Module 9 : Fetal GU Pathology Flashcards
(95 cards)
1
Q
what do the ureteric buds become
A
- ureters
- renal pelvis
- calyces
- collecting tubules
2
Q
what do the ureteric buds come from
A
- the wolffian ducts
3
Q
what structure gives origin to the nephrons
A
- metanephros
4
Q
what is the nephrons
A
- glomeruli
- loop of Henle
5
Q
when does fetal urine production begin
A
- 11 weeks LMP
6
Q
what produces amniotic fluid prior to 11 weeks
A
- produced by membranes and a bit by the lungs
7
Q
where are the primitive kidneys located
A
- the pelvis
8
Q
what does a failure of migration of the kidneys cause
A
- ectopic kidneys
9
Q
what view is usually used to image the kidneys, what view is added when pathology is seen
A
- transverse
- sagittal
10
Q
what is normal kidney length equal too
A
- gestational age
11
Q
up to 20 weeks gestation what can mild fetal renal pelvis dilation be up to
A
5mm
12
Q
from 20 weeks to term what can mild fetal renal pelvis dilatation be up to
A
8mm
13
Q
what is the cloaca
A
- terminal end of the hind gut
- divided into two segments
14
Q
where are the two compartments of the cloaca
A
- urinary
- rectal
15
Q
what does the caudal end of the cloaca form
A
- urethra and bladder neck
16
Q
what is the rest of the bladder formed by
A
- allantois which ends at the urachus
17
Q
where do the mesonephric (ureters) enter the bladder
A
- posterior wall of bladder at trigone
18
Q
what shape is the bladder in the transverse plane
A
- triangular
19
Q
prior to 8 weeks LMP what state are the fetal genitals in
A
- ambiguous
20
Q
when do normal male genitalia formed and why
A
- 8-10 weeks LMP
- when testosterone is present
21
Q
what develops without the presence of testosterone
A
- female genitalia are developed due to maternal estrogens
22
Q
up to what week can we not identify gender of baby
A
- 8 weeks
23
Q
what sign means baby girl
A
- hamburger sign
24
Q
what sign means baby boy
A
- turtle sign
+ needs to include penis
25
what is bilateral renal agenesis associated with
- GU abnormalities
- GI abnormalities
- cardiac abnormalities
- sirenomelia-mermaid syndrome
- teratogens
26
what are teratogens
- warfarin
- cocaine
- maternal diabetes (type 1)
27
why can unilateral renal agenesis be missed on ultrasound
- patients asymptomatic
| - kidney will become enlarged because doing all the work
28
what is bilateral renal agenesis
- absent kidneys
29
what shape do the adrenals assume with bilateral renal agenesis
- discoid shape
| - can be mistaken for kidneys
30
what 4 other sonographic features are present with bilateral kidney agenesis
- absent bladder
- oligohydramnios - anhydramnios
- small AC
- IUGR
31
what is potters syndrome
- refers to bilateral renal agenesis
32
what does potters sequence refer to
- consequence of severe oligohydramnios
33
physical appearance of potters syndrome
- pulmonary hypoplasia
- abnormal hand and foot positions
- facial anomalies
- IUGR
34
what are the facial anomalies of potters syndrome
- beaked nose
- low set ears
- prominent epicanthic folds
- hypertelorism
35
what is one tool that can help us diagnose unilateral kidney agenesis
- color doppler
| - only one renal artery
36
sonographic appearance of adrenals with renal agenesis
- laying down adrenal gland
| - adrenals can be mistaken for kidney as they occupy the space where the kidneys should be
37
what is the definition of hydronephrosis
- distention of the renal pelvis and calyces with urine due to obstructions
38
how many renal abnormalities will be hydro and how many are associated with syndromes
75%. 20%
39
is hydro more commonly unilateral or bilateral
- unilateral
40
three causes of hydro
- obstruction
- reflux
- ureterocele
41
4 things to determine when assessing hydro
- bilateral vs unilateral
- degree of hydro
- level of obstruction
- evaluate for other abnormalities
42
3 levels of obstruction for hydro
- hydronephrosis only/only kidneys are dilated
- dilated ureters with hydro
- dilated bladder and keyhole appearance
43
hydro only / only kidneys are dilated
- UPJ obstruction
44
dilated ureters with hydro
- UVJ obstruction
45
dilated bladder and keyhole appearance
- PUV (posterior urethral valve obstruction)
| - typically males
46
grade I hydro
- renal pelvis only
| - pelviectasis
47
grade II hydro
- renal pelvis and calyces visible
48
grade III hydro
- renal pelvis and calyces dilated
49
grade IV hydro
- parenchymal thinning
| + when a nephrostomy tube needs to be put in
50
what is the most common urinary obstruction in neonates
- UPJ (ureteropelvic junction) obstruction
51
characteristics of unilateral UPJ obstruction
- normal bladder and amniotic fluid
52
characteristics of bilateral UPJ obstruction
- oligohydramnios
| - hydronephrosis of varying degrees
53
characteristics of severe UPJ obstruction
- renal parenchymal may be destroyed
54
sonographic difference between bilateral UPJ obstruction and duodenal atresia
- they will be on different levels in the transverse plane
55
3 pitfalls of UPJ
- extra renal pelvis
- prominent renal veins
- reflux
56
what is an extra-renal pelvis
- normal renal pelvis is outside of the kidney
| - extra renal pelvis is under 1.5cm it may mmimic a small hydronephrosis
57
what is reflux
- urine is retrograding from the bladder up, the ureter into the kidney
- transient = kidney dilation comes and goes
58
what is a UVJ obstruction usually caused by
- due to duplicated collecting system with an ectopic ureter location from the upper pole of the kidney
59
UVJ on ultrasound
- dilated upper pole of the kidney with a dilated tortuous ureter
- lower pole of the kidney is normal
60
what structure may the ureter may mimic
- bowel
61
how to differentiate between bowel and ureter
- bowel is medial in the abdomen
| - ureter would be lateral in the abdomen
62
what is an ectopic ureter associated with
- ureterocele in bladder
63
definition of ureterocele
- cystic dilation of the intravesicular portion of the ureter
64
what is a ureterocele associated with
- dilation of the upper pole of the kidney in duplicated collecting system
65
definition of a PUV
- PUV membranes that occur in the prostatic urethra of a male fetus that obstruct the retrograde flow of urine
66
sonographic appearance of PUV
- large distended bladder
- oligohydramnios
- hydronephrosis
- males only
67
three sonographic appearances of bladder rupture
- ascites apparsa
- bladder wall appears thickened
- moderate uretero-pelvicalyceal dilatation
68
what might PUV be a precursor to
- prune belly syndrome (eagle-barrette syndrome)
69
what is eagle- Barrett syndrome
- undescended testicles (cryptorchidism)
70
characteristics of eagle - Barrett syndrome
- very large bladder with abdominal distention
- lack of abdominal musculature
+ after birth abdomen looks like prune form stretching
- ureters may be tortuous and dilated
- kidneys
+ normal
+ hydronephrotic
+ dysplastic
71
what is bladder exstrophy associated with
- cloacal exstrophy
72
what is a cloacal exstrophy
- lower abdominal wall defect
| - involving the lower GI tract, bladder and genitalia
73
what is the OEIS complex
- omphalocele
- exstrophy of bladder
- imperforate anus
- spinal abnormalities
74
4 renal cystic disease
- infantile polycystic kidney disease (ARPKD)
- adult polycystic kidney disease (ADPKD)
- muulticystic dysplastic kidney kidney
- obstructive cystic renal dysplasia
75
what is infantile polycystic kidney disease
- aka IPKD / ARPKD
- autosomal recessive disorder
- primary defect of collecting ducts
- multiple small cysts under 1-2mm ( to small to see on sonography )
76
what is the sonographic appearance of IPKD
- GROSSLY ENLARGED ECHOGENIC KIDNEYS
- but retain reniform shape
- absent bladder
- severe oligohydramnios
77
is IPKD unilateral or bilateral
- always bilateral
78
3 diagnostic criteria of IPKD
- bilateral enlarged echogenic kidneys
- oligohydramnios
- absent bladder
79
4 subtypes of IPKD
- perinatal
- neonatal
- infantile
- juvenile
80
why do IPKD kidney appear echogenic
- all of the interfaces between the small cysts
81
what 3 syndromes is IPKD associated with
- mucked - gruber syndrome
- Roberts syndrome
- trisomy 13
82
three sonographic signs of meckel gruber
- IPKD
- polydactyl
- encephalocele
83
3 sonographic signs of reverts syndromes
- IPKD
- phocomelia (hands and feet attached to truck with single bone)
- cleft palate
84
DDX of IPKD
- benign glomerulosclerosis
85
what is benign glomerluosclerosis
- large echogenic kidneys
- echogenic pyramids and normal fluid
* diagnosed under a microscope
86
characteristics of adult polycystic kidney disease
- aka ADPKD, APKD
- rarely seen in antenatal sonography
- fetus is assessed if parent has disease
87
sonographic appearance of APKD
- enlarged kidneys with cyst
- may be hyperehoic
- amniotic fluid is normal
- fetal bladder is present
- scan parents as well
88
characteristics of multi cystic dysplastic kidney
- aka MCDK
- multiple cystic lesions which due not communicate
- kidneys lose reniform shape
89
what is prognosis of MCKD
- unilateral is good prognosis
- bilateral is rare
+ fatal due to lack of amniotic fluid
+ associated with potters sequence
90
does MCKD have a genetic predisposition
- no
91
two types renal tumors
- nephroblastoma
| - mesoblastic nephroma
92
what is a nephroblastoma
- aka wilms tumor
- solid mass
- not commonly identified in utero
93
what is a mesoblastic nephroma
- most common congenital renal tumor
94
2 adrenal pathologies
- neuroblastoma
| - hemorrhage
95
6 pathologies of genitalia
- hydroceles (male)
- cryptorchidism (male)
- hydrometrocolpos (female)
- ambiguous genitalia
- x linked syndromes
+ turners, noonans, hemophilia
- ovarian cysts (female)
