usually a _______ defect

A

unilateral ; amniotic fluid remains normal because of the normal contralateral kidney

119
Q

What is a urinoma?

A

a large cyst in contact with spine associated with ureteropelvic junction obstruction

120
Q

Uterovesical junction obstruction commonly presents with

A

dilation of lower end of ureter (megaureter)

121
Q

What may megaureter result from?

A
  • primary ureteral defect (stenotic ureteral valves or fibrosis)
  • secondary to obstruction at another level (causing reflux of urine)
122
Q

With obstructed urinary tract, the affected kidney shows what?

A
  • dilation of the renal pelvis
  • tortuous dilated ureter
  • duplication of the renal collecting system
123
Q

When a dilated upper renal pole is observed with abnormal lower pole:

A

an obstructed duplicated collecting system may be indicated

124
Q

What is a ureterocele?

A

a cystic dilation of the intravesical (bladder) segment of the distal ureter

125
Q

What is an ectopic ureter?

A

one thaat does not insert near the posterolateral angle of the trigone area of the bladder

126
Q

Where does an ectopic ureter insert for females?

A
  • vagina
  • vestibule
  • uterus
127
Q

Where does an ectopic ureter insert in males?

A
  • seminal vesicle
  • vas deferens
  • ejaculatory ducts
128
Q

What is bladder outlet obstruction produced by?

A

a membrane within the posterior urethra

129
Q

What does posterior urethral valve obstruction result in?

A
  • hydronephrosis
  • hydroureters
  • dilation of the bladder and post. urethra
130
Q

What causes the keyhole sign?

A

posterior urethral valve obstruction which causes urine to be unable to pass through the urethra into AF..bladder wall is severly thickened with a dilated posterior urethra

131
Q

Oligohydramnios results in what lung and chest problems?

A

lungs are hypoplastic, chest circumference is severelyl depressed.

132
Q

Severe oligohydramnnios is a classic finding of

A

complete obstruction form

133
Q

What abnormalities should be considered in the female fetus with sonographic findings consistent with obstructive urinary tract abnormalities?

A
  • sacrum anomaly (caudal regression)
  • megacystis-microcolon intestinal hypoperistalsis syndrome
134
Q

Prune belly syndrome is AKA

A

urethral obstruction malformation complex

135
Q

Prune belly syndrome/ urethral obstruction malformation complex consists of:

A
  • cryptorchidism
  • agenesis of abdominal wall muscle
  • megaureters
  • bladder outlet obstruction caused by urethral anomalies, such as atresia, stenotic valves, or diverticulum
136
Q

Son findings of prune belly syndrome:

A
  • oligohydramnios
  • mild to severe bilateral hydronephrosis
  • fetal ascites
  • hypoplastic lungs
  • abdomen is extremely distended compared with small thoracic cavity
  • dilated ureters ad bladder appear as numerous cystic lesions within distended abd. cavity
  • bladder may be obstructed and massively dilated or may rupture and not be seen except thru ascites
137
Q

Describe true hermaphroditism

A
  • rare condition in which both ovarian and testicular tissues are present
  • internal and external genitalia are variable
  • most fetuses have normal karyotype
138
Q

What karyotype does a female fetus with pseudohermaphroditism have?

A

46XX

139
Q

The most common cause of pseudohermaphroditism in females is

A

congenital virilizing adrenal hyperplasia that causes masculinization of the external genitalia (enlarged clitoris, abnormalities of urogenital sinus, and partial fusion of the labia majora)

140
Q

The male fetus with pseudohermaphrodistism has what karyotype?

A

46XY and testes

141
Q

What does male psuedohermaphroditism look like?

A

variable external and internal genitalia depending on developement of the penis and genital ducts

142
Q

What is hydrometrocolpos?

A
  • collection of fluid in the vagina and uterus, sometimes seen in conjunction with a doube uterus and septated vagina
  • sometimes fluid is so large that it extends into the abd. cavity or may cause compression of the ureters and hydronephrosis of kidneys
143
Q

Son. findings of hydrometrocolpos

A
  • hypoechoic “cystlike” mass posterior to the bladder in the area of the uterus
  • may be predominately cystic, may contain midlevel echoes, or fluid-debris levels
144
Q

Echoes within hydrometrocolpos may result from

A

mucous secretions

145
Q

What do ovarian cysts in fetuses result from?

A

maternal hormonal stimulation and is usually benign

146
Q

Differential considerations for ovarian cysts in fetuses:

A
  • mesenteric cyst
  • urachal cyst
  • enteric duplication
147
Q

Sonographic findings of fetal ovarian cysts?

A

multiseptated and bilateral

148
Q

What happens when an ovarian cyst twists on itself?

A
  • torsion
  • rupture
  • or intestinal obstruction

OB Pathology (16 decks)

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