Genitourinary System Flashcards
(67 cards)
1
Q
Uro
A
Entire urinay tract
2
Q
Cysto
A
Bladder
3
Q
Nephro
A
Kidney
4
Q
Cystourethro
A
Bladder and urethra
5
Q
Peylography
A
Renal pelvis and calyces
6
Q
urethro
A
Urethra
7
Q
Urogram
A
Radiographic record obtained by urography
8
Q
Urography
A
A radiograph of part of the urinary tract after the introduction of cm
9
Q
Pelyography
A
Radiographic study of the kidney and usually the bladder
Performed using cm
10
Q
Cystogram
A
A radiograph of the bladder
11
Q
Cystography
A
A radiograph of the bladder after cm has been instilled
12
Q
Cystourethrography
A
A radiograph of the urethra and bladder after the injection of cm
Also called a cystourethrogram
13
Q
Ureterography
A
A radiograph of the ureter after the injection of cm
14
Q
Void or voiding
A
To empty or drain the bladder
15
Q
Nephrogram
A
A radiograph of the kidneys after the injection of cm
Also called nephrography
16
Q
Nephrostomy
A
Surgery to make an opening from the outside of the body to the renal pelvis
17
Q
Kidney Anatomy
A
Rotated about 30 degrees anteriorly toward the aorta
Lie between the level of T12-L3
Right kidney is slightly lower than the left b/c of the liver
Retroperitoneal
Upper pole of the kidney lies posteriorly
Drop about 5cm when standing and mover 1-4cm while breathing
18
Q
Indications for Urinary Studies
A
Renal calculi are the most common reason for performing exams
Chronic UTI’s
Urethral strictures
Anatomic evaluation of the renal pelvises, calyces, and ureters
19
Q
Renal Calculi what are they made of and how they appear on radiographs
A
More than 80% of symptomatic stones contain enough calcium to be radiopaque and detectable on x-rays
Stones are comprised of calcium, uric acid oxalates and mineral Mg
34% of stones are missed due to size, shape or location b/c they are obscured by bone or bowel
20
Q
Locations of Constriction in the urinary system
A
Uretreopelvic junction - where kidney joins the ureters
Brim of pelvis - where the iliac b.v cross over the ureters
Ureterovesical junction - where the ureters enter the bladder. Most common location for a constriction
21
Q
Where do renal calculi occur
A
In the luminal aspect of the urinary tract as well as the renal pelvis
Often lead to renal obstruction
22
Q
Exam prep for urinary tract studies
A
NPO 8 hours before exam
Prep involves cleansing of the bowel to avoid gas and fecal shadows that could obscure areas of interest
23
Q
KUB purpose
A
Scout or preliminary image Done with no contrast given before IVU Verify if the pt prep was successful Determine acceptable exposure factors Verify positions of structures Detect any abnormities prior to cm given such as renal calculi or lesions
24
Q
KUB positioning
A
Pt is supine CR perpendicular IR center on the crests L4 Ensure no rotation of the pelvis Collimate side to side to ASIS Must include both kidneys to symph Expose on expiration
25
Intravenous Urography (IVU) purpose
To visualize the collecting portion of the urinary system, minor and major calyces and renal pelvis of the kidney, entire ureters and bladder
Pt recieves and injection of CM through an intravenous
Assess FUNCTIONAL ability of the kidneys
Evaluate the urinary system for pathology or anatomic anomalies
26
Indications for IVU
```
Abdominal masses renal tumors/cysts
Abnormal calcifications that may be renal calculi
Pyelonephritis
Hydronephrosis
Trauma
Pre-op evaluation
```
27
Contraindications for IVU
```
Renal failure
Diabetes with renal insufficiency
Renal hypertension
Congestive heart failure
Prior contrast reaction
Anuria or absence of urine excretion
Multiple myeloma
Sickle cell anemia
Pheochromacytoma
```
28
Kidney Function Lab Tests
Glomerular Filtration Rate - most accurate screening method b/c it equalizes all body forms. It is NOT influenced by size and muscle mass of pt
BUN - blood urea nitrogen
Creatinine - normal 0.6-1.5mg/100ml, normal for male is 120 or less and female is 100 or less
Significant elevation of these levels suggests renal dysfunction
29
Glucophage/metformin and Contrast Media
Pt with diabetes taking these must wait 48hrs post contrast injection
Dr may order blood work on pt to check renal function after injection if required
30
Prep for IVU
Collect pt history (clinical history, allgeries, blood chem, LMP)
Have pt fill out and sign contrast consent form
Have pt void prior to exam, may use strainer to see if stone has passed
Draw up contrast and have injection supplies read for injection
31
IVU Procedure
Scout KUB taken and shown to rad
30sec-1min nephrogram, kidneys only
5 min AP projection of the kidneys only
10 min AP projection of the entire urinary system "full length"
20 or 30 min AP projection of the entire urinary system
Post void film done recumbent or erect after the pt has voided, entire urinary system included
*each projection taken must have a time marker and is time sensitive*
32
IVU routine and marker procedure
Must be used on each image
30sec-1min AP kidney (blush/nephrogram) to capture early stages of contrast entering system
5 min AP of kidneys or KUB
10 AP full length - include entire system
20 min obliques
Post void PA or erect AP (20-30min)
Depending on pathology can be taken hourly
33
AP Axial Projection of the bladder
Pt lying with legs extended so that lumbosacral portion of spine is arched to tilt anterior pelvic bones inferiorly
CR 2" superior to symph pubis
Angle the tube 10-15 degrees caudad
Angle depends on lordosis of the patient
34
Full length Posterior Obliques
Rotate pt 30 degrees
CR perpendicular to the level of crests, entering approx 10cm lateral to midline of elevated side
Full length done - include kidney to bladder
Expose on expiration
*kidney on elevated side is parallel with IR*
Demonstrates downside ureter off spine
35
Compression
Applied to distal ureters, apply snug fair amount of pressure at levels of crests
Allows for enhanced visualization of renal pelvis and calyceal filling and prod ureters
Contraindications - stones, recent surgery, or pelvic mass or tumour, aneurysms or trauma
36
Structures shown on a KUB
Entire urinary system
| Superior portion of the kidneys and the entire bladder is demonstrated on the image
37
AP Axial Structures shown
Urinary bladder should not be superimposed by pubic bones
| Distal ureters and proximal portion of urethra and bladder
38
PA Axial Projection of the Bladder
Pt is lying prone
CR through the region of the neck of the bladder
Angle tube 10-15 degrees cephalad
Beam entires 1" distal to the tip of the coccyx
39
Posterior Oblique View of the Bladder
Rotate body 40-60 degrees into a LPO or RPO (depending on which ureter is to be demonstrated)
Partially flex downside leg for stabilization
CR perpendicular to IR
CR 2" superior to symph and 2" medial to elevated side
Suspend breath on expiration
40
Structures shown on a Posterior Oblique view of the Bladder
Distal ureters, where the enter the bladder
| Bladder and the proximal portion of the urethra
41
Lateral view of the bladder Positioning
Pt lying in true lateral
Left lateral is the most common, slightly flex knees for stabilization
CR perpendicular to IR
CR 2" superior and 2" posterior to the symph
Suspend breath on expiration
42
Structures shown on a lateral view of bladder
Anterior and posteriors walls and base of bladder
Hips and femurs should be superimposed
*view is optional due to high gonadal dose*
43
Retrograde Urography Purpose
To evaluate the urinary collecting system in patients who are hypersensitive to CM or have renal insufficiency and can't receive an injection of CM
NON FUNCTIONAL exam using contrast which is directly introduced into the urinary system
44
where/who performs a Retrograde Urography
Done by a urologist in the OR using surgical asepsis
45
Retrograde Urography Procedure
Pt is in lithotomy position, arms are crossed over their chest
Contrast is introduced via catheterization
Scout image is taken before cm is introduced
Most projections taken include the entire urinary system
No time considerations when images are taken but sequence of images taken must be accurately marked
46
Structures shown in Retrograde Urography
The entire urinary system from the superior portion of the kidney to bladder
Can be unilateral or bilateral
Catheters used for injection will be in the image
Respect the surgical field during imaging
47
Where/who performs a IVU
Done by the radiologist in the DI department
48
Retrograde Cystography
Performed to rule out tumors, calculi, trauma and inflammatory diseases of the bladder
NON FUNCTIONAL exam to demonstrate the size and shape of the bladder after cm has been injected directly into the bladder
49
Where/who performs a Retrograde Cystography
Done in the DI department by a rad and tech
50
Procedure for Retrograde Cystography
A urinary catheter is placed into the bladder using aseptic conditions after the patient has voided
The cm is allowed to flow by gravity
Never attempt to introduce cm under pressure as it may caused the bladder to rupture
Take 4 exposures - AP view of bladder, both AP obliques of the bladder and a lateral projection of the bladder
51
Voiding Cystourethrogram
Evaluates the patients ability to urinate or void
FUNCTIONAL study of the urethra and bladder
May be performed after a routine cystogram
52
Indications for Voiding Cystourethrogram
Adults - in continence and trauma
| Kids - chronic UTI's or kidney infection, suspicion of reflux, bed wetting or difficulty toilet training
53
Where/who performs a voiding cystourethrogram
Done in the x-ray department using Fluoro to demonstrate the action of voiding
Done by radiologist and tech
54
Procedure for a voiding Cystourethrogram
A catheter is introduced into the patients full bladder and contrast runs by gravity through the catheter until the bladder is full
Then the catheter is gently removed and patient it required to void
Easier to void erect than supine (dependent on pt mobility)
Female projections - AP or slight oblique position
Male projections - 30 degree oblique RPO
Post void image may be required to demonstrate any reflux of urine into the bladder
55
Percutaneous catheter Nephrostomy (PCN) performed for
THERAPEUTIC procedure performed for
Drainage - for obstruction of the urinary tract, leakage of fistulas, or for an abscess or infected cyst
Drug instillation - for antibiotics, chemical dissolution of stones or chemotherapy
Instrument insertion - for basket catheters (stone removal), biopsy brushes, ballon catheters (dilation)
56
Complication of PCN
May include infection, catheter dislogement, catheter obstruction or hemorrhage
57
PCN procedure
Pt is prone on the Fluoro table in DI department
Affected side is cleansed and draped, the kidney is localized using ultrasound or can injection of contrast into the kidney using Fluoro
Area is anesthetized with local anesthetic and a fine bore needle is inserted into the kidney. Cm is injected directly through the needle and into the kidney to demonstrate the collecting system
A small incision is made on the surface of the skin and a trocar cannula unit is inserted into the calyx of the kidney using Fluoro. Once the correct location for the cannula is established the trocar is removed and the cannula is left in the kidney
58
Nephrostography purpose
Examination of the collecting system of the kidneys and ureters via injection of cm into a Nephrostomy tube
Is a follow up exam to determine the extent or progress of the pathological condition for which the Nephrostomy tube placement was required
59
Nephrostography procedure
Pt prone on table w/ Nephrostomy tube exposed
Using aseptic techniques, the rad will inject water soluble contrast into the Nephrostomy tube and takes images of the structures of the kidney while they are being filled with contrast
When pathology condition is stabilized/decreased in size the Nephrostomy tube will be removed
60
Purpose of a Extracorporeal shock wave lithotripsy (ESWL)
Involves generating shock waves from an electrical source to pulverize calculi w/o any incision into the kidney
A preliminary abdomen film and intravenous urogram are taken and evaluated by the radiologist
The calculus must be radiopaque and greater than 2mm in size
Some large staghorn calculi and stones composed of syringe may be harder to break up
Fragments of pulverized stones will pass down the ureter so the utter must not be obstructed
61
ESWL procedure
Radiography may be required to localize the calculi
The shock chambers of the lithotripsy machine are placed against the skin surface to which ages has been applied
Pulses are sent to the chambers, producing shock waves, which fragment the stone. The location can be verified periodically using Fluoro
When the calculi are pulverized, it will have a fuzzy appearance on the Fluoro monitor
62
ESWL post procedure
Pt is observed for a few hours for erythema, bruising, hematuria, dysuria, and renal colic
Blood pressure will be checked regularly and urine will be strained for calculi
Pt is encouraged to drink fluids to help flush the fragments of the stone
Follow up visits occur to check blood pressure and KUB projections are performed to determine the status of the stone
63
Percutaneous Nephrolithotomy procedure
Involves an incision into the kidney to remove the stones with a basket catheter extraction or an ultrasonic lithotripter
Radiographic assistance is required to help localize and guide the catheter
64
Basket extraction (Nepthrolithotomy)
Performed to remove small, free floating calculi in the kidney. The stone is trapped in the basket and dragged through the incision out of the body
65
Ultrasonic Lithotripter (Nephrolithotomy)
A small device that can be inserted into an opening in the kidney and rest up against a calculus. Ultrasonic vibrations are transmitted to the calculi, which will break up the stone. The center core of the device is hollow and attached to a suction apparatus, which will remove the fragments as they are broke off the calculi
66
Hysterosalpingraphy purpose
To investigate the patency of uterine tubes in pt's who were unable to conceive
To determine the shape, size, position of the uterus and uterine tubes, and to delineate lesions such as polyps, submucous tumor masses and fistulous tracts
*scheduling must be 10 days after onset of menstruation, pt must not be pregnant at the time of examination*
67
Hysterosalpingraphy procedure
Pt is supine in the lithotomy position
Exam performed in the DI department by gynaecologist and tech
Uterine cannula is inserted through the cervical canal and then contrast is injected into he uterine cavity
Contrast flows through pt uterine tube and then spills into the peritoneal cavity where it is absorbed/eliminated by the urinary system
If there is a blockage contrast will not spill into the peritoneal cavity
Contrast is injected then visualized using Fluoro
Images are taken to confirm spillage/blockage
Ensure anatomical marker is on before taking images
