Intravenous Urography IVU Flashcards by Alvernia Li

What is IVU/IVP(Intravenous Pyelogram)

It is a specialized X-Ray examination of the kidneys, Ureters and Bladder (Urinary System), following the injection of a contrast media

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What does IVU demonstrates on the radiograph?

Renal Calyces
Renal Pelvis
Ureters
Bladder

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What is the purpose of doing an IVU?

To visualise the collecting portion of the urinary system
To assess functional ability of the kidneys
To evaluate the urinary system for pathology or anatomic abnomalities

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Where do the kidneys lie in the body?

Retroperitoneal Space

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What are the fatty tissues surrounding the kidneys called?

Perirenal Fats

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Which kidney lie more inferiorly than the other?

Right Kidney

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How much angulation and the positioning type used for IVU?

30 degrees rotation, Posterior Oblique to place kidney parallel to IR.

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Where do the ureters lie?

Anterior to kidneys

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What is the capacity of the bladder?

350 - 500mls

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Which anatomical structure surrounds the proximal urethra, inferiorly to the bladder?

Prostate Gland

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Define Polycystic kidney?

Polycystic kidney disease (PKD) is a genetic disorder that causes many fluid-filled cysts to grow in your kidneys. PKD cysts can change the shape of your kidneys, including making them much larger.

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Define Ureterocele

A ureterocele is a congenital abnormality that involves a swelling or ballooning at the lower end of one or both ureters, which are the tubes that carry urine from the kidneys to the bladder. This condition typically affects the portion of the ureter where it enters the bladder.

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Define Glomerulonephritis

Glomerulonephritis refers to a group of diseases that affect the glomeruli. Inflammation of the glomeruli occurs, leading to impaired kidney function.

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Define Vesicoureteral reflux

Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder into one or both of the ureters and, in some cases, may reach the kidneys.

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Define Cystitis

Inflammation of the Bladder.

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Define Intravenous extravasation

Intravenous extravasation refers to the unintentional leakage of fluid or medication from a vein into the surrounding tissues instead of flowing into the bloodstream as intended.

What are the 3 constriction points?

Ureteropelvic Junction
Brim of Pelvis
Ureterovesical Junction (UV Junction)

What is the name of the junction between the distal ureters and urinary bladder?

Ureterovesical Junction

What is the medical term for involuntary urination?

Urinary Incontinence

A common bacterium that may lead to a Urinary Tract Infection (UTI)?

Escherichia Coli

What are some IVP contra-indications?

Pregnancy
Hypersensitivity to Iodinated contrast media
Diabetes Mellitus (compromised renal function)
Acute or chronic renal failure
Congestive Heart Failure
Elevated Creatine Level (>200mls) - contrast cannot be excreted.

Can patients on anti-diabetic medications undergo IVP?

Depends on Dr’s assessment. Patients on Metformin MUST WITHOLD for 48 hours following iodinated contrast media adminstration to prevent drug-drug interactions.

Name FOUR(4) pieces of equipment which should be present in an IVU room that are not usually found in a general x-ray room.

Emesis basin
Lead markers - anatomical, minute markers
Ureteric compression band
Oxygen supply

Explain the reasons for patients to fast at least 8 hours before the intravenous urography procedure.

Clear Visualization of Abdominal Structures:
Minimize Bowel Gas Interference
Reduce Potential Complications
Patient Comfort and Cooperation - reduce nausea and vomiting.

State TWO(2) situations where fasting is not required for IVU.

Pediatric cases/ Emergency Adult cases/ Frail elderlies

Explain the reason(s) patients are told to empty their bladder before the IVU procedure

A full bladder could rupture if compression is applied. Urine present in the bladder will dilute the contrast medium.

List FOUR(4) conditions that, if present, may place the patient at a greater risk of contrast media reactions.

Diabetes Mellitus (due to compromised renal function) Hypersensitivity to iodinated contrast media (including other things such as seafood) Asthma Acute or Chronic kidney Disease Congestive heart failure

What are some examples of contrast media reactions?

Extravasation Phlebitis Anaphylactic reaction Urticaria Hives

List the sequence of radiographs taken for a routine IVU procedure.

1. Inject CM 2. Wait for 1 minute 3. Do 1 minute nephrogram or nephrotomogram (place the 1 min marker) 4. Apply compression band immediately 5. Wait until the 10th minute, then do a 10min cone-down kidney projection (place the 10 min marker) 6. Release compression after 20mins 7. Do a 20mins full KUB immediately after releasing compression (place the 20mins marker) 8. Instruct patient to empty his/her bladder 9. Do a post-micturition KUB after voiding (place the POST VOID marker) - can be done errect, supine or prone. Extra: Bladder view may be added just before (Scouting) or after the patient has emptied his/her bladder, depending on hospital's protocol.

State TWO(2) situations where the routine sequence has to be changed and describe the primary differences.

Routine sequence has to be changed when: 1. Compression is contra-indicated 2. Extended imaging time (slower) in patients with compromised renal function (can happen when ureteric calculi is present - resulting in slow filling of the ureter). Primary differences are in the timing of the sequence - 1, 3, 5mins, post-micturition.

Why is Ureteric Compression necessary in IVU?

Ureteric compression may be employed to delay the passage of contrast material through the ureters, allowing for better visualization of the anatomical structures in the urinary system.

State the precautions a radiographer needs to take before applying the compression.

Make sure the patient has no contra-indications (e.g. any recent abdominal surgery, pregnancy, any abdominal pains) No radio-opaque objects. Make sure the compression band is free of any contrast media.

State FOUR(4) situations when compression is contra-indicated.

Recent abdominal surgery (<3 - 4 months ago)/Abdominal mass/Severe abdominal pain/Acute abdominal trauma/Pregnancy

Where should the tourniquet be placed?

The tourniquet should be placed 5 cm proximal to the site of a venipuncture.

If IVU and barium enema are both scheduled, state and explain which procedure should be performed first?

IVU should be done first. Although the contrast used for both procedures are different, its clearance rate varies. Hence, the residual CM can interfere with visualization of the anatomical structures of interest.

State and explain what the radiographer has to do for a patient who has a urinary catheter and bag before IVU.

Ensure that urinary catheter tubing is clamped before procedure to prevent the flow of CM into the urinary bag.

State with reasons the kVp range recommended for IVU.

75kVp. Maximises contrast enhancement by CM for better visualization of anatomical regions.

The renal parenchyma is best seen at which stage of an IVU?

Arterial

kidneys received about ______% of the total cardiac output.

20 - 25%