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Urinary 2 Flashcards

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1
Q

Accessory renal arteries occur in what % of individuals?

A

30%

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2
Q

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

A

right renal artery, posterior to IVC

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3
Q

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

A

interlobar arteries

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4
Q

What do the interlobar arteries divide into?

A

arcuate arteries farther into the cortex

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5
Q

Small veins in the renal cortex combine and drain into

A

interlobar veins

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6
Q

The interlobar veins join to form the

A

main renal vein

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7
Q

Which renal vein is longer?

A

left, anterior to the aorta and posterior to the celiac

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8
Q

The angle of incidence should be adjusted to

A

30-600 degrees

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9
Q

Describe the PW doppler characteristics of main renal artery

A

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

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10
Q

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

A

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

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11
Q

Describe the waveform for the renal vein

A

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

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12
Q

What is the major cause of renal artery stenosis?

A

arteriosclerosis

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13
Q

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

A
  • direct: eval. main renal artery

- indirect: eval. the arcuate and interlobar arteries

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14
Q

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

A

greater than 150-190 cm/s

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15
Q

RAR (Renal Aorta Ratio) of direct method

A

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

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16
Q

RI equation

A

(Peak systole-end diastole)/peak systole

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17
Q

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

A

.70

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18
Q

What does the indirect method of evaluating renal artery stenosis do

A
  • eval. the intrarenal arteries

- look at the wave form and evaluate the acceleration time and acceleration index

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19
Q

Describe what the indirect method finds:

A

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

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20
Q

Tardus Parvus describes

A

the decreased acceleration time and the decreased peak

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21
Q

Renal variants:

A
  • dromedary hump
  • junctional parenchyma defect
  • fetal lobulation
  • duplex collecting system
  • extrarenal pelvis
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22
Q

Renal agenesis:

A

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

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23
Q

Renal dysgenesis:

A

defective embryonic formation

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24
Q

Renal pseudotumor

A

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

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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

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