URINARY WORKBOOK EX 4-11 Flashcards
(108 cards)
1
Q
The urinary system has two principal functions: excreting _____ and regulating the composition of _____.
A
wastes, blood
2
Q
the right kidney lies slightly _____ than the left kidney because the large right lobe of the _____ pushes it ______.
A
Lower, liver, inferiorly
3
Q
the kidneys move with respiration; on deep inspiration, both kidneys move ______ approximately 1 inch.
A
downward
4
Q
Within the hilus of the kidney are other _____ structures, a ureter, and the _______
A
vascular, lymphatics
5
Q
A fibrous capsule called the ______ surrounds the kidney.
A
true capsule
6
Q
Outside of this fibrous capsule is a covering of _______
A
perinephric fat
7
Q
The _____ fascia surrounds the perinephric fat and encloses the kidneys and adrenal glands.
A
perinephric
8
Q
The renal fascia, known as ______fascia, surrounds the true capsule and perinephric fat.
A
Gerota’s
9
Q
The medullary substance consists of a series of striated conical masses, called the renal _____
A
pyramids
10
Q
A nephron consists of two main structures, a renal _____ and a renal _____
A
corpuscle, tubule
11
Q
Nephrons ____ the blood and produce _____
A
blood, urine
12
Q
The renal corpusle consists of a network of capillaries, called the _____, which is surrounded by a cuplike structure known as ________
A
glomerulus, Bowman’s capsule
13
Q
Blood flow into the glomerulus through a small ______ arteriole and leaves the golmerulus through a(n) _______ arteriole.
A
afferent, efferent
14
Q
There are three constrictions along the ureter’s course (1) _______,(2) ______,and (3) ________
A
- Where the ureter leaves the renal pelvis,2. Where it is kinked as it crosses the pelvic brim3. where it pierces the bladder wall
15
Q
The main renal artery is a lateral branch of the aorta and arises just inferior to the ________ artery.
A
superior mesenteric
16
Q
The renal vein drains into the ______ of the inferior vena cava.
A
lateral wall
17
Q
The urinary system is located posterior to the peritoneum lining and the abdominal cavity in an area called the ______
A
retroperitoneum
18
Q
The kidneys adjust the amounts of _____ and ______ leaving the body so that these equal the amounts of substances entering the body.
A
water. electrolytes
19
Q
The principle metabolic waste products are ____, _____ and nitrogenous wastes.
A
water, carbon dioxide
20
Q
Both urea and uric acid are carried away from the liver into the kidneys by the ______ system.
A
vascular
21
Q
The presence of an acute infection causes _____, which is ____ in the urine; pyuria means there is _____ in the urine.
A
hematuria, RBC, pus
22
Q
The pH refers to the strength of the urine as a partly ____ or _____ solution.
A
acidic, alkaline
23
Q
The ________ is the measurement of the kidney’s ability to concentrate urine.
A
specific gravity
24
Q
The specific gravity is especially ______ in cases of renal failure, glomerular nephritis, and pyelonephritis
A
low
25
A decreased ______ occurs with acute hemorrhagic processes secondary to disease or blunt trauma.
hematocrit
26
Impairment of renal function and increased protein catabolism results in BUN _____ that is relative to the degree of renal impairment and rate of urea nitrogen excreted by the kidneys.
elevation
27
The renal parenchyma surrounds the fatty central renal sinus, which contains these five structures:
calyces infundibula pelvis vesselslymphatics
28
Dilation of the collecting system has also been noted in ____ patients, especially the right kidney.
pregnant
29
The ________ and _______ arteries are best demonstrated as intense specular echos in cross section or oblique section at the corticomedullary junction.
arcuate arteries, interlobar
30
The \_\_\_\_\_\_is the area from the renal sinus to the outer renal surface.
parenchyma
31
The _____ generally is echo producing, whereas the meduallary pyramids are \_\_\_\_\_\_
cortex, hypoechoic
32
The cortex and medullary pyramids are separated from each other by bands of cortical tissue, called \_\_\_\_\_\_\_\_, that extend inward to the renal sinus.
column's of Bertin
33
The ____ lie posterior to the renal arteries and should be identified by their lack of pulsations and absence of Doppler flow.
Crura
34
The ____ of the pyramids points towards the sinus, and the _____ lies adjacent to the renal cortex.
Apex, base
35
The ________ is a cortical bulge that occurs on the lateral border of the kidney, typically more on the left side
dromedary hump
36
A(n) _______ is a triangular, echogenic area in the upper pole of the renal parenchyma that can be seen during normal scanning.
junctional parenchymal defect
37
In a patient with a(n) \_\_\_\_\_\_\_, there is fusion of the kidneys during fetal development that almost invariably involves the _____ poles.
horseshoe kidney, lower
38
A cystlike enlargment of the lower end of the ureter is called \_\_\_\_\_\_\_
ureterocele
39
a cystic mass presents sonographically w/ several characteristic features:
-Smooth, thin, well-defined border -round or oval shape -sharp interface btwn cyst and renal parenchyma -anechoic w/ ↑ posterior acoustic enhancement
40
Renal stones have very ____ foci with posterior acoustic sha
Echogenic
41
If the stone causes obstruction, there will be ____ and, depending on the location of the stone, the ureter may be dilated\_\_\_\_ to the level of obstruction.
Hydronephrosis, superior
42
\_\_\_\_ entails herniation of all layers of the bladder wall and is located in the posterior angle of the trigone.
Congenital Diverticulum
43
\_\_\_ diverticula are herniations of only the two inner layers through the muscle layer.
Acquired
44
\_\_\_\_ is usually secondary to another condition that causes stasis of the urine in the bladder.
Cystitis
45
The majority of bladder tumors in adults are ____ carcinoma.
Transitional Cell
46
Sonographically, it is difficult to differentiate between a(n) _____ cyst and a small adjacent cortical cyst.
Septated
47
The parapelvic cyst is found in the ____ but does not communicate with the renal collecting system.
Renal hilum
48
Name the four forms of autosomal recessive polycystic kidney disease. (ARPKD)
Perinatal, neonatal, infantile, and juvenile
49
Usually a(n) ____ renal contour is the first finding that a mass may be present and requires further treatment.
Abnormal
50
One of the most common benign renal tumors is called \_\_\_\_.
Adenoma
51
An uncommon benign renal tumor composed mainly of fat cells and commonly found in the renal cortex is \_\_\_\_\_.
Angiomyolipoma
52
A(n) ____ appears as a well-defined echogenic mass, found more often in females.
Lipoma
53
Sonographic findings include one or more fluid spaces at the ____ junction that corresponds to the distribution of the renal pyramids.
Corticomedullary
54
Although the kidneys appear enlarged with a highly echogenic renal sinus, the intrarenal anatomy is preserved with uniform loss of renal tissue in patients with \_\_\_\_\_.
Renal atrophy
55
The most common medical renal disease that produces acute renal failure is \_\_\_\_\_.
Acute Tubular Necrosis
56
Chronic renal disease is loss of renal ____ as a result of disease, most commonly parenchymal disease.
Function
57
There are 3 primary types of chronic renal failure: \_\_\_\_\_, _____ and \_\_\_\_\_.
Nephron, vascular, and interstitial abnormalities
58
\_\_\_\_ is when the dilated pyelocalyceal system appears as separation of the renal sinus echoes by fluid-filled areas that conform anatomically to the infundibula, calcyes, and renal pelvis.
Hydronephrosis
59
A localized hydronephrosis occurs as a result of \_\_\_\_, calculi, \_\_\_\_\_, or the \_\_\_\_.
Strictures, focal masses, duplex collecting system
60
Hydronephrosis with a dilated ureter and bladder indicates obstruction of the ____ junction or of the \_\_\_\_.
Ureterovesical, urethra
61
If hydronephrosis is suspected, the sonographer should evaluate the \_\_\_\_.
Bladder
62
Name two conditions that might mimic hydronephrosis.
peripelvic cyst- (the septations may be numerous) extrarenal pelvis - would protrude outside of the renal area,-(renal vessels in the peripelvic area also mimic hydronephrosis. (Color flow Doppler is extremely useful.)
63
Describe the sonographic findings in acute obstruction.
\* Resistive index of intrarenal vessels may be \> 0.70 for 48 to 72 hours after obstruction. \* The RI returns to normal. \* No ureteral jet will be present on the affected side, or flow will be decreased if the obstruction is partial.
64
Ureteral jets are best visualized by ____ imaging.
Color doppler
65
When pus is found within the obstructed renal system, the condition is called \_\_\_\_\_.
Pyonephrosis
66
\_\_\_\_\_ is a diffuse foci of calcium deposits, which is usually located in the medulla and infrequently can also be seen in the renal cortex.
Nephrocalcinosis
67
A renal ____ occurs when part of the tissue undergoes necros
Infarction
68
The major problem encountered with renal transplantation is \_\_\_\_.
Graft Rejection
69
Early after surgery, a baseline sonographic examination is performed to determine \_\_\_\_, \_\_\_\_\_, and \_\_\_\_\_.
Renal size, calycealpattern, extrarenal fluid collections
70
Perirenal fluid collections, such as \_\_\_\_, \_\_\_\_, \_\_\_\_, or ____ can be diagnosed reliably and differentiated from acute rejection.
Hematoma, abscess, lymphocele, urinoma
71
\_\_\_\_ rejection occurs within hours of transplantation and is caused by vasculitis leading to thrombosis and usually the loss of the graft.
Hyperacute
72
\_\_\_\_ rejection occurs within days to months after transplant.
Acute
73
\_\_\_\_\_ rejection causes include performed antibiodies, immune complexes, and cell-mediated responses.
Immunologic
74
\_\_\_\_ rejection can occur months after transplantation with gradual onset.
Chronic
75
The incidence of acute tubular necrosis is usually higher in ____ transplants than in ____ transplants.
Cadaveric, donor-relative
76
Early signs of obstruction are ___ or severe ___ in a patient with satisfactory renal volumes.
Anuria, oliguria
77
Renal artery stenosis exhibits a(n) ____ jet with distal turbulence.
High-velocity
78
\_\_\_\_ Doppler is not angle dependent and has a greater sensitivity to detect blood flow.
Power
79
The initial clinical sign of a kidney stone is extreme \_\_\_\_,
Pain
80
Discuss the characteristics of autosomal dominant polycystic kidney disease (ADPKD)
* -common genetic disease men & women.
* -progressive (start age 40-50) -50% age 60 has end-stage renal disease
* -severity varies w/ genotype.
* -most common is PKD1 (16th chromosome), severely affects kidneys (more than PKD2 (4th chromosome).
* -spontaneous mutations (no genetic marker to ADPKD)
* -Clinical S/: pain\*\*, ↑BP, palpable mass, hematuria, headache, UTI, & renal insufficiency.
* -bilateral w/ multiple cysts in cortex & medulla
* varied size and shape.
81
Define the characteristics of renal cell carcinoma.
* -most common renal tumors (85%).
* -2x more common in males - 60-70 years old
* -classic presentation: nonspecific; may experience hematuria, flank pain, and palpable mass.
* -bilateral is rare
* - ↑ incidence w/ von Hippel–Lindau disease long-term dialysis.
82
When using ultrasound to help diagnose rejections, care must be taken to visualize these 5 things:
* -The size and shape of the kidneys
* -appearance of pyramids, cortex, and parenchyma
* -presence of any surrounding fluid collections
83
\*\*WB IMAGE\*\* list the anatomic structures shown to arise from the IVC in this coronal image
The renal veins arise from the IVC in this image.
84
\*\*WB IMAGE\*\* What structure are the arrows pointing to?
crura of the diaphragm
## Footnote
*crura lie posterior to the renal arteries and can be identified by their lack of pulsatility, and Doppler flow*
85
\*\*WB IMAGE\*\* what anatomic variation of the kidney are the arrows pointing to?
column of Bertin.
86
\*\*WB IMAGE\*\*what anatomic variant is shown in this image?
A dromedary hump
## Footnote
*a coritcal bulge that occurs on the lateral border of the kidney (usually left)*
87
\*\*WB IMAGE\*\* Name the structure the arrow is pointing to
junctional parenchymal defect.
88
\*\* WB IMAGE\*\* describe the sonographic finding in this transverse and longitudinal image of the kidney
renal sinus lipomatosis.
## Footnote
*appears as enlarged kidneys with an echogenic, enlarged sinus and thin cortical rim.*
89
\*\*WB IMAGE\*\* what pathology is shown on these longitudinal scans of both kidneys of a young adult male
extrarenal pelvis.
*appears as a cystic area that extends beyond the confines of the renal borders (color Doppler confirms the extrarenal pelvis)*
90
\*\*WB IMAGE\*\* 66 year old male presents w/ an incidental finding on his abdominal ultrasound. what pathology do the images demonstrate?
Renal cyst with good transmission
91
\*\*WB IMAGE\*\* a 14 month old child presents w/ a palpable right sided mass, decreased appetite, and lethargy. What is the sonographic finding?
**Wilms’ tumor (nephroblastoma)**
* a large Wilms tumor (M) extending from the right kidney (KID) into the IVC.*
* on coronal scan D, tumor mass is seen w/in IVC*
* (Pt is slight decubitus for better imaging of the IVC and Aorta (Ao).*
92
\*\*WB IMAGE\*\* a 6 year old male presents with chronic urinary tract infections. what is the ultrasound finding?
Medullary sponge kidney
*Medullary sponge kidney show nephrocalcinosis and stone formation*
93
\*\*WB IMAGE\*\* does this patient have hydronephrosis? explain why or why not
No, this patient does not have hydronephrosis. The hyperechoic pyramids are consistent with nephrocalcinosis. There is a large stone with shadowing.
94
\*\*WB IMAGE\*\* a yound adult male presents with flank pain after renal transplant surgery. what are the sonographic findings?
These images show normal ureteral jets in the fluid-filled bladder.
95
**\*\*know this diagram\*\***
**\*\*know this diagram\*\***
96
anatomic structures related to the anterior surface of the kidneys
97
**Kidneys (relational anatomy)**
**Anterior to the right kidney**
* Right adrenal gland and liver
* Morison’s pouch
* Second part of the duodenum
* Right colic flexure
**Anterior to the left kidney**
* Left adrenal gland
* Spleen, stomach, and pancreas
* Left colic flexure
* Coils of jejunum
98
vascular relationship of great vessels and their tributaries to the kidneys
99
Dilation of the kidney or ureter or both occurs superior to the obstruction, true or false?
true
100
**\*What is the most common correctable cause of hypertension?**
Renal artery stenosis (RAR)
101
**\*True or false? a basline US can be done as early as 48 hours after transplant to evaluate renal size, calyceal pattern, and extraranal fluid collections**
True
102
\***complete obstruction demonstrates an _____ of ureteral jet**
## Footnote
**partial obstruction shows a __ \_\_\_ jet on the side of teh obstruction or an asymmetry of the ureteral jets or both**
obstruction
low-level
103
\***what may cause dilation of the renal pelvis?**
* polyuria
* distended bladdder
* reflux
* pregnancy
* atrophy after obstruction
104
\***grade 4 hydronephrosis is characterized by:**
* prominent dilation of the collecting system
* thinning of the renal parenchyma
* lack of differentiation btwn collecting system and renal parenchyma
105
\***herniation of the bladder wall?**
diverticulum
106
\***after voiding the bladder, __ cc of urine is considered normal in the adult**
20
107
true or false? a complication of (nephroblastoma) Wilm's tumor is spreading into the IVC
true
108
**\*what are the 4 perinephric fluid collections?**
hematoma, abscess, urinoma, lymphocele
