Urinary System Pathologies Flashcards
(108 cards)
1
Q
What are the procedures/modalities of choice for Urinary system pathologies?
(6 points)
A
- CT
- Ultrasound
- Urography (CT or MRI)
- Voiding cystogram or Voiding Cystourehtrogram (VCUG)
- Retrograde urethrogram / Ureterogram / Pyelogram (in OR)
- Blood tests
2
Q
Abnormally positioned kidney that may be found in various locations
A
Ectopic Kidney
3
Q
What does Ectopic mean?
A
Abnormally positioned
4
Q
Where does ectopic kidney most commonly occur?
A
Within the pelvis (pelvic kidney)
5
Q
Ectopic kidneys can occur above the diaphragm, what is the name of this pathology?
A
Intrathoracic ectopic kidney
6
Q
Ectopic Kidney function:
A
- Kidney usually functional
7
Q
Ectopic Kidney symptoms:
A
Usually asymptomatic BUT may cause:
- pain
- hematuria
- urinary frequency
8
Q
What is the radiographic appearance of ectopic kidney
A
Kidney appears off of normal anatomic position (unusual place)
9
Q
When both kidneys fuse at the top or bottom and form a ‘C’
A
Horseshoe Kidney
10
Q
Where do the kidneys fuse USUALLY?
A
Both poles mal-rotated, the lower poles usually fused
11
Q
What can horseshoe kidney commonly cause?
A
Obstruction at ureteropelvic junction
12
Q
Horseshoe Kidney: What is a complete fusion?
A
- Rare
- One big, weird shaped structure
13
Q
Horseshoe Kidney: what is crossed ectopia
A
When both kidneys are on the same side and usually fused
14
Q
Radiographic appearance of Horseshoe Kidney
A
- Kidneys joined at lower poles
- Horseshoe shaped
- Complete fusion / Crossed ectopia sometimes
15
Q
What is the most common type of fusion anomaly?
A
Horseshoe Kidney
16
Q
What is Duplication?
A
When the kidney has 2 sets of collecting systems or 2 Renal pelves
17
Q
Duplication can also be called:
A
Duplex Kidney
18
Q
How can duplication appear radiographically?
A
Many variations
- 2 collecting systems to one renal pelvis and join into 1 ureter
- 2 renal pelvis and 2 ureters
- etc
As long as the kidney appears to have more than 1 renal pelvis and ureter per kidney, its probably duplication
19
Q
What can duplication cause?
A
- Obstruction
- Vesicoureteral reflux with infection
20
Q
Abnormal flow of urine from the bladder back into the ureters
A
Vesicoureteral Reflux (VUR)
21
Q
VUR usually occurs in ____ but can be caused by __________
A
- Pediatric patients (congenital)
- nerve damage or urethral blockage
22
Q
Why does VUR occur?
A
Because the vesicoureteral valve linking the ureter to the bladder is failing to work
23
Q
what can VUR cause?
A
- swelling in the ureter and kidney
- UTI (common symptom)
24
Q
Radiographic appearance of VUR:
A
- Reflux shown under fluoro
- Can be uni or bilateral
- May show
- Hydroureter
- Hydronephrosis
- Pyelonephritis
25
Ureter does not develop properly causing swelling of distal ureter
Ureterocele
26
What can ureterocele cause?
- stenosis and blockage of urine flow
- Prolapse of ureter into the bladder
- Dilation of ureter
- Often leads to hydronephrosis
27
What are the symptoms of ureterocele?
- abdomen, back, or side pain
- Hematuria
- Painful urination
- UTI
28
How many grades of VUR are there?
5
29
What is grade I VUR?
Urine refluxes halfway into nondilated ureter
30
What is grade II VUR?
Urine reflux all the way into renal pelvis and calyces (non-dilated)
31
what is grade III VUR?
- Mild to moderate dilation of ureter
- Reflux into ureter, renal pelvis and calyces
- slightly blunted fornices
32
What is grade IV VUR?
- Moderately twisted ureters
- Moderate dilation of ureter, pelvis and calyces
33
What is grade V VUR?
- Very twisted ureters
- Very dilated ureter, pelvis, and calyces
- Loss of papillary impressions
34
How do we image ureterocele?
- Ultrasound
- Intravenous urography
35
Are horseshoe kidneys still functional?
Usually
36
Radiographic appearance of ureterocele:
- Dilated ureter
- Halo around possible prolapsed ureter
- Cobra sign (distal ureters look like a cobra)
- Radiolucent mass (if contrast in bladder but not ureterocele)
- Filling defect (If there is duplication, ectopic ureterocele present)
37
Inflammation/infection of the urinary bladder
Cystitis
38
Cystitis may be caused by:
| (4 things)
- bacterial infection
- Instrumentation (use of medical devices/tools)
- catheterization
- sexual intercourse
39
Cystitis occurs more commonly in ________ because _______
women, they have shorter urethras
40
Why do we keep urine bags lower than the patient's bladder?
To prevent retrograde flow and potential for infection
41
What can occur in diabetic patients with cystitis?
Emphysematous cystitis, gas bubbles in bladder wall
42
What are symptoms of cystitis?
| (5 symptoms)
- Dysuria
- Hematuria
- Frequent urination
- cloudy urine
- urinary incontinence
43
What is the radiographic appearance of cystitis?
- Voiding cystogram shows smaller bladder
- Irregular bladder wall with chronic cystitis
- CT: Bladder wall filled with gas (if emphysematous)
44
What is Renal Calculi?
Kidney stones
45
What are kidney stones usually made of?
- Calcium
- Uric acid
- Cystine (amino acid)
- Struvite (phosphate)
46
What is a staghorn calculus?
Phosphate stone, shaped like a staghorn due to being lodged at the renal pelvis
47
What are symptoms of kidney stones?
- severe back/side pain
- hematuria
- dysuria
- cloudy urine
BUT asymptomatic until it moves and gets lodged in ureter
48
what percent of renal stones contain calcium? (radiopaque)
80%
49
What exams are done to assess renal calculi?
- CT
- Ultrasound
50
Radiographic appearance of renal calculi?
| (KUB, CT, Contrast CT, US)
Radiopaque calcium renal stone
KUB - shows the stone
CT - Shows precise location of stone
Contrast CT - Shows stones that are radiolucent as filling defects
US - echogenic region with acoustic shadowing (idk if this matters)
51
Calcified clot within a vein in the lower part of the pelvis, can mimic kidney stones.
Phleboliths
52
Symptoms of phleboliths
Depends on the size of the stone
- asymptomatic
- abdominal pain (if large)
53
Radiographic appearance of phleboliths:
stones that appear...
- ...calcified around the outside
- ...lateral and below ischial spines
54
What is renal colic?
Severe pain that can show up without warning
55
What usually causes renal colic?
stone(s) stuck in the kidney, renal pelvis and/or ureters
56
What causes the pain felt with renal colic?
dilation, stretching and spasm of ureter
57
Symptoms of renal colic:
- hematuria
- dysuria
58
Radiographic appearance of renal calculi:
- Stone present in kidney, renal pelvis or ureter (or other if different cause)
59
Dilation/distention of the renal pelvis and calyces as urine is trapped
hydronephrosis
60
what causes hydronephrosis?
Obstruction
- calculi
- urethral strictures
- pelvic tumors
- enlarged prostate
- etc.
61
What condition is indicative of obstruction at the base of the urinary bladder/urethra?
Bilateral hydronephrosis
62
What can hydronephrosis do?
can completely and permanently destroy kidney function
63
Symptoms of hydronephrosis:
| (3 things)
- pain at side and back
- Dysuria
- frequent urination
64
How do we image hydronephrosis?
- urography
- CT
- US
65
Radiographic appearance of hydronephrosis
- enlarged/dilated renal calyces and pelvis
66
Dilation of the ureter caused by obstruction
Hydroureter
67
Hydroureter: If blockage above bladder, it is _________
Unilateral
68
Hydroureter: If blockage at or below bladder, it is _______
Bilateral
69
How do we treat renal calculi?
- hydrate and wait (pain management)
- lithotripsy (sound waves break stone)
- laser lithotripsy (laser waves break stone)
- chemolysis (medication break stone)
- surgery
70
What procedure is this:
Small incision made, tube passed through to stone, visualize stone and break or remove. Follow up in fluoro
Percutaneous nephrolithotomy / Lithotripsy
71
What 2 retrieval methods are there for calculi removal?
- basket extraction
- stent insertion
72
Fluid filled benign mass, usually unilocular in the kidney (common)
Renal cyst
73
Where are renal cysts usually at?
can be unifocal or multiple across the kidney
can be in one or both kidneys
74
True or false: Renal cysts may have wall calcifications
true
75
Symptoms of renal cysts:
typically asymptomatic
- may have dull pain in back, side, and upper abdomen
76
What is the modality of choice for viewing renal cysts?
ultrasound
77
CT is also used for viewing renal cysts, how would it appear?
- round hypodense region
- CT- shows region with the same HU as water
- CT+ shows lack of contrast enhancement
78
What do we need to do to get a definitive diagnosis for renal cyst?
A biopsy, because other conditions can look like a cyst (some may be malignant)
79
An inherited disorder in which multiple cysts of various sizes cause lobulated enlargement of kidneys and progressive renal impairment.
Polycystic Kidney
80
What causes polycystic Kidney
Compression of nephrons
81
Symptoms of polycystic kidney
| (5 things)
- Feeling of fullness in abdomen
- increased abdomen size
- hematuria
- high BP
- kidney failure
82
Radiographic appearance of polycystic kidney:
CT - similar to simple cysts but theres a lot. some may look hyperdense due to being hemorrhagic
IVU - enlarged kidney and mottled presence of lucent lesions, like swiss cheese
83
What is an adenocarcinoma?
Malignancy involving glandular tissue in epithelium
84
What is the name of adenocarcinomas of the kidney?
renal cell carcinoma (RCC) or hypernephroma
85
Whats the most common cancer of the kidney
RCC
86
Whats the primary symptom of RCC?
painless hematuria
87
What are the other symptoms of RCC?
| (4 things)
- pain or dull ache in side or lower back
- abdominal lump
- fatigue
- weight loss
88
what is the modality of choice for RCC?
CT
89
Radiographic appearance for RCC:
- Enhanced CT = contrast uptake into tumor (cysts dont do that) less than normal parenchyma though
- localized bulging and renal enlargement
- Distorted kidney shape
90
What is a bladder carcinoma?
bladder tumor arising from epithelium
91
Who are most commonly affected by bladder carcinomas?
Men over 50
92
Often the only symptom of bladder carcinoma
painless hematuria
93
other symptoms of bladder carcinoma:
| (5 things)
- abdominal pain
- dysuria
- frequent and urgent urination
- fatigue
- urinary incontinence
94
radiographic appearance of bladder carcinoma:
- CT and MRI: mass projecting into bladder lumen, thickening of wall
- KUB: may show calcifications
95
What is acute renal failure?:
Quick onset, sudden damage
Rapid deterioration of kidney function causing nitrogen wastes to accumulate in blood
96
What is chronic renal failure?
slow progression over months, slow damage
97
What is the recommended modality for renal failure?
ultrasound
98
Cause for renal failure can be:
- pre-renal
- intrarenal (intrinsic)
- post-renal
99
what is pre-renal renal failure
Sudden and severe drop in blood pressure (shock) or severe drop in blood supply to kidneys from disease or injury
100
what is intrarenal renal failure?
direct damage to the kidneys by:
- inflammation
- toxins
- drugs
- infection
- reduced blood supply
101
what is post-renal renal failure
sudden urine flow obstruction due to enlarged prostate, kidney stones, bladder tumor or injury
102
What are causes for chronic renal failure?
| 8 things
- diabetes mellitus
- hypertension
- chronic glomerulonephritis
- pyelonephritis or other infections
- obstruction of urinary tract
- hereditary lesions
- Vascular disorders
- medications or toxic agents
103
Symptoms of renal failure:
| (5 things)
- urinary incontinence
- recurring UTI
- oliguria/anuria/polyuria
- itchy skin
- fatigue
104
What is renal hypertension
elevated BP caused by narrowing in the arteries that deliver blood to kidney
105
Renal hypertension symptoms
aside from the inherent high BP, its asymptomatic
106
why is the BP really high in renal hypertension?
Kidneys produce hormones that increase pressure because it wants more blood, so it can retain more water and salt
107
What is caused by renal hypertension?
pressure damage to nephrons
108
Treatment for renal hypertension:
- blood pressure meds (usually)
- angioplasty, stenting or surgery (extreme cases)
