Week 3 Flashcards
(61 cards)
1
Q
MCU
A
micturating cystouretherography
2
Q
MCU AKA
A
voiding cystouretherography
3
Q
purpose of MCU
A
functional & structural test of urethra & urinary bladder as patient urinates to look for vesicoureteral reflex
4
Q
child patient indications for MCU
A
- vesicoureteral reflex
- recurrent UTIs
5
Q
adult patient indications for MCU
A
- recurrent UTIs
- study urethra during micturition
- stress incontinence
- bladder abnormalities / trauma / rupture
6
Q
if we want to evaluate for cystogram, which part should we skip
A
voiding part
7
Q
contraindication for MCU
A
- acute / untreated UTI
- hypersensitivity to CM
- fever within past 24 hours
8
Q
iodinated CM used for MCU
A
hypaque, urografin
9
Q
what volume is sufficient to fill bladder
A
20ml for infants
500ml for adults
10
Q
CM should be warmed to __
A
body temperature
11
Q
MCU procedure
A
- patient lies supine for catheterization
- introduce lubricated catheter / feeding tube into bladder & drain residual urine
- connect feeding tube with CM through extension tube & slowly drip in CM using drip set
- observe bladder filling using intermittent fluoroscopic screening
- continue till radiologist convinced that patient can micturate immediately or no more CM can drip into bladder
- Prepare to void
- take spot films during micturition
- repeat using valsalva maneuver during void / void in another position / missed shot
12
Q
what spot films are taken for MCU
A
AP, Anterior oblique, KUB, lateral
13
Q
what is anterior oblique used for in MCU
A
demonstrate lower ureter / urethra
14
Q
what is KUB used for in MCU
A
demonstrates any reflux of CM that might occur unnoticed into kidneys & record post micturition residue
15
Q
what is lateral used for in MCU
A
better view of vesico-vaginal / rectovesical fistula
16
Q
VUR
A
vesicoureteral reflux
17
Q
what complications occur in VUR
A
pyelonephritis & renal scarring
18
Q
what is the aftercare for MCU
A
- change wet clothing & keep patient warm
- warn patients of dysuria
- delay film needed to demonstrate extent of urinary reflux
19
Q
PCN
A
percutaneous nephrostomy
20
Q
PCNL
A
percutaneous nephrolithotomy
21
Q
purpose of PCN
A
placement of drainage catheter through skin into kidney to drain urine
22
Q
purpose of PCNL
A
placement of drainage catheter through skin into kidney to drain urine & removal of kidney stone from body
23
Q
indications for PCN/PCNL
A
- urinary tract obstruction
- renal stone / staghorn stone
- unexplained hematuria / fever
24
Q
contraindications for PCN/PCNL
A
uncorrected coagulopathy
25
indications for PCNL
- emergency PCNL may save lives in cases of urosepsis with obstruction
- removing renal calculi
- disintegrate large renal calculi
26
patient evaluation of PCN/PCNL
patient must be able to
- lie prone
- cooperate with breath holding as needed
27
pre-procedural care of PCN/PCNL
- antibiotic cover
- proper pre-op check
- 4hr Fast
- empty bladder before procedure
28
what is the function of CM for antegrade pyelogram
outlines pelvicalyceal system
29
what is the prelim film for PCN
supine AP of renal area / KUB
30
what is the fine needle used in PCN/PCNL
chiba 22G or 16G angiocath
31
what dilators are used for PCN
4 - 8F
32
what dilators are used for PCNL
7 - 30F
33
what lithotripsy / drainage catheter used for PCN/PCNL
pigtail 7 / 8 F
34
what is the procedure of PCNL
calculi < 1cm removed using nephro-scope & forceps; larger stones broken down by laser first
35
what is the procedure of PCN
after introducing catheter, securely fixed to the skin & drainage commenced
36
film series of antegrade pyelogram
AP, both sides of 35 degrees posterior obliques
37
why should CM be removed from obstructed pelvis
prevents development of chemical pyelitis
38
stents have small openings in their walls towards the ends which are called __
fenestrations which aid in passage of urine
39
PCN / PCNL complications
HIPPAH
- perirenal & intrarenal hemorrhage
- haematuria
- pneumothorax
- infection
- arteriovenous fistula
- puncture adjacent organs
40
aftercare for PCN/PCNL
- vacuum bottle connected to drainage catheter to promote healing & drain blood out of body
- CXR TRO pneumothorax/haemopneumothorax
- rest for 12hrs
- monitor BP & temp every 30 mins for 6 hours
- urine cultures to ?infection
41
purpose of retrograde pyeloureterography
demonstrate site, length, upper limit & nature of obstructive lesion
demonstrates pelvicalyceal system after unsatisfactory IVU
demonstrates shape, patency, calyceal distention
42
what info is the least provided for retrograde pyeloureterography
little physiologic info provided as it is not a functional study
43
indications for retrograde pyeloureterography
- unsatisfactory excretory urogram
- demonstrate site of obstruction & nature of obstructive lesion
- patients with renal insufficiency / contrast sensitivity
44
contraindications for retrograde pyeloureterography
acute UTI
45
procedure for retrograde pyeloureterography
1. 5 - 6F catheter introduced via cystoscope from urethra to upper pole of ureter
2. upper end of catheter at upper pole with lower end of catheter exposed outside body & secured by adhesive tape
3. uni- / bi- lateral catheterization
4. inject CM through catheter under fluoroscopic monitoring & take spot films
5. angulate C-arm to obtain AP / Lat / RAO / LAO
6. EUS + Laser lithotripsy used
7. Double J-Shaped stent used to maintain unobstructed flow from kidney to bladder
46
purpose of double J-shaped stent for retrograde pyeloureterography
maintains unobstructed flow from kidney to bladder
47
EUS
endoscopic ultrasound
48
if doing retrograde pyeloureterography in the x-ray room, when should u take spot films
1. catheter at 10cm below renal pelvis
2. midstream
3. just above ureteric orifice when catheter withdrawn
49
complications of retrograde pyeloureterography
PIM
- infection
- mucosal damage to ureter
- perforate ureter / renal pelvis by catheter
50
aftercare of retrograde pyeloureterography
- post anesthetic observation
- prophylactic antibiotics
- inform possibility of haematuria
51
HSG
hysterosalpingography
52
purpose of HSG
- evaluate uterine abnormalities such as infertility, adhesions, fibroids, congenital uterine anomalies
- evaluate tubal patency following PID & tubal ligation reversal
53
indications of HSG
- infertility
- recurrent miscarriages
- post fallopian tube surgery
- assess integrity of caesarean uterine scar due to adhesion / perforation
54
contraindications of HSG
- pregnancy
- contrast sensitivity
- immediately post menstruation
- recent dilatation & curettage / abortion
- purulent discharge upon inspection of vulva/cervix / diagnosed PID in last 6 months
55
HSG patient preparation includes
patient abstain from intercourse between appointment booking & exam timing unless reliable contraceptive used such as BTL / IUCD
- exam booked between 4-10 days in regular 28 day cycle
56
BTL
bilateral tubal ligation
57
IUCD
intrauterine contraceptive device
58
prelim film of HSG
coned AP view of pelvic cavity on request
59
HSG procedure
1. patient lies supine in lithotomy position
2. clean skin & insert speculum into vagina & clean vagina & cervix with chlorhexidine
3. steady anterior lip of cervix with vulsellum forceps
4. insert cannula / balloon catheter / cervical vacuum cup into cervical canal
5. slowly inject CM under intermittent fluoroscopic control to relieve spasm of uterine with IV glucagon
6. take spot films in coned view of AP pelvis
- as tubes begin to fill
- when peritoneal spill occurs
- with all instruments removed
60
complications of HSG
- bleeding from trauma to uterus / cervix
- Intravasation of CM esp when using oily CM
- infection
61
aftercare for HSG
- ensure no serious discomfort / significant bleeding before she leaves
- advise patient that bleeding will occur for 1-2 days & pain persists up to 2 weeks
