Ch. 29 The Fetal Genitourinary system Flashcards
The fetal kidneys develop within the pelvis and ascend into their normal position by _____weeks. By the 10th week of gestation, fully functional kidneys exist. If the kidneys fail to ascend into the normal position, the result is an _____ kidney (renal ectopica), most often located within the pelvis. This is referred to as a _______.
9; ectopic; pelvic kidney
The most common renal anomaly is the ________, also referred to as a duplicated, duplex, or double collecting system. In this variant, the kidney is composed of ______ separate collecting systems, divided into what is termed an upper pole moiety and a lower pole moiety.
duplex collecting system; two
(renal) refers to a separate collecting system in the upper pole or the lower pole of the kidney in a duplex collecting system
moiety
___________are kidneys that are attached at their lower poles.
Horseshoe kidneys
Initially, the bladder is continuous with the _______, although eventually this channel closes and develops into a fibrous cord referred to as the _______.
allantois; urachus
a membrane that is present during early embryonic development that contributes to urinary bladder formation and development
allantois
canal connecting the fetal bladder with the allantois; normally closes during fetal development and becomes a fibrous cord
urachus
the urachus is located between the ______ of the bladder and the _______. In newborns, occasionally, the urachus can remain patent or open.
apex; umbilicus
The gonads develop in the _____ fetal abdomen and descend into the pelvis. The testicles move down into the scrotum during the _____ month of gestation.
upper; 7th
The kidneys can be sonographically identified as early as 11 weeks with endovaginal imaging and by _____ weeks with transabdominal imaging. Indeed, by the second-trimester fetal anatomy screening examination, the kidneys should be consistently seen adjacent to the fetal ______ bilaterally
12; spine
The fetal bladder can be seen as early as 12 weeks and should always be seen by ______ weeks and beyond
15
It is important to note that the fetal urinary bladder normally fills and empties once in every ___ to ___minutes.
30 to 45 minutes
Normal fetal ureters are _____ perceived with sonography. Therefore, visualization of the ureters would indicate some _______ process.
not; pathologic
The adrenal glands are triangular-shaped hypoechoic structures located _______ to the upper pole of the kidneys. They are easily identified within the fetus
superior
VACTERL stands for _______, _______, _________, _________ or _________, ________, and __________ Patients are considered to have this association if ______of the organ systems listed have abnormalities. Therefore, if an irregularity is noted within one structure or system, this should prompt the sonographer to further investigate the other systems for associated anomalies.
vertebral anomalies, anal atresia, cardiac anomalies, tracheoesophageal fistula or esophageal atresia, renal anomalies, and limb anomalies; three
*VACTERL association may also be referred to as VATER sequence, VATER, or VACTERL syndrome.
Renal abnormalities are the most frequent cause of _______. Therefore, if ________ is discovered, a thorough analysis of the fetal urinary tract is warranted.
oligohydramnios; oligohydramnios
During fetal development, around ____ weeks, the fetal kidneys begin to produce urine. ______ comprises the greater part of amniotic fluid after 14 weeks. ________ is a substance that contains valuable proteins that are essential for normal fetal development. It also contributes greatly to normal fetal growth and maturation.
9; Urine; Amniotic fluid
The fetus ingests amniotic fluid by _________. The fluid passes through the esophagus, into the stomach, and travels through the small bowel and into the colon, where normal ________ takes place.
swallowing; absorption
In circumstances in which the fetus has a renal abnormality, specifically those that are linked with bilateral renal agenesis, inadequately functioning kidneys, or obstruction of the urinary tract, ________ will be present, and, in some cases, anhydramnios may occur. Therefore, if a normal amount of fluid is noted during a sonogram, one can assume that there is at least ______ functioning fetal kidney present.
oligohydramnios; one
no amniotic fluid
anhydramnios
The most worrisome consequence of oligohydramnios is ________, or underdevelopment of the lungs.
pulmonary hypoplasia
With fetal renal disease, keep in mind that while _______ conditions carry a better prognosis, _____ disease often leads to oligohydramnios and is thus related to a poor outcome, in most cases, as a result of ________.
unilateral; bilateral; pulmonary hypoplasia
Failure of a kidney to form is referred to as ________. Can be unilateral or bilateral.
renal agenesis
There are two sonographic findings that are helpful in making the sonographic diagnosis of renal agenesis. First, when the kidney is absent in the abdomen, the adrenal gland can be noted in a parallel, flattened position, a sonographic finding known as the “________” adrenal sign. Second, _______ can be employed over the _______branches of the abdominal aorta. When there is absence of the kidney, there will be no identifiable renal artery branches
lying down; color Doppler; renal artery branches
Bilateral renal agenesis, which results in _______ or Potter sequence, is a fatal condition. Potter sequence is caused by any condition in which there is a significant ______ of amniotic fluid around the fetus as it develops.
Potter syndrome; lack
physical features of a fetus as a result of oligohydramnios; characterized by bilateral renal agenesis, abnormal facies, pulmonary hypoplasia, and limb abnormalities; also referred to as Potter sequence
Potter syndrome
The absence of both the fetal kidneys can be difficult to detect sonographically, secondary to the _____ of amniotic fluid surrounding the fetus. Therefore, it is extremely beneficial to utilize _________ to investigate the renal area. Nonvisualization of the urinary_______ and ________, with associated severe __________, is considered to be a trustworthy finding consistent with bilateral renal agenesis.
lack; color Doppler; bladder and kidneys; oligohydramnios
Bilateral renal agenesis may be seen in conjunction with _________and various cardiovascular malformations.
sirenomelia
a fetal abnormality characterized by fusion of the lower extremities, renal agenesis, and oligohydramnios; may also be referred to as mermaid syndrome
sirenomelia
enlargement of an organ secondary to an increased workload; often seen when part of an organ has been destroyed or when there is absence or decreased function of paired organs
compensatory hypertrophy
facial features seen with severe oligohydramnios, including low-set ears, flattened nose, wrinkled skin, and micrognathia
Potter facies
Before making the conclusion of unilateral renal agenesis, the sonographer should always analyze the fetal ______for a __________, because this is the most common location of an ectopic kidney. In the presence of unilateral renal agenesis, the contralateral kidney will enlarge, a condition known as __________
pelvis; pelvic kidney; compensatory hypertrophy
Any abnormality that brings about oligohydramnios, especially severe, can start the sequence referred to as ________, which ultimately can result in fetal growth restriction, pulmonary hypoplasia, Potter facies, and limb abnormalities.
Potter sequence
Most often, with _______ renal agenesis, there is an average amount of amniotic fluid, and the prognosis is good.
unilateral
Features of ________
Bilateral renal agenesis
Abnormal facial features (Potter facies)
Pulmonary hypoplasia (small chest)
Limb abnormalities (e.g., clubfeet)
Intrauterine growth restriction
Low-set ears
Oligohydramnios
Potter syndrome or Potter sequence
Sonographic Findings of _________
1.Absent kidneys
2.Absent urinary bladder
3.Severe oligohydramnios or anhydramnios
4.Bilateral lying-down adrenal signs
5.Undetectable renal artery branches with color Doppler (bilateral)
Bilateral Renal Agenesis
Sonographic Findings of __________
1.Absent kidney
2.Compensatory hypertrophy of the contralateral kidney
3.Visible urinary bladder
4.Normal amniotic fluid volume
5.Unilateral lying-down adrenal sign
6.Undetectable renal artery branch with color Doppler (unilateral)
Unilateral Renal Agenesis
In order for an _______ disease to be passed to the fetus, both parents must be carriers of the disease. Each offspring of parents, who are both carriers of an autosomal recessive disorder, has a 25% chance of being affected and a 50% chance of being a carrier.
autosomal recessive disease
In the case of an __________ disease, at least one of the parents has to be the carrier of the disease, and the gene must be dominant. That means, the dominant gene is capable of overriding the normal gene from the parent who is not a carrier.Each offspring of a parent who is a carrier of an autosomal dominant disease has a _____ chance of receiving the gene from their parents. It is important to note that dominant disorders tend to be ______ severe than recessive disorders
autosomal dominant disease; 50%; less
_______ may also be referred to as autosomal recessive polycystic renal disease or infantile polycystic kidney disease. The typical sonographic findings of a fetus affected by ARPKD are bilateral, enlarged, ______ kidneys, nondetectable urinary bladder, and _________
ARPKD; echogenic; oligohydramnios
Sonographic Findings of __________
1.Bilateral, enlarged echogenic kidneys
2.Absent urinary bladder
3.Oligohydramnios
Autosomal Recessive (Infantile) Polycystic Kidney Disease
One condition associated with ARPKD is ____________, which is a fatal disorder that includes renal cystic disease, occipital encephalocele, and polydactyly
Meckel–Gruber syndrome
fetal syndrome associated with microcephaly, occipital encephalocele, polydactyly, and polycystic kidneys
Meckel–Gruber syndrome
protrusion of the brain and meninges through a defect in the skull
encephalocele
having more than the normal number of fingers or toes
polydactyly
Referring to this condition (ARPKD), a renal cystic disease can be puzzling to a sonographer because cysts are not always perceptible with sonography. This is secondary to the size of the cysts because the cysts with ARPKD are often _________and not macroscopic.
microscopic
Sonographic Findings of ________
1.Normal-appearing or bilateral, enlarged echogenic kidneys
2.Visible urinary bladder
3.Normal amniotic fluid volume
4.Cysts often do not manifest until approximately the fifth decade of life
Autosomal Dominant (Adult) Polycystic Kidney Disease
The sonographic appearance of fetal kidneys with ADPKD is similar to that of ______ in that both kidneys will appear enlarged and echogenic, although the kidneys may appear completely ______. If the kidneys do appear enlarged and echogenic, a distinguishing difference between the two diseases is that in the fetus with ADPKD, the urinary bladder is often _______ and there is a _______ amniotic fluid volume, whereas with ARPKD, the bladder is absent and there is oligohydramnios.
ARPKD; normal; present; normal
ADPKD does not typically manifest until approximately the _____ or _____decade of life, at which time the adult will develop renal cysts and may die from end-stage renal failure. Adult renal cystic disease is also associated with the development of ______ within the liver, pancreas, and spleen. Fetuses with trisomy 13 and trisomy 18 may also have polycystic kidney disease.
fourth or fifth; cysts
Multicystic dysplastic renal disease may also be referred to as _________and multicystic renal dysplasia. MCDK disease is thought to be caused by an early, first-trimester obstruction of the _____.
multicystic dysplastic kidney (MCDK) disease; ureter
Sonographic Findings of ____________
1.Bilateral, smooth-walled, noncommunicating cysts of varying sizes located within the renal fossae
2.Absent urinary bladder
3.Oligohydramnios
Bilateral Multicystic Dysplastic Renal Disease
Sonographic Findings of Unilateral _________
1.Unilateral, smooth-walled, noncommunicating cysts of varying sizes located within the renal fossae
2.Compensatory hypertrophy of the contralateral kidney
3.Visible urinary bladder
4.Normal amniotic fluid volume
Unilateral Multicystic Dysplastic Renal Disease
There is typically no normal functioning renal tissue present in the kidney affected by MCDK disease. Therefore, MCDK disease is fatal if ________, with the consistent associated findings of oligohydramnios and absent bladder.
bilateral
Fetuses with _______ disease can also have additional related anomalies, such as abnormalities of the gastrointestinal tract and central nervous system, limb anomalies, and further renal abnormalities.
MCDK
MCDK disease is fatal if _______, but fortunately, most cases of MCDK are unilateral.
bilateral
______, like MCDK disease, is caused by an early renal _______. It can be unilateral or bilateral.
Obstructive cystic dysplasia; obstruction
A ________, or a severe bladder outlet obstruction, early in gestation, can lead to bilateral obstructive cystic dysplasia, in which case ________ will be present.
ureterocele; oligohydramnios
an abnormality in which the distal ureter projects into the urinary bladder
*appears as a thin-walled cyst inside the bladder
ureterocele
the junction of the ureter and the renal pelvis
pelviureteral junction
Unilateral obstructive cystic dysplasia is most often caused by a ______ or vesicoureteral junction obstruction. Bilateral cystic dysplasia may be associated with ________ or posterior urethral valves.
pelviureteral junction; urethral atresia
Sonographic Findings of __________
1.Small, echogenic kidneys
2.Peripheral renal cysts
3.Bilateral hydronephrosis
4.Thick-walled urinary bladder
5.Oligohydramnios
Bilateral Obstructive Cystic Dysplasia
irregular thin membranes of tissue located within the male posterior urethra that does not allow urine to exit the urethra
posterior urethral valves
the dilation of the renal collecting system resulting from the obstruction of the flow of urine from the kidney(s) to the bladder; also referred to as pelvocaliectasis or pelvicaliectasis
hydronephrosis
the funnel-shaped collecting system in the central portion of the kidney that allows urine to flow from the kidney to the ureter
renal pelvis
the junction of the ureter and the urinary bladder
ureterovesical junction (UVJ)
the junction of the ureter and the renal pelvis
ureteropelvic junction (UPJ)
the part of the collecting system that encompasses the apex of the renal pyramids
renal calices
An obstruction of the fetal urinary tract can lead to _______ of the urethra, bladder, ureters, and renal collecting system, depending upon the level of obstruction.
distension
The sonographer must understand the creation and flow of urine through the urinary tract in order to determine the ______ of a urinary tract obstruction.
origin
Urine is produced by the kidney; exits the kidney by means of the _______; travels down the ureter, into the bladder; and exits the body via the ______.
renal pelvis; urethra
if there is an obstruction at the region where the ureter meets the bladder, the ______, then those structures that are positioned _______ to the obstruction will be dilated. That means, the entire ureter, the renal pelvis, and the renal calices will be eventually dilated and filled with urine. Conversely, if the obstruction level lies at the point at which the renal pelvis meets the ureter, the ________, then the ipsilateral renal pelvis and renal calices will be dilated, whereas the ureter and bladder will most likely remain normal, provided that contralateral urine flow is not obstructed in any way
ureterovesical junction (UVJ); proximal; ureteropelvic junction (UPJ)
________is the most common fetal abnormality noted during an obstetric sonogram.
Hydronephrosis
________, or pelvocaliectasis, may be described as pelviectasis (pyelectasis) or caliectasis, depending on which _____ of the collecting system is dilated.
Hydronephrosis; part
Enlargement of the bladder is called ______, whereas dilation of the ureter may be referred to as _______ or hydroureter.
megacystis; megaureter
dilation of the renal pelvis; may also be referred to as pyelectasis
pelviectasis (pyelectasis)
dilation of the calices
caliectasis
Fetal pelviectasis, or dilation of the renal pelvis, can be established and measured with sonography by taking a ________. The measurement of the renal pelvis is made in the _______ plane and should not exceed ______ before 20 weeks’ or _____ after 20 weeks’ gestation. However, it is important to note that ________ hydronephrosis should be reported because of the possible gradual evolution of this disorder and because of possible chromosomal associations
renal pelvic diameter; anteroposterior; 7mm; 10mm; borderline
It is also important to note that ______ common causes of hydronephrosis in the fetus include ureterocele, ectopic ureter, vesicoureteral reflux, and urethral atresia
less
the retrograde flow of urine from the urinary bladder into the ureter
vesicoureteral reflux
the congenital absence of the urethra
urethral atresia
_______, or _____ obstruction, is the most common cause of hydronephrosis in the neonate and the most common form of fetal renal obstruction.
Ureteropelvic junction obstruction; UPJ
The _____ is located at the junction of the renal pelvis and the ureter. The cause of this abnormality may be due to irregular development of the smooth muscle in the area of the _____ (UPJ obstruction). Some authors suspect ureteral stenosis or kinks, adhesions, crossing vessels, or abnormal outlet shapes. The disease is usually _______ and more common in ________.
UPJ; UPJ; unilateral; males
It is important to note that fetal pyelectasis can be a sonographic marker for _________.
Down syndrome
Sonographic Findings of _____________
1.Hydronephrosis (dilated renal pelvis and calices)
2.Normal ureters (nonvisualization)
3.Normal bladder
Ureteropelvic Junction Obstruction
Renal pelvis diameter measurements indicative of fetal hydronephrosis
-Gestational Weeks: 20 weeks
-Renal Pelvis Diameter Measurement: ≥7 mm (borderline between ___ and ___)
-Gestational Weeks: After 20 weeks
-Renal Pelvis Diameter Measurement: ≥10 mm (borderline between ___ and ___)
4 and 6 mm; 5 and 9 mm
Sonographic Findings of _______
1.“Keyhole” sign (dilated bladder and urethra)
2.Bilateral hydroureter
3.Bilateral hydronephrosis
4.Oligohydramnios
5.Thickened bladder wall
Posterior Urethral Valves
A __________describes the condition in which there is a blockage of the flow of urine out of the urinary bladder.
bladder outlet obstruction
It is especially significant to determine the _____of the fetus once a renal obstruction is identified. For example, posterior urethral valves are a common cause of bladder outlet obstructions in ____ fetuses. These thin membranes of tissue located within the posterior urethra do not allow urine to exit the ______.
sex; male; urethra
The “keyhole” sign is seen when there is dilation of the _______and ________.
urinary bladder; posterior urethra
_____________ result in dilation of the bladder, ureters, and renal collecting system. Oligohydramnios and bladder wall thickening will be observed as well.
Posterior urethral valves
Prune belly syndrome is typically caused by ________, a massively dilated urinary bladder. This syndrome is seen mostly in ____ fetuses and is the result of a _______ abnormality, which, in turn, leads to a bladder outlet obstruction.
megacystis; male; urethral
_________ describes the result of the abdominal wall musculature being stretched by the extremely enlarged urinary bladder. The sonographic finding of the “_______” sign is also seen with prune belly syndrome. Dilatation of the _____ and the ________ systems will occur
Prune belly; keyhole; prune belly syndrome; ureters; renal collecting
The triad of absent _________, undescended _____, and _______ abnormalities is consistent with the diagnosis of prune belly syndrome.
absent abdominal musculature; testis; urinary tract
Sonographic Findings of ________
1.Dilated bladder and, possibly, urethra (“keyhole” sign)
2.Absent abdominal musculature
3.Undescended testis
4.Urinary tract abnormalities (megacystis and hydronephrosis)
Prune Belly Syndrome
________, or UVJ obstruction, is the least common cause of hydronephrosis in the fetus.
Ureterovesical junction obstruction
The _________system and ______ will be dilated with a UVJ obstruction. Whereas unilateral UVJ obstructions lead to ______amounts of amniotic fluid, bilateral obstructions lead to ___________.
renal collecting system; ureter; normal; oligohydramnios
Sonographic Findings of __________Obstruction
1.Hydronephrosis
2.Dilated ureter
3.Normal bladder
4.Normal amniotic fluid (if unilateral)
Ureterovesical Junction Obstruction
________ is an anomaly wherein the bladder is located outside of the fetal pelvis.
Bladder exstrophy
After an extended amount of investigation, nonvisualization of the bladder in the presence of a normal amniotic fluid volume and normal kidneys should warrant a search for ________.
bladder exstrophy
the embryonic structure that develops into the normal rectum and urogenital sinus
cloaca
Sonographic Findings of _______
1.Lower abdominal wall mass inferior to the umbilicus
2.Absent urinary bladder
3.Normal kidneys
Bladder Exstrophy
the region between the external genitalia and the anus
perineum
The ______ is the embryonic structure that develops into the rectum and urogenital sinus. The cloaca can be persistent and result in the ________ of the urinary, genitals, and intestinal tract, emptying into a common orifice located on the perineum.
cloaca; combination
With cloacal exstrophy, also referred to OEIS complex, there is an ______, _______, _______, and ________.
omphalocele; bladder exstrophy, imperforate anus, and spina bifida.
the most common sold fetal renal mass
mesoblastic nephroma
The most common solid fetal renal mass is the _______, which is essentially a hamartoma of the kidney. This tumor will typically appear as a solid, _______mass within the renal fossa and may completely replace the kidney. However, it may contain ______ components.
mesoblastic nephroma; homogeneous; cystic
Sonographic Findings of The _________
1.Solid, homogeneous mass within the renal fossa and may completely replace the kidney.
Mesoblastic Nephroma
The sex of the embryo depends upon the ______ gamete. The sperm carries either an X or a Y chromosome, whereas the ovary always contributes an ____ chromosome. An X chromosome from the sperm will yield XX, which is _______ offspring. The combination of a Y chromosome will yield XY, which is a ______ offspring.
male; X; female; male
The external genitalia can be visualized and differentiated in the _______ trimester. Determining the _____ of the fetus can offer important diagnostic information. When a urinary tract obstruction is noted, the sonographer should determine the _____of the fetus, because there may be different causes of obstructions specific for each sex. For example, posterior urethral valves are a common cause of urinary obstruction in only the ________ fetus.
second; sex; sex; male
____________ is a birth defect in which the sex of the fetus cannot be determined. Findings of abnormal external genitalia in the ______ are micropenis, hypospadias, hypospadias with chordee, epispadias, and undescended testicles.
Ambiguous genitalia; male
a fluid collection within the scrotum between the two layers of the tunica vaginalis
hydroceles
_________ is the abnormal ventral curvature of the penis as a result of a shortened urethra that exits on the ventral penile shaft.
Hypospadias
enlargement of the clitoris
clitoromegaly
Fetal ____ cysts may be noted in the fetal pelvis, secondary to maternal hormone stimulation. These cysts are most often benign and resolve ________, although if they continue to grow, they can lead to hemorrhage and, possibly, ovarian torsion.
ovarian cysts; spontaneously
an abnormally small penis
micropenis
abnormal ventral curvature of the penis as a result of a shortened urethra that exits on the ventral penile shaft
hypospadias
the head of the penis curves upward or downward
chordee
in males, the urethral opening is located on the upper aspect of the penis
epispadias
The most common malignant abdominal mass in neonates is the _________, located primarily within the ________.
neuroblastoma; adrenal gland
