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Abdominal > Urinary 2 > Flashcards

Urinary 2 Flashcards

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
Q

Supernumerary kidney

A

complete duplication of the renal system

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26
Q

Most ectopic kidneys are located in the

A

pelvis

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27
Q

Characteristics of pelvic kidney

A
  • may be malrotated
  • may simulate adnexal mass
  • associated with other abnormalities
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28
Q

Complications of pelvic kidney

A
  • chronic pyelonephritis
  • hydronephrosis
  • stones
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29
Q

***Horseshoe kidney characteristics:

A
  • 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
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30
Q

***Crossed-fuse kidney characteristics

A
  • 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
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31
Q

Characteristics of duplicated ureters

A
  • 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
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32
Q

Describe ureterocele

A
  • 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
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33
Q

Residual bladder volume

A
  • evaluated in pts with outflow obstruction
  • post-void bladder scanned in 2 planes
  • (L x W x H) x .523
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34
Q

What residual volume is normal in an adult

A

<20 cc

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35
Q

***Normal bladder wall measurements

A

-nondistended: <3mm

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36
Q

How much fluid does a normal bladder hold?

A

600-800 ml of fluid

37
Q

Parts of bladder:

A
  • apex =top
  • neck=bottom
  • trigone= middle
38
Q

Acute cystitis

A

inflammation of the urinary bladder

39
Q

What can acute cystitis be caused by?

A

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

40
Q

What does acute cystitis look like sonographically?

A

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

41
Q

What is ureterocele?

A

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

42
Q

What is a papiloma?

A

pre-malignant tumor to transitional cell carcinoma

  • .5-2 cm in size
  • same appearance as TCC
  • lateral to bladder wall
43
Q

What is the most common malignant bladder tumor?

A

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

44
Q

squamous cell

A

associated with infections, stones, strictures

45
Q

What is patent urachus?

A

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
Q

What is posterior urethral valve syndrome?

A

presence of valve in posterior urethra, presenting with:

  • thickened urinary bladder wall (keyhole sign)
  • hydronephrosis
  • hydroureter
47
Q

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

A

False, male fetuses only

48
Q

What is prune belly syndrome?

A
  • dilation of fetal abdomen

- secondary to severe bilateral hydronephrosis and fetal ascites, oligohydramnios

49
Q

What is urinary bladder extrophy?

A
  • fetal anomaly in utero
  • defect in abdominal wall of urinary bladder
  • everted bladder becomes exposed on abdominal wall
50
Q

Where are adrenal glands situated?

A

superior anterior and medial to kidneys bilaterally

51
Q

What shape is the right adrenal gland?

A

triangle

52
Q

What shape is the left adrenal gland?

A

crescent

53
Q

What pts can you see the adrenal glands easily?

A

infants and young children..abnormal if seen in adults

54
Q

The cortex is what % of the adrenal gland?

A

90%

55
Q

What does the cortex produce?

A

steriod hormones, regulated by the pituitary

56
Q

What does the adrenal medulla produce?

A

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

57
Q

What is the 4th most common site for metastasis?

A

adrenal glands, most commonly from lung and renal cell carcinoma

58
Q

Son findings of metastatic disease in adrenal glands.

A
  • usually bilateral
  • hypoechoic
  • 4cm
  • round/oval
  • large mass displaces kidney inferiorly
59
Q

Characteristics of cysts in the adrenal glands

A
  • uncommon
  • no clinical symptoms
  • females
  • unilateral, found incidentally
  • vary in size
  • most are benign
  • ring calcifications around cysts indicative for malignancy
60
Q

Who is most likely to have adrenal gland hemorrhage?

A

neonates (large size of gland and trauma during birth)

61
Q

Hemorrhage of adrenal glands in adults:

A

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

62
Q

Chronic primary hypoadrenalism AKA

A

Addison’s disease

63
Q

What is chronic primary hypoadrenalism/ Addison’s disease ?

A

atrophy of glands due to insufficient secretions of hormones

-uncommon, usually occurs from autoimmune disorder of TB

64
Q

Symptoms of Addison’s disease:

A

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

65
Q

Hyperadrenalism AKA

A

Cushing’s syndrome

66
Q

What is hyperadrenalism AKA Cushings?

A
  • 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
Q

What happens with congenital adrenal hyperplasia?

A
  • 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
Q

Hursitism

A

excessive body hair

69
Q

Adrenal adenoma

A
  • 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
Q

What do adrenal adenomas consist of?

A
  • lipid filled cells that do not secrete hormones

- single nodule larger than 1 cm

71
Q

What are myelolipomas

A
  • rare benign tumors of cortex
  • found between 4th and 6th decades of life
  • most found post mortem
  • asymptomatic (fatty and bone marrow elements)
72
Q

Son findings of myelolipomas

A

hyperechoic mass in adrenal bed

73
Q

What do adenocarcinomas produce?

A

steroids

74
Q

Adenocarcinomas that do not produce steroids are:

A

highly malignant

75
Q

Son findings on adenocarcinomas:

A

small mass: homogenous

large mass: necrosis, hemorrhage or calcifications

76
Q

Adenocarcinomas have what tendency?

A

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

77
Q

What organs are most often primary for adrenal gland metastisis?

A

lung, breast, stomach, colon, kidney

78
Q

What does metastisis of the adrenal gland cause?

A

adrenal insufficiency

79
Q

Son findings of metastasis of the adrenal glands:

A
  • glands will vary in size and echogenicity

- central necrosis causes sonolucent areas within the tumors

80
Q

What % of pheochromocytoma originates on medulla?

A

90%

81
Q

Incidence of malignancy in pheochromocytoma:

A

5-10%

82
Q

What do pheochromocytoma excreet?

A

epi and norepi in excessive quantities

83
Q

Symptoms of pheochromocytoma:

A

high blood pressure, headaches, tachycardia, excessive perspiration

84
Q

Son findings of pheochromocytoma:

A
  • large sharply marginated tumors
  • significant solid components
  • central hemorrhage and necrotic changes are common
  • can produce cystic component focal echogenic abnormalities
85
Q

What is a neuroblastoma?

A

highly malignant tumor of the medulla

86
Q

What is the most common malignancy in the adrenal gland?

A

neuroblastoma

87
Q

Neuroblastomas present as abdominal mass in what age group?

A

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

88
Q

Neuroblastomas can metastasize to what?

A
  • lymph nodes
  • liver
  • lung
  • bone
89
Q

Son findings of neurblastoma

A
  • appears as inhomogenous echogenic solid mass
  • occasional calcifications and cystic degeneration
  • must be differentiated from Wilm’s tumor

Abdominal (15 decks)

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