Urinary System Flashcards

Question

Normal kidney function values:

Answer 1

•eGFR: 90-120 mL per minute per 1.73 m2 •BUN: between 8 and 25 mg •Creatine: 0.6 and 1.2 mg

Answer 2

•Nonionic, low-osmolar contrast agents (type of iodinated contrast) •Intravenously

Answer 3

•iodinated water-soluble contrast material •insertion of a urinary catheter through the urethra into the bladder

Answer 4

•Contrast used: iodinated water-soluble contrast •Administered: catheter is inserted into the urethral opening and contrast is slowly injected

Answer 5

• •injected through the ureter into the affected kidney

Answer 6

**•How is the IVU exam carried out?** • 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 **•Indications for performing IVU?** flank pain, calculus disease, suspected urinary tract obstruction, abnormal urinary sediment (especially hematuria), systemic hypertension, urinary tract infections, screening for congenital GU anomalies, or history of transitional cell or renal cell carcinoma (RCC), concern of injury to the GU tract related to trauma or abdominopelvic surgery **•CM used:** Nonionic, low-osmolar contrast agents (type of iodinated contrast) **•What is the nephrogram phase?** An image to taken within 30 seconds to 1 minute after IV contrast injection to demonstrate the contrast agent in the nephrons before it reaches the renal calyces

Answer 7

**● How is a cystogram procedure carried out?** thin, flexible catheter is inserted into the bladder through the urethra **● What projections are traditionally included in radiographs?** AP, LPO, RPO, and Lateral **● How does kidney function impact contrast administration for this exam?** Has no impact **● Identify a frequent indication for this exam:** vesicoureteral reflux (VUR), congenital bladder anomalies, tumors, diverticula, calculi, bladder injury, fistula, urinary retention, or neurogenic bladder **● What is a VCUG, and how might it relate to this exam?** a VCUG allows visualization of the urethra during voiding (micturition) and also is frequently used to assess for VUR **● What is (RUG), which gender is it performed on, and why:** a retrograde exam that examines the distal urethra in men. Looking for urethral trauma or to assess for urethral injury following a pancreas transplant

Answer 8

**•Describe this this exam:** Placement of a catheter into the ureteric orifice in a retrograde fashion. This is usually performed by a urologist during intraoperative cystoscopy so that contrast medium is directly injected into the ureter to opacify the renal collecting system **•Why it is termed retrograde?** the contrast agent is injected through the ureter into the affected kidney, opposite of the normal direction of urine flow

Answer 9

•It maintains patency of the diseased ureter and enables urine to flow normally •Placed surgically or via cystoscopy, with the upper portion of the stent in the renal pelvis and the lower portion within the urinary bladder. **Each end of the stent forms a loop, commonly called a “pigtail,”** to help secure its placement.

Answer 10

•A tube that connects the renal pelvis to the outside of the body to allow urine to drain outside of the body •It is inserted percutaneously through the renal cortex and medulla into the renal pelvis

Answer 11

-Drains urine from the bladder when someone is unable to urinate normally -It is placed within the urinary bladder using **sterile technique.** Once the catheter is placed through the urethra and the internal urinary sphincter, a small balloon is inflated to keep the catheter in place within the urinary bladder. This catheter is generally connected to a bag that collects urine outside of the body.

Answer 12

•Ensure that the catheter is not displaced during a radiographic procedure •Urine collection bag must be placed at a level lower than that of the person’s bladder to prevent the reflux of urine back into the bladder, which could result in a urinary tract infection (UTI)

Answer 13

•Individuals such as those with quadriplegia who require long-term catheterization •A person who has urethral trauma or disease, such as a stricture, that prevents traditional urinary catheter insertion

Answer 14

•One or both kidneys do not form in the normal manner •Generally manifests as absence of a kidney on one side (unilaterally) and an associated unusually large kidney on the other side •Detected by prenatal **sonography**

Answer 15

•Involves the presence of a third small, rudimentary kidney. The third kidney is more frequently located below the normal kidney on the left side

Answer 16

•Anomaly of size involving a kidney that has developed less than normal in size but contains normal nephron structure •Usually associated with hyperplasia of the other kidney

Answer 17

•Overdevelopment of a kidney •Often associated with renal agenesis or hypoplasia of the other kidney

Answer 18

•Most common fusion anomaly •The lower poles of the kidneys are joined across the midline by a band of soft tissue, called the isthmus, causing a rotation anomaly on one side or both sides •Incidence is higher in individuals with Down syndrome and Turner syndrome

Answer 19

•One kidney lies across the midline and is fused with the other kidney •Second most common fusion anomaly •Both kidneys demonstrate various anomalies(not normal) of position, shape, fusion, and rotation •**Sonography, Retrograde Pyelogram**

Answer 20

•An ectopic kidney is one that is out of its normal position, generally involving overascent or underascent (underascent is more common) •Usually asymptomatic •However, renal ectopia is associated with UPJ obstruction, VUR, and decreased function. Stone formation can also occur more frequently if urinary drainage is impaired

Answer 21

•Kidney is mobile and may drop toward the pelvis when the person is in the erect position •**Distinguished from a pelvic kidney by the length of the ureter**; if the ureter is short, it is a congenital pelvic kidney

Answer 22

•Kidney is located in pelvis •Ureter is short

Answer 23

•Cyst-like dilation of a ureter near its opening into the bladder •May result from congenital stenosis of the ureteral orifice. •Radiographically, a ureterocele appears as a filling defect in the bladder with a characteristic **“cobra head”** appearance •Orthotopic or simple ureteroceles are mostly asymptomatic and often incidentally found in adults •Ureteroceles larger than 2 cm are more likely to contribute to ureteral obstruction or stone formation within a ureterocele •**Ultrasound, Intravenously urography (IVU)**

Answer 24

•Congenital anomaly and may represent a dilated, branched ureteric remnant (out-pouching on the ureter) •**Retrograde urography**

Answer 25

•May occur as a congenital anomaly or be caused by chronic bladder outlet obstruction and resultant infection (out-pouching on bladder) •They usually occur in middle-aged men, often associated with benign prostatic hyperplasia (BPH) •**Cystography or cystoscopy**

Answer 26

•A congenital, familial kidney disorder that may be classified as either autosomal recessive or autosomal dominant. This anomaly results from mutations of the PKD-1 and PKD-2 genes. Innumerable tiny, nonfunctioning cysts replace the renal collecting tubules within the nephron unit. The cysts are present at birth and may be discovered within utero **ultrasonography**

Answer 27

•Most common renal disease •A bacterial infection of the calyces and renal pelvis •Microorganisms involved: E. coli, Proteus, or Pseudomonas •Urinalysis demonstrates pyuria, the presence of pus (white cells) •Radiographic findings are often nonspecific

Answer 28

•Recurrent or persistent infection of the kidneys, such as that caused by chronic reflux of infected urine from the bladder into the renal pelvis •It generally has no relation to acute pyelonephritis and is seen sometimes in those individuals with a major anatomic abnormality or more commonly in children with VUR •Chronic pyelonephritis is often bilateral and leads to destruction and scarring of the renal tissue, with cortical atrophy and marked dilation of the calyces. The eventual result is an overall reduction in kidney size •**Intravenous Urography (IVU), Sonography**

Answer 29

•An antigen–antibody reaction in the glomeruli causes an inflammatory reaction of the renal parenchyma •This condition occurs mainly in children after streptococcal infection •CT or sonographic guidance helps the physician obtain samples of renal tissue and send them to the laboratory for inspection **•Radiographically, both kidneys appear enlarged, particularly during the nephrogram phase of IVU**

Answer 30

•An obstructive disorder of the urinary system that causes dilation of the renal pelvis and calyces with urine •Although the most common cause of hydronephrosis is a calculus, it may also occur as a congenital defect or because of a blockage of the system by a tumor, stricture, blood clot, or inflammation •Symptoms: flank pain, and their urine may contain blood (hematuria) or pus (pyuria) **•Abdominal sonography**, abdominal CT for obstruction

Answer 31

Abdominal sonography

Answer 32

● **Define cystitis:** an acute or chronic inflammation of the bladder, is a fairly common infection that is generally caused by bacteria such as E. coli and Staphylococcus saprophyticus. ● **Which population is more susceptible to cystitis and why?** females, because the short urethra in females provides bacteria easier access into the bladder ● **What symptoms are present with this condition?** burning pain during urination or the urge to urinate frequently. ● **What might lead to VUR?** in the normal urinary tract, VUR is prevented by compression of the bladder musculature on the ureters during micturition. Failure of this valve mechanism usually results from a shortening of the intravesical portion of the ureter caused by abnormal embryologic development, leading to ureteric orifices that are displaced laterally ● **Which radiographic exam may demonstrate VUR?** Cystography ● **What is the etiology of bladder stones?** Chronic infection or bladder outlet obstruction ● **Identify the modality/ modalities that may be used to diagnose bladder stones:** Conventional radiographs, US, or CT

Answer 33

•Urine •Precipitate crystalline materials (calcium and its salts)

Answer 34

•Hyperparathyroidism •Excessive intake of calcium •Metabolic rate that causes high urine concentration •Chronic UTI

Answer 35

the calyces or renal pelvis

Answer 36

a large calculus(stone) that assumes the shape of the pelvicalyceal junction

Answer 37

the calcium content in renal calculi

Answer 38

Sonography and noncontrast CT(first choice)

Answer 39

•**UVJ**, the ureter at the UPJ, and the pelvic brim

Answer 40

•First treatment is to wait for the stone to pass normally through the urinary system in combination with the administration of antibiotics for the presence of any infection. •Stones larger than 10 mm are unlikely to pass on their own. If the stone is not passed, either **lithotripsy of the stone or surgical excision** of the cause of obstruction is necessary. •**Shockwave Lithotripsy** is often used to crush calculi less than 2 cm in diameter located in the renal pelvis or ureter. •A **percutaneous nephrolithotomy** may be used to remove larger renal calculi, and **ureteroscopy** is necessary to remove larger stones within the ureter.

Answer 41

The prostate gland

Answer 42

the calcification must remain within the outline of the kidney on both frontal and oblique projections

Answer 43

**● What is renal failure?** Although it can arise acutely, renal failure usually represents the end result of a chronic process such as chronic glomerulonephritis or PKD that gradually results in diminished kidney function. The normal regulatory and excretory functions become impaired because of loss of glomerular filtration and subsequent deterioration of the renal parenchyma **● Define Uremia:** retention of urea in blood **● How is renal failure “defined” based on lab results?** a progressive increase in serum creatinine and BUN and a decrease of eGFR **● How can contrast studies lend themselves to help diagnose renal failure?** Contrast-enhanced studies are contraindicated in individuals with renal failure as the contrast media will most likely result in further decline of renal function. However, they are not impossible and can be performed, if medically necessary, using prophylactic IV hydration strategies and/or dialysis after contrast administration. With IVU examination, acute renal failure would manifest as a delayed nephrogram because of markedly delayed excretion of contrast

Answer 44

Ultrasound

Answer 45

filling defects within contrast-filled structures or alter the contrast enhancement pattern of the organ

Answer 46

**● What are the usual symptoms of renal cysts?** usually asymptomatic, in some instances, they may cause symptoms from rupture, hemorrhage, infection, or obstruction **● How are these commonly discovered?** incidentally on imaging studies ordered for other reasons **● Where are renal cysts most commonly found?** a lower pole of the kidney **● How might tumors be differentiated from cysts during an IVU?** by tomography, in which a cyst shows an absence of early parenchymal enhancement after contrast medium injection. In contrast, tumors, the majority of which have vascularity, may show irregular opacification during the nephrogram phase.

Answer 47

Ultrasound

Answer 48

**● Identify the etiology of this condition:** unknown **● List risk factors associated with RCC:** chronic inflammation from obstruction, cigarette smoking, obesity, and hypertension are risk factors **● List 4 treatment options that might be considered for RCC:** surgical excision of the kidney in combination with chemotherapy, the use of RFA and cryoablation therapies, targeted immunotherapies such as interferon and IL-2 are also currently being tested **● Identify common metastatic sites for RCC:** lungs, brain, liver, and bone

Answer 49

Renal cell carcinoma

Answer 50

**● What is it?** malignant renal tumor found in approximately 500 children per year **● Another term for nephroblastoma is:** Wilms tumor **● Nephroblastoma is benign/ malignant?** malignant **● Which population is affected by nephroblastoma?** It is an embryonal tumor that is almost invariably diagnosed before 5 years of age with a peak incidence at 3 years **● Identify the signs/ symptoms associated with nephroblastoma:** often have no symptoms but may have the tumor discovered by a parent or physician who feels a large, palpable abdominal mass **● List three modalities/ exams that help diagnose Wilms Tumor:** **Sonography:** differentiates a cystic mass from a solid mass, **IVU:** the kidneys appear quite enlarged with marked calyceal spreading, **Abdominal CT:** modality of choice for assessing the extent and spread of the tumor

Answer 51

**● Identify 4 risk factors associated with bladder carcinoma:** cigarette smoking, certain industrial chemicals, abuse of analgesics, and pelvic radiation therapy **● What is the main symptom associated with bladder cancer?** hematuria(blood in urine) **● Which modality/ exam is of choice to investigate bladder carcinoma?** Cystoscopy **● How is a definitive diagnosis made?** concurrent biopsy, resection, or small lesions **● Define loopogram and describe its association with bladder cancer treatment:** The loop of bowel may be connected to the native urethra, a fluoroscopic injection study of this type of anatomy is called a loopogram and it is a retrograde contrast study requiring catheterization of the urostomy and bowel segment. A loopogram may be requested to evaluate for patency of the anastomoses between the ureters and the bowel segment, rule out obstruction, evaluate for postoperative urine leaks, or assess for tumor recurrence..

Answer 52

Bladder carcinoma

Answer 53

CT stone study

Answer 54

All of the above

Answer 55

All of the above

Answer 56

Nephrostomy tube

Urinary System Flashcards

(82 cards)