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Pediatric and Superficial Structures > Pediatric Urinary System, Adrenals, and Retroperitoneum > Flashcards

Pediatric Urinary System, Adrenals, and Retroperitoneum Flashcards

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1
Q

At what age are kidneys a similar size to adults?

A

> 15 yrs

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2
Q

SF of pediatric kidneys

A
  1. Prominent renal pyramids
  2. Increased echogenicity of cortex
  3. Irregular renal outlines due to lobulations
  4. Should not be a difference of >2cm between kidneys
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3
Q

What is another term for renal junctional defect?

A

Interrenucular defect - prominent renal lobulation

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4
Q

SF of renal junctional defect?

A

Triangular echogenic indentation of cortex

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5
Q

What are column of bertin?

A

Extension of the cortex that separates the pyramids - cortical tissue invaginating renal sinus

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6
Q

What should the renal pelvis typically measure?

A

<10mm

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7
Q

What is another name for bilateral renal agenesis?

A

Potter syndrome

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8
Q

What should you suspect with a “lying down adrenal sign”?

A

No kidney within the renal fossa - absent kidney

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9
Q

What is the most common palpable mass in neonates and most common renal anomaly diagnosed in infants?

A

Hydronephrosis

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10
Q

What is hydronephrosis most commonly caused by?

A

Obstruction - UPJ

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11
Q

Signs and symptoms of hydro?

A
  1. Palpable abdominal mass
  2. Flank pain
  3. Hematuria
  4. UTI’s (often recurring)
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12
Q

Hydronephrosis grading?

A

Grade 1: Small, fluid-filled separation of the renal pelvis

Grade 2: Dilation of some but not all calyces; renal sinus orientation still concave

Grade 3: Complete pelvocaliectasis; calyx presentation is changed in convex.

Grade 4: Prominent dilation of collecting system; thinning of renal parenchyma; no differentiation between the collecting system and renal parenchyma

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13
Q

What is a common NON-obstructive cause of hydro?

A

VUR - vesicoureteral reflux

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14
Q

What is the most common site of obstruction in the kidneys?

A

UPJ obstruction

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15
Q

Is UPJ obstruction more common in males or females?

A

Males

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16
Q

What is the second most common cause of pediatric hydronephrosis in peds?

A

Distal ureteral obstruction

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17
Q

Signs and symptoms of distal ureteral obstruction?

A

Recurring UTI’s

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18
Q

What is the most common congenital anomaly of GU tract?

A

Duplicated collecting system - the 3rd most common cause of hydro

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19
Q

What is a common complication of a duplicated collecting system?

A

Ureterocele

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20
Q

Is duplicated collecting system more common in males or females and is it unilateral or bilateral?

A

Females - bilateral

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21
Q

What is a common location of the kidneys with horseshoe kidney?

A

Lower and are medially rotated - anterior to the Ao

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22
Q

What is known as a fold or flap of tissue in the urethra causes the obstruction?

A

PUV

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23
Q

What is the most common cause of urethral obstruction in boys?

A

PUV

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24
Q

What are PUV associated with?

A

Prune Belly Syndrome

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25
SF of PUV?
1. Bilateral hydro w/ parenchymal thinning 2. Possible dysplastic kidneys with increased parenchymal echogenicity and cysts 3. Bilateral tortuous dilated ureters 4. Thick bladder walls 5. Key hole sign: visualization of dilated posterior urethra
26
What abnormality is associated with the "key hole sign" ?
PUV
27
What is prune belly also called?
Eagle Barrett
28
Classic triad of prune belly?
1. Absent abdominal muscles 2. Urinary tract abnormalities 3. Cryptorchidism
29
SF of prune belly?
1. Flaccid dilated bladder 2. Small cystic dysplastic kidneys or hydronephrotic kidneys
30
What is the cause of medullary cystic disease in young adults?
Metabolic dysfunction
31
What are the two types of medullary cystic disease?
1. Medullary sponge kidney AKA renal collecting tubular ectasia 2. Juvenile nephronopthisis AKA uremic medullary kidney disease
32
12 year old patient presents with bilateral echogenic renal pyramids. What is the likely diagnosis?
Medullary sponge kidney
33
Patient presents with small echogenic kidneys and a loss of the CMJ. What is the likely diagnosis?
Juvenile nephropthisis AKA uremic medullary kidney disease
34
What is the most common cystic dysplasia?
MCDK
35
What is the 2nd most common cause of an abdominal mass in newborns after hydro?
MCDK
36
What is the etiology of MCDK?
Complete ureteral obstruction in utero
37
T or F? MCDK does not have communication between cysts?
TRUE
38
What are the two types of polycystic kidney disease?
Infantile PKD (ARPKD) and Adult PKD (ADPKD)
39
SF of infantile PKD?
Bilateral, echogenic, enlarged kidneys
40
What abnormality is associated with infantile PKD?
Hepatic fibrosis - can later on cause renal failure or liver failure
41
What is the most common SF of ADPKD?
Renal enlargement - usually bilateral
42
What is known as cystic dilation of bowman’s capsule and normal tubules?
Glomerular cystic disease
43
What is the most common malignant renal tumour in peds?
Nephroblastoma/Wilm's tumour
44
What is the most common SOLID abdominal tumour in children?
Nephroblastoma/Wilm's tumour
45
What pathology is associated with anirida and BWS?
Nephroblastoma/Wilm's tumour
46
Nephroblastoma's frequently invade what structures?
IVC and renal vein - mets occurs to liver and lungs
47
SF of nephroblastoma?
1. Large well-circumscribed smooth homogenous mass 2. Hyperechoic 3. May contain hypoechoic or cystic areas
48
What is a precursor to Wilm's tumour?
Nephroblastomatosis
49
SF of multilocular cystic nephroma?
1. Mass with multiple cysts that have septations 2. Normal renal parenchyma may be present elsewhere and is sharply demarcated from the mass
50
What is the most common abdominal neoplasm seen in the neonate?
Mesoblastic nephroma
51
T or F? Mesoblastic nephroma's have malignant potential?
TRUE
52
SF of mesoblastic nephroma?
1. Resembles Wilm’s tumour 2. Homogenous / hyperechoic 3. May be heterogeneous w/ areas of necrosis & hemorrhage centrally (usually 5-8cm)
53
What is RCC associated with (2)?
1. Tuberous sclerosis 2. Von-hippel lindau
54
AML's can be associated with what?
Tuberous sclerosis
55
SF of chronic pyelonephritis?
1. Small kidney, 2. Increase echogenicity 3. Irregular shape due to focal parenchymal loss & scarring
56
Renal scarring is typically due to what?
Chronic infection
57
What pathology is known as a deposit of calcium in the kidney?
Nephrocalcinosis
58
SF of renal vein thrombosis?
1. Enlarged kidneys 2. Possible thrombus in renal vein or IVC
59
What is the most common urinary tract infection in children?
Cystits - 10x more common in girld
60
SF of cystitis?
1.Bladder wall thickening (>3mm when full bladder or 5mm when empty) 2. Typically diffuse but can be focal/asymmetrical (suggestive of a mass.. f/u after treatment to see if resolved) 3. Hyperemia of bladder wall
61
The urachus is a tubular structure continuous with what?
Anterior bladder extending to the umbilicus
62
What is the most common urachal variant?
Patent urachus - patent lumen causing urine to drain from umbilicus
63
Urachal sinus vs diverticulum
Sinus - urachus CLOSES at bladder but not umbilicus Diverticulum - urachus CLOSES at umbilicus but not bladder
64
What is a malignant mass of the urinary bladder?
Rhabdomyosarcoma - homogenous mass adherent to bladder wall
65
Shape of the R adrenal vs L adrenal?
Rt - pyramid shaped Lt - crescent shaped
66
How to determine a hemorrhage vs neuroblastoma?
Hemorrhage - will change and resolve Neuroblastoma - will remain unchanged and grow larger
67
What stands for CAH?
Congenital Adrenal Hyperplasia
68
Female patient presents with virilism. Ultrasound shows enlarged adrenal glands with a cerebriform pattern. What is the most common diagnosis?
CAH
69
What is the most common adrenal tumour in childhood?
Neuroblastoma
70
Neuroblastoma's are uncommon after what age?
8
71
What is the term for a mature neuroblastoma and considered less malignant?
Ganglioneuoma
72
SF of neuroblastoma?
1. Echogenic mass with poorly defined borders 2. Calcifications, hypoechoic areas of necrosis 3. Displacement of the kidney (downward and outward)
73
What is known as a "functioning tumours originating in chromaffin tissue of the medulla"
Pheochromocytoma
74
Signs and symptoms of pheochromocytoma?
1. Urinary catecholamine excretion (important in stress response) 2. Hypertension 3. Headaches 4. Palpitations 5. Diaphoresis
75
What muscle is a common location for hemorrhage, abscess or changes related to neoplasm?
Psoas
76
Where are retroperitoneal lymph nodes most commonly located near?
Ao/IVC
77
Enlargement of lymph nodes in the retroperitoneum are most commonly associated with? (3)
1. Neuroblastoma 2. Lymphoma 3. Wilm's tumour

Pediatric and Superficial Structures (23 decks)

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