Urinary 2 Flashcards Preview

Abdominal > Urinary 2 > Flashcards

Flashcards in Urinary 2 Deck (89):
1

Accessory renal arteries occur in what % of individuals?

30%

2

Which renal artery is longer and where does it cross the IVC?

right renal artery, posterior to IVC

3

Segmental branches of the renal arteries become the _____ as they pass through the junction between the cortex and the medulla.

interlobar arteries

4

What do the interlobar arteries divide into?

arcuate arteries farther into the cortex

5

Small veins in the renal cortex combine and drain into

interlobar veins

6

The interlobar veins join to form the

main renal vein

7

Which renal vein is longer?

left, anterior to the aorta and posterior to the celiac

8

The angle of incidence should be adjusted to

30-600 degrees

9

Describe the PW doppler characteristics of main renal artery

quick upstroke with a sharp systolic waveform and low impedance flow pattern

10

Describe the PW waveform for the segmental, interlobar and arcuate arteries:

all exhibit quick upstrokes in systole and a continuous low impedance flow pattern

11

Describe the waveform for the renal vein

low velocity monophasic flow that responds to respiratory variations and flows away from the renal hilum

12

What is the major cause of renal artery stenosis?

arteriosclerosis

13

What two methods are used for evaluation of renal artery stenosis?

-direct: eval. main renal artery
-indirect: eval. the arcuate and interlobar arteries

14

The direct method for eval. renal artery stenosis results in what values?

greater than 150-190 cm/s

15

RAR (Renal Aorta Ratio) of direct method

compares the peak systolic velocity of the aorta to the PSV of the main renal artery
-if the renal artery PSV of the main renal artery is 3.5 X's greater than that of the aorta, a diagnosis of a 60%or greater stenosis is made

16

RI equation

(Peak systole-end diastole)/peak systole

17

What RI is the upper limits of normal, except in pts. under the age of 6 and older pts.

.70

18

What does the indirect method of evaluating renal artery stenosis do

-eval. the intrarenal arteries
-look at the wave form and evaluate the acceleration time and acceleration index

19

Describe what the indirect method finds:

The ESP and prolonged systolic upstroke or acceleration time together with decreased peak systole and a dampening of the waveform are indicative of RAS

20

Tardus Parvus describes

the decreased acceleration time and the decreased peak

21

Renal variants:

-dromedary hump
-junctional parenchyma defect
-fetal lobulation
-duplex collecting system
-extrarenal pelvis

22

Renal agenesis:

failure of one or both kidneys to form , can be bi or unilateral

23

Renal dysgenesis:

defective embryonic formation

24

Renal pseudotumor

overgrowth of cortical tissue that indents the echogenic renal sinus...may be mistaken for renal tumor

25

Supernumerary kidney

complete duplication of the renal system

26

Most ectopic kidneys are located in the

pelvis

27

Characteristics of pelvic kidney

-may be malrotated
-may simulate adnexal mass
-associated with other abnormalities

28

Complications of pelvic kidney

-chronic pyelonephritis
-hydronephrosis
-stones

29

***Horseshoe kidney characteristics:

-fusion anomaly
-fusion of polar regionsof the kidneys during fetal dev.-almost always lower poles**
-assoc. with improper ascent and malrotation of the kidneys
-generally lie close to spine

30

***Crossed-fuse kidney characteristics

-fusion anomaly
-both kidneys located on the same side of the body-commonly the upper pole of the ectopic kidney is fused to the lower pole of the other kidney

31

Characteristics of duplicated ureters

-may be complete with separate ureters draining the upper and lower collecting systems of the kidneys
-enter the bladder separately
-unilateral or bilateral
-more common in females
-incomplete duplication occurs when the ureters join together and enter the bladder as one

32

Describe ureterocele

-cysts like enlargement of the lower end of the ureter
-caused by congenital or acquired stenosis of the distal end of the ureter
-may cause infection of the upper urinary system
-if large they may cause bladder outlet obstruction
-found more often in adults than children

33

Residual bladder volume

-evaluated in pts with outflow obstruction
-post-void bladder scanned in 2 planes
-(L x W x H) x .523

34

What residual volume is normal in an adult

<20 cc

35

***Normal bladder wall measurements

-nondistended: <3mm

36

How much fluid does a normal bladder hold?

600-800 ml of fluid

37

Parts of bladder:

-apex =top
-neck=bottom
-trigone= middle

38

Acute cystitis

inflammation of the urinary bladder

39

***What can acute cystitis be caused by?***

catheterization, obstruction, bladder calculi, pregnancy, getting pregnant, sexual intercourse, poor hygiene

40

What does acute cystitis look like sonographically?

thick urinary bladder mucosal wall, smooth, continuous redundant and polypoid looking

41

What is ureterocele?

obstructed ureter, wall of ureter will balloon into urinary bladder
-cyst-like enlargement lower end of ureter

42

What is a papiloma?

pre-malignant tumor to transitional cell carcinoma
-.5-2 cm in size
-same appearance as TCC
-lateral to bladder wall

43

What is the most common malignant bladder tumor?

transitional cell carcinoma (mass or focal thickening of wall)
ex. squamous cell

44

squamous cell

associated with infections, stones, strictures

45

What is patent urachus?

early in life continuous with allantois, allantois progresses into urachus if lumen persists while urachus forms and a fistula develops.
-causes urine to drain from bladder to umbilicus
-urachal cysts develop if lumen persists

46

What is posterior urethral valve syndrome?

presence of valve in posterior urethra, presenting with:
-thickened urinary bladder wall (keyhole sign)
-hydronephrosis
-hydroureter

47

T/F: posterior urethral valve syndrome is found in female fetuses only?

False, male fetuses only

48

What is prune belly syndrome?

-dilation of fetal abdomen
-secondary to severe bilateral hydronephrosis and fetal ascites, oligohydramnios

49

What is urinary bladder extrophy?

-fetal anomaly in utero
-defect in abdominal wall of urinary bladder
-everted bladder becomes exposed on abdominal wall

50

Where are adrenal glands situated?

superior anterior and medial to kidneys bilaterally

51

What shape is the right adrenal gland?

triangle

52

What shape is the left adrenal gland?

crescent

53

What pts can you see the adrenal glands easily?

infants and young children..abnormal if seen in adults

54

The cortex is what % of the adrenal gland?

90%

55

What does the cortex produce?

steriod hormones, regulated by the pituitary

56

What does the adrenal medulla produce?

Caticolmines-epinepherine and adrenaline (responsible for fight or flight)

57

What is the 4th most common site for metastasis?

adrenal glands, most commonly from lung and renal cell carcinoma

58

Son findings of metastatic disease in adrenal glands.

-usually bilateral
-hypoechoic
-4cm
-round/oval
-large mass displaces kidney inferiorly

59

Characteristics of cysts in the adrenal glands

-uncommon
-no clinical symptoms
-females
-unilateral, found incidentally
-vary in size
-most are benign
-ring calcifications around cysts indicative for malignancy

60

Who is most likely to have adrenal gland hemorrhage?

neonates (large size of gland and trauma during birth)

61

Hemorrhage of adrenal glands in adults:

associated with anticoagulation therapy (liver transplant, surgery, trauma or tumor)

62

Chronic primary hypoadrenalism AKA

Addison's disease

63

What is chronic primary hypoadrenalism/ Addison's disease ?

atrophy of glands due to insufficient secretions of hormones
-uncommon, usually occurs from autoimmune disorder of TB

64

Symptoms of Addison's disease:

fatigue, muscle weakness, hypotension, GI disease (managed by administering steroids)

65

Hyperadrenalism AKA

Cushing's syndrome

66

What is hyperadrenalism AKA Cushings?

-excessive glucose production
-pancreas no longer able to produce insulin and diabetes will occur
-protein loss occurs (results in weakened muscle & elastic tissue)
-poor wound healing, susceptible to tearing and bruising
-red welts on thighs and abdomen
-hypertension in 99% of cases

67

What happens with congenital adrenal hyperplasia?

-deficiency of an enzyme
-overstimulates pathway of an enzyme
-results in virilazation (male characteristics in women)
-glands symmetrically enlarged
-hursitism, ambiguous genitalia, precocious puberty

68

Hursitism

excessive body hair

69

Adrenal adenoma

-hyperfunctioning or nonfunctioning tumor, mostly benign
-poorly encapsulated tumors ranging in size 1-5 cm in diameter
-difficult to detect with u/s
-may cause Cushings

70

What do adrenal adenomas consist of?

-lipid filled cells that do not secrete hormones
-single nodule larger than 1 cm

71

What are myelolipomas

-rare benign tumors of cortex
-found between 4th and 6th decades of life
-most found post mortem
-asymptomatic (fatty and bone marrow elements)

72

Son findings of myelolipomas

hyperechoic mass in adrenal bed

73

What do adenocarcinomas produce?

steroids

74

Adenocarcinomas that do not produce steroids are:

highly malignant

75

Son findings on adenocarcinomas:

small mass: homogenous
large mass: necrosis, hemorrhage or calcifications

76

Adenocarcinomas have what tendency?

to invade renal veins, IVC, HV's, and Rt. atrium

77

What organs are most often primary for adrenal gland metastisis?

lung, breast, stomach, colon, kidney

78

What does metastisis of the adrenal gland cause?

adrenal insufficiency

79

Son findings of metastasis of the adrenal glands:

-glands will vary in size and echogenicity
-central necrosis causes sonolucent areas within the tumors

80

What % of pheochromocytoma originates on medulla?

90%

81

Incidence of malignancy in pheochromocytoma:

5-10%

82

What do pheochromocytoma excreet?

epi and norepi in excessive quantities

83

Symptoms of pheochromocytoma:

high blood pressure, headaches, tachycardia, excessive perspiration

84

Son findings of pheochromocytoma:

-large sharply marginated tumors
-significant solid components
-central hemorrhage and necrotic changes are common
-can produce cystic component focal echogenic abnormalities

85

What is a neuroblastoma?

highly malignant tumor of the medulla

86

What is the most common malignancy in the adrenal gland?

neuroblastoma

87

Neuroblastomas present as abdominal mass in what age group?

children, usually less than 4 years old, 50% less than 2 years

88

Neuroblastomas can metastasize to what?

-lymph nodes
-liver
-lung
-bone

89

Son findings of neurblastoma

-appears as inhomogenous echogenic solid mass
-occasional calcifications and cystic degeneration
-must be differentiated from Wilm's tumor