1. Removes waste from the blood 2. Maintain fluid and electrolyte balance 3. Helps regulate BP

UNIT 2: Urinary System: Anatomy and Radiography (IVP/IVU) Flashcards by R X

Urinary System Anatomy consists of

2 Kidneys, 2 ureters, 1 urinary bladder and 1 urethra

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Function of Kidneys

Removes waste from the blood
Maintain fluid and electrolyte balance
Helps regulate BP

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Kidney: Retroperitoneal at a slight ______ angle and a ___ degree oblique

anterior, 30

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Kidneys occupy the space between _____ - ____

T12-L3

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T or F: Right kidney sits lower due to location of liver

True

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Kidneys may move as much as __ inch during respiration and as much as __ inches from supine to upright

1, 2

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T or F: Normal excretion of 3 to 4 liters of urine/day

False, 1 to 2

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Anatomy of a kidney

• Renal Capsule- outer layer
• Renal cortex- next layer as you move internally
• Renal sinus- fat filled space surrounding the renal pelvis and vessels
• Renal medulla- collecting tubules
• Renal Papilla- opening into the minor calyx
• Renal Pyramid- 8-15 cone shaped segments
• Calyces- cup shaped stems arising at the sides of the papilla of each renal pyramid
• Minor- located just passed the renal pyramids
• Major- unite to form the renal pelvis
• Renal Pelvis- unites with the ureter to create the UPJ
• Hilum- the entry and exit site for structures servicing the kidneys: vessels, nerves, lymphatics, and ureters
• Ureter- drains urine to the bladder

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The Nephron

• Renal corpuscle
•Glomerular capsule (Bowman capsule)
•Glomerulus
• Renal tubule
• Proximal convoluted tubule
•Nephron loop (loop of Henle)
•Distal convoluted tubule
• Collecting duct

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The Ureter

-Peristalsis contractions work to move urine and debris down to the bladder
-Bottle-Neck at UPJ and UVJ

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Bladder

-Bladder
-Freely movable
-Adult bladder can hold up to 500ml urge for micturition is felt at about 250ml
-Males sits directly anterior to the rectum
-Females sits anterior to the vaginal canal
-The bladder lining has folds (rugae), except over the area of the trigone. In the normal bladder, the rugae disappear when the bladder is full.

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Urethra

-Passes urine from bladder to the outside of the body
-Male Urethra divided into 3 sections
-Prostatic, urethral, spongy
-Also serves as excretory canal of the reproductive system

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Adrenal Glands (Suprarenal)

-Endocrine gland
-Produces and secretes adrenaline (epinephrine), norepinephrine, dopamine and corticol hormones

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Urinary System Radiography

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What is Urography?

Urography is a general term for radiographic investigation of the renal drainage and collecting system which requires injection of iodinated contrast material

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2 methods of Urography

Antegrade method
•IVP, IVU, or excretory urography.
•Percutaneous method
Retrograde method (Also called the instrumental method)

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Intravenous Pyelogram(IVP) aka Intravenous Urogram(IVU) Clinical Indications:

• Renal Hypertension
• Kidney stone
• Urinary Tract Infection
• Anatomic Anomaly
• Renal/bladder CA
• Hydronephrosis
• Polycystic Kidney
• Trauma
• Surgical planning

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Intravenous Pyelogram(IVP) aka Intravenous Urogram(IVU) Exam

-Functional study of the urinary system
• Antegrade: contrast enters the body in the normal direction of bloodflow
• Iodinated contrast material is introduced intravenously
• Contrast is conveyed through the bloodstream to the kidney and is removed from the blood during the normal filtration process
• The contrast is then excreted down the ureters and into the bladder in the urine.

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Intravenous Pyelogram(IVP) aka Intravenous Urogram(IVU) Exam Equipment preparation

• Tomographic equipment if required
• Standard Radiographic equipment
• Lead markers for side, body position, time intervals, and fulcrum level if applicable
• Emergency Crash Cart
• Supplies required for obtaining intravenous access
• Up to 100 mL Intravenous Contrast media
• Emesis basin
• Positioning wedges
• Compression band if required

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Intravenous Pyelogram(IVP) aka Intravenous Urogram(IVU) Exam Patient Prep

For an unobstructed view of the urinary tract, the bowel should be free of gas and solid material
-Low-residue diet given for 1-2 days prior
-Laxative given the evening prior
-A light meal on the evening prior to the exam
-NO FOOD for 12 hours prior, only water.

*Bowel preps are not done on infants and children

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Intravenous Pyelogram(IVP) aka Intravenous Urogram(IVU) Exam Considerations

•Patients with Diabetes, multiple myeloma or high uric acid levels should be well hydrated
•Diabetics taking Glucophage (metformin) must stop using this medication at least 48 hours prior to the exam, and not resume its use for 24-48 hours afterwards.
•Untreated Renal Failure (assessed by taking BUN and Creatinine levels as well as GFR prior to exam)
• Allergy to Iodinated Contrast
• Premedication with antihistamine and steroids
• Asthma
• Circulatory or cardiovascular disease
• Sickle cell disease
If a patient has any of these conditions, a Radiologist should be informed prior to the administration of contrast material
The only true contraindication for an IVP is contrast media concerns

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Intravenous Pyelogram(IVP) aka Intravenous Urogram(IVU) Procedure

• Patients often undergo blood test prior to exam to assess their kidney function
• BUN (normal 8-25 mg/dL)
• Creatinine (normal: 0.6-1.2 mg/dL)
• GFR (Glomerular filtration rate): calculation that considers creatinine, age, & race (normal: 90 to 125 mL/ min. values under 90 = possible renal compromise)
• Patients fill out a questionnaire confirming they do not have any contraindications
• Patient asked to empty bladder

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Typical Urography Sequence

• Scout KUB and possible scout tomogram
• Contrast Injection (30 to 100 ml)
• Immediate AP KUB or kidney film (nephrogram/blush stage)
• **3 to 4 tomo cuts through the kidneys
• 5 minute KUB
• 10 minute KUB (possibly prone)
• RPO/LPO obliques at 10 to 15 minutes (greatest concentration of contrast in the kidneys occurs at 15– 20 min after injection)
• pre-voiding KUB at 20 to 30 minutes
• AP upright post-voiding

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Scout image taken before starting exam

-The scout radiograph usually is made supine
-The patient will stay in this position for the injection
-Upon injection, the posterosuperior portions of the collecting system fill more readily with contrast
-Location of Urinary Structures
-If patient has been properly prepped
-Kidney Stones present
-Positioning for Radiographer

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T/F: Compression bands can be used to increase pressure and visualization of the ureters

True

T or F: during the IVP/IVU Intravenous access is obtained at 30-100 ml iodinated contrast agent is administered

True

T or F: Nearly all life-threatening contrast reactions occur within the first 10 minutes after injection

False, first 20 minutes

Nephrograms Positioning and Evaluation Criteria

-After injection of contrast, a KUB with up to 4 tomograms are done during the “blush” stage -Immediately after injection -14 X 17 CW -CR perpendicular to MSP at the level of L1 -Side and Time Marker -Shield Gonads -Respiration: Expiration

Tomograms are performed primarily to evaluate

Renal hypertension (high blood pressure caused by the narrowing of your arteries that carry blood to your kidneys)

Visualizing the Ureters

**• After tomograms, the patient may be asked to lay prone to help visualize ureters** **• A Valsalva maneuver also sometimes helps to demonstrate ureters**

KUB taken after Nephrogram

•Usually a 5 minute and 10 minute KUB are done with time markers. -Major and Minor Calyces -Renal Pelvis -Ureters in entirety -Bladder

Oblique KUB Positioning and Evaluation Criteria

• Bilateral obliques are obtained between 10 and 15 min • 30 degree obliquity • CR perpendicular to the iliac crest 2 inches lateral from midline on elevated side **• Side UP kidney is parallel to IR** **• Side DOWN kidney is perpendicular to IR** • Breathing: expiration -When positioned correctly, both kidneys are seen without superimposition over the spine. The pedicles are anterior to the vertebral bodies’ centers (in contrast to lumbar obliques).

KUB taken after Oblique KUB images

• At 20 to 30 minutes a KUB is then obtained to show “full bladder” • This can also be done as just a bladder film on a 10 X 12 CW • Note distension of Stomach (patient drank a carbonated beverage prior to exam to distend stomach)

Upright Postvoid KUB

• After radiologist’s approval, IV is removed and the patient is asked to void completely • A post-void image is then obtained. • Upright full KUB • CR: centered 2 inches below the crest • Breathing: expiration • Mobility of kidneys (may drop up to 2 in) • Prolapsed bladder • Ability to empty

Pathology: Horseshoe Kidney

-Congenital disorder in which the kidneys are fused across the abdomen (aka: super kidney or renal fusion) -Occurs in 1/400 people

Anatomic Anomaly: duplicated ureters

Anatomic Anomaly: Hydronephrosis

-Distention and dilation of the renal pelvis and calyces usually caused by obstruction -Can be a stone, cyst, or a tumor

Kidney Stones

Small, hard mineral deposists that form inside the kidney

Phlebolith

Calcified pelvic vein that can often resemble a kidney stone

Urine is expelled from the body via the

Excretory system

Urinary system is also called the

Excretory system

The calyces and the renal pelvis together are known as the

Pelvicaliceal system

the _____ extends from the kidneys

Ureters

The ______ conveys urine to the exterior of the body

Urethra

What 2 substances do the suprarenal glands aka adrenal glands furnish

-Epinephrine: secreted by the medulla -Cortical hormones: secreted by the cortex

the left kidney is usually slightly ________ and __________ than the right kidney

Longer, narrower

In AP oblique projections, the elevated kidney is demonstrated without

distortion, as the 30-degree rotation puts the upper kidney parallel to the IR plane

In AP oblique projections, the dependent kidney is positioned almost perpendicular to the IR plane, so the lower kidney is oriented to demonstrate

the anterior and posterior surfaces in the oblique positions

The capsule and kidney are are enveloped in a sheath called the ________ ________ which is attached to the diaphragm, lumbar vertebrae, peritoneum, and other adjacent structures

renal fascia

When you breathe the kidneys move

1 inch

the kidneys drop __ inches when going from supine to upright

The essential microscopic components of the parenchyma of the kidney are called

Nephrons

A nephron is composed of

a renal corpuscle and a renal tubule

the renal corpuscle consists of of a double walled membranous cup called the ___________ __________ and a cluster of blood capillaries called the ____________

glomerular capsule (aka bowman capsule), glomerulus

The vessel entering the glomerular capsule is called the _________ ___________ and the one leaving is called the _________ ___________

Afferent arteriole, Efferent arteriole

the __________ serves a a filter for the blood

Glomerulus

Each ureter is ___ to ___ long

10-12 inches

The ureters convey the urine from the _______ _________ to the _________

Renal pelvis, bladder

How does the bladder lie in males vs females

-Males: anterior to the rectum -Females: anterior to the vaginal canal

When the bladder is empty it is located in the

Pelvic cavity

As the bladder fills, it expands into the

Abdominal cavity

The portion of each ureter where it joins the bladder is called the

Ureterovesical junction (UVJ)

What are the folds in the bladder called

Rugae

How does the female urethra pass

Along the thick anterior wall of the vagina to the external urethral orifice

How does the male urethra pass

From the bladder to the end of the penis and is divided into prostatic, membranous, and spongy portions

What does the prostate do in males

secretes a milky fluid that combines with semen

An upright position may be used to show

The mobility of the kidneys to demonstrate nephroptosis and for the detection of low grade obstruction, prolapsed bladder, ability to empty

Antegrade contrast fillings

Allow the contrast medium to enter the kidney in the normal direction of blood flow

What is percutaneous antegrade urography?

Introducing contrast media directly into the kidneys through a percutaneous puncture of the renal pelvis

Which technique has the contrast media administered intravenously?

Intravenous Urography

Intravenous Urography is also called

Excretory urography or IVP

The Intravenous Pyelogram (IVP) demonstrates

the renal pelves and calyces

Retrograde filling

The contrast medium is introduced against the normal flow, also called retrograde Urography

Bladder examinations are called

Cystography

A procedure that includes inspection of the lower ureters is called

Cystoureterography

A procedure that includes inspection of the urethra is called

Cystourethrography

Lateral projections are used to show

conditions such as rotation or pressure displacement of a kidney and to localize calcareous areas and tumor masses

IVP and IVU look at the

Kidneys, ureters, bladder

What is parenchyma?

Functional tissue or cells of an organ or gland

Which of the following structures are NOT found in the renal cortex? A. Loop of Henle B. Distal convoluted tubule C. Bowman's capsule D. Afferent arteriole

A. Loop of henle

Where is the nephron located

Renal cortex