Radiology year 4 lecture 8 Flashcards
(24 cards)
Why is general anawsthesia used when studying the urogenital tract?
minimises adverse reactions and problems associated with contrast administration. Ensures accurate positioning.
How are the kidneys and ureters studies?
Through IV administration of a water soluble contrast medium (WSICM), which is then excreted through the kidneys and bladder: intravenous urogram or excretory urogram
When would you use a urogram to look at the kidenys and ureters?
identify shape, size and position, urinary incontinenece, haematuria or pyuria of the upper urinary tract
what is the technique for looking at the kidenys/ ureters?
starve for 24hours, high soapy water enema (need transverse colon to be empty), general anaesthesia, plain films first.
How is a bolus intravenous urogram (IVU) carried out?
low volume, rapid injection technique, useful for looking at renal vasculature and parenchyma. 2ml/kg high conc WSICM, rapidly IV injection through catheter, immediated ventrodorsal exposure, centred at xiphisternum. Further ventrodorsal and lateral views taken at 1, 5, 10 and 20mins. Caudal abdomen can be compressed to encourage contrast accumulation in the renal pelvis.
How is an infusion IVU carried out?
high volume infusion technique. Useful for assessing urters. Catheterise and empty bladder, instil a small amount of air, infuse 8-10ml/kg of low conc WSICM over 5-15 mins. Ventrodorsal and lateral projections at 5,10 and 15 mins. Ureters distended through osmotic diuresis.
What can be assessed on an IVU?
renal size, shape, position, parenchyma, pelvis, ureters (especially at entry into bladder).
When is renal angiography performed and what is the technique?
renal failure. General anaesthesia, femoral artery catheterised, fed into aorta and up to renal artery. small bolous of high concentration of WSICM (3-5ml).
When would the bladder be investigated?
haematuria, dysuria, stranguria, urinary retention/ incontenance, identify position/ integrity.
What is the technique for bladder study?
enema, sedation(males), general anaesthesia (female), plain films first, catheterise bladder, drain urine out, retaining sterile sample for culture/ sensitivity testing.
When is a pneumocystogram used and what is the technique?
easy, quick, cheap. catheterise and empty bladder, inflated bladder with air until moderately distended by palpation.
What is a positive contrast cystogram used for and what is the technique?
radiolucent calculi, lesions, rupture.
catheterise and empty bladder, instil low conc. WSICM until moderately distended
why is a double contrast cystogram used and what is the technique?
fine mucosal detail. Catheterise and empty bladder, instil 55-10ml WSICM, roll animal onto either side to coat bladder mucosa, inflate bladder with air as before.
If you are unable to catheterise for bladder investigation what should you do and why is it not as good?
intravenous cystography. No control over distension of bladder and may create artefactual lesions
What is assessed in the bladder?
size, shape, position, wall thickness, mucosal irregularities, caliculi, polyps, tumour
When would the urethra be investigated?
dysuria, stanguria, urinary incontinence, prostatic disease, vulval discharge
What is the technique for urethra investigation?
enema, sedation (male), general anaesthesia (female), plain film first, small pneumocystogram performed.
How is a male retrograde urethrogram performed?
urinary catheter introduced just caudal to the level of interest (eg prostatic disease to the ischial brim, urethral lesion at mid os penis), use low conc WSICM and KY jelly, 5-20ml total of 50:50 mixture injected, occulding urethral opening, lateral projection immediately at the end of injection, pull legs caudally to show pelvic and penile urethra, pull elefs cranially to demonstrate ischial urethra
how is a femal retrograde vaginourethrogram carried out?
end-opening foley catheter with no tip introduced just into vestibule. inflate bulb and clamp vulval lips shut with forceps, instil less than 1.5ml/kg low concentration WSICM slowly. Lateral projection immediately at end of injection.
what is a urethrogram used to assess?
position of bladder neck, mucosa, filling defects, abnormal anatomy.
Is general anaesthesia used for muelography? What is injected?
yes. low osmolar, non-ionic WSICM to prevent toxic effects on the CNSInjected into the subarachnoid space at either the cisternal or lumbar level
when would a myelogram be performed?
ataxia, paresis or paralysis, spinal pain, neurogenic incontinence.
Describe how to take a cisternal puncture
see sheets
Describe how to take a lumbar puncture
see sheets
