Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

SON131-Abd 2 > Chapter 27 > Flashcards

Chapter 27 Flashcards

1
Q

What are some neonatal indications?

A 
Abnormal prenatal ultrasound
Flank masses
Abdominal distention
Anuria-no urination
Oliguria-little urination
Hematuria-blood in urine
Sepsis or UTI
Meningomyelocele-Spinal bifida
VATER and VACTERL anomalies
Abnormal external genitalia
Prune belly syndrome
Skin tags (usually near ear and associated with cardiac anomalies)
Two-vessel umbilical cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are normal kidneys characterized by?

A

Characterized by a distinct demarcation of cortex and medullary pyramids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sonographic appearance of medullary pyramids

A

Medullary pyramids are large and hypoechoic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

sonographic appearance of cortex

A

Cortex is thin with echogenicity similar to or slightly greater than the liver (cortical echogenicity usually decreases to less than that of the liver by 4-6 months)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sonographic appearance of renal sinus

A

Renal sinus is hypoechoic and indistinct (lack of fat in renal sinus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

sonographic appearance of arcuate arteries

A

Arcuate arteries- echogenic structures at the base of the pyramid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the contour of the neonatal kidney?

A

Contour is usually lobulated from residual fetal lobulations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List normal anatomy for adrenal glands

A

Larger in a neonate than in an older infant or young child
Superior to the upper pole of the kidney
Lt. is slightly more medial than Rt.
In long it has an inverted “V” or “Y” shape
In transverse a portion is seen as a linear or curvilinear outline
Medulla in a neonate is a thin echogenic line surrounded by a more prominent and less echogenic cortex
When the kidney is absent or ectopic, the ipsilateral adrenal gland remains in the renal fossa, but may have an altered configuration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Normal anatomy of the bladder

A

Bladder wall should be thin-walled
When distended it should be less than 3 mm
When empty wall should be less than 5 mm
Distal ureters may bee seen at bladder base on a well hydrated child.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do sonographers evaluate for hydro?

A 
Sonographers evaluates for:
Severity of hydro
Unilateral vs. bilateral
If ureters and bladder are dilated
Status of renal parenchyma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are common causes of hydro?

A

Common causes:
Obstruction
Reflux
Abnormal muscle development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do you have to make sure of when evaluating hydro?

A

Make sure you can connect small peripheral cyst (dilated calyces) to central cyst (renal pelvis) to determine hydro vs. cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common cause of obstruction of the upper urinary tract

A

UPJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most often result of UPJ?

A

Most often result of an intrinsic narrowing or extrinsic vascular compression at the level of UPJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Charactericis of UPJ

A

May be bilateral with contralateral multicystic dysplastic kidney or vesicoureteral reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When does proximal dilation occur?

A

Proximal dilation occurs and the ureter remains normal size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ultrasound findings of UPJ

A

Pelvocalyceal dilation without ureteral dilation
When the obstruction is pronounced the renal pelvis extends inferiorly and medially
If vesicoureteral reflux or primary megaureter is present the ureter may be dilated
The best way to image the ureter at the UPJ is with a coronal scan plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where can ureteral obstruction be obstructed?

A

May be obstructed anywhere along its course or at ureterovesical junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are potential causes of ureteral obstruction?

A 
Potential causes:
Abscess or lymphoma
Primary megaureter
Atresia 
Ectopic ureter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can cause a megaureter and define it?

A

Ureteral obstruction

Primary megaureter- hydronephrosis and hydroureter with a narrow segment of the distal ureter behind the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where is bilateral hydro usually found?

A

Bilateral hydronephrosis is frequently caused by obstruction at the level of the bladder or bladder outlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some causes of bladder outlet obstruction?

A

Possible causes of obstruction:
Neurogenic bladder
Pelvic mass
Congenital anomaly such as posterior urethral valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the most common cause of bladder outlet obstruction in male neonates?

A

Posterior urethral valves are the most common cause of bladder outlet obstruction in a male neonate

24
Q

Ultrasound findings of bladder outlet obstruction?

A

Ultrasound Findings:
Thick bladder wall
ML sagittal imaging angling caudally may demonstrate the distended posterior urethra
The resultant hydronephrosis and hydroureter are usually bilateral
Urinary ascites or perirenal urinoma can result from high-pressure vesicoureteral reflux, rupturing a calyceal fornix or tearing the renal parenchyma
Perirenal urinoma is usually anechoic, but could have septations

25
Where is a n ectopic ureterocele more common?
More common in females | More common on the left side
26
What does ectopic ureterocele results from?
Results from an ectopic insertion and cystic dilation of the distal ureter of the upper moiety in a completely duplicated collecting system
27
US findings of ectopic ureterocele
Ultrasound findings: Ectopic ureterocele, seen as a fluid mass within the urinary bladder’ Located inferomedially to the ureteral insertion of the lower pole ureter Weigert-Meyer Rule
28
describe prune belly syndrome
Triad of hypoplasia or deficiency of abdominal musculature, cryptorchidism, and urinary tract anomalies Severely affected patients have urethral atresia and bilateral cystic renal dysplasia secondary to the obstruction Resultant pulmonary hypoplasia is fatal Less severely affected neonates have a bladder with poor contractility without obstruction; however, ureters may be ectatic and dilated Reflux is a common finding with prune belly syndrome
29
Us findings of prune belly syndrome
Most severely affected neonates-dysplastic echogenic kidneys Less severely affected, nonhydronephrotic kidneys with dilated ureters and a huge bladder Physically a wrinkled “prune like” abdomen aids in clinical diagnosis
30
What is the Most common cause of renal cystic disease in the neonate?
MCDK
31
describe MCDK
When hydronephrosis is excluded it is the most common cause of an abdominal mass in a newborn Congenital Caused by an obstruction, collecting tubules enlarge, becoming cystic and distorting the shape of the kidney. Renal parenchyma becomes virtually nonfunctioning
32
US findings of MCDK
Unilateral multicystic mass “cluster of grapes” Noncommunicating cysts No identifiable renal pelvis Bilateral MCDK is fatal Association with contralateral ureteropelvic junction obstruction has been noted
33
What is Most severe form is seen in the neonatal stage, least severe form is seen in the infantile and juvenile stage
ARPKD
34
describe ARPKD
Polycystic renal disease seen in the neonate is most often ARPKD also known as infantile polycystic disease Not common Female predominance 2:1
35
US findings of ARPKD
Ultrasound findings Bilateral renal enlargement Increased echogenicity with loss of definition of the renal sinus, medulla, and cortex The cystlike appearance reflects dilated renal tubules, the innumerable acoustic interfaces cause the increase in echogenicity
36
What is Adult form usually appears during middle age
ADPKD
37
describe ADPKD
Rarely it has been reported in a young infant Typically presents in the fourth decade with hypertension, hematuria, and enlarged kidneys Cyst are macroscopic and vary in size, may also be seen in the liver, spleen and pancreas Cerebral berry aneurysm seen in 10-15% of patients with ADPKD Patients are at increased risk of renal cell carcinoma (RCC)
38
US findings ADPKD
Similar to ARPKD Lack of significant renal impairment, normal amniotic fluid (in utero), family hx., and histologic sampling allows for differentiation Cysts of varying sizes can be seen in adults-tubular and ductal cells become engorged
39
US findings of acute pyelonephritis
sudden fever, flank pain, and tenderness Typically begins in the bladder and ascends the ureter to the renal pelvis May be slightly enlarged and hypoechoic If infection spreads to the pyramids may see increased echogenicity there Renal pelvis and ureter may show thickening Infection can be focal or diffuse, and it may develop into an abscess
40
US findings of chronic pyelonephritis
Repeated episodes of acute pyelonephritis Kidneys become scarred and decreased in size Outline of the parenchyma may be irregular Kidneys have increased echogenicity Difficult to separate pyramids from renal parenchyma
41
describe common things for renal vein thrombosis
Most likely to occur in a septic/dehydrated infant More prevalent in infants of diabetic mothers One or both kidneys may be involved Renal enlargement Hematuria, proteinuria, and low platelet count
42
Us findings of renal vein thrombosis
Starts in the small intrarenal venous branches-heterogeneous parenchyma If it reaches the renal vein and IVC it can be seen May have coexistent adrenal hemorrhage, particularly on the left where adrenal vein drains into the left renal vein Calcifications may be seen in involved veins
43
Most common abdominal masses in the pediatric patient are renal in origin where?
Most common abdominal masses in the pediatric patient are renal in origin: hydronephrosis and multicystic renal dysplasia
44
What is sonographers role for renal/ adrenal tumors
Determine the origin of the mass Internal pattern (cystic, solid, or mixed) Determine whether or not there is vascular flow
45
The most common renal tumor of the neonate
Congenital Mesoblastic Nephroma
46
Describe Congenital Mesoblastic Nephroma
Rare Consist of connective tissue elements and can completely replace the renal tissue Benign but indistinguishable from Wilms’ tumor Because the tumor may invade adjacent structures, nephrectomy is indicated Seen in children
47
Us findings of Congenital Mesoblastic Nephroma
Ultrasound findings: Solid Hypoechoic, hyperechoic, or mixed echogenicity Mass may extend through the renal capsule into the retroperitoneum Indistinguishable from Wilms’ tumor
48
Most common intraabdominal malignant renal tumor in young children
Wilms tumor
49
describe wilms tumor
Incidence of tumor peaks between 2 and 5 years of age Usually unilateral, but can be bilateral Risk in developing Wilms’ tumor in patients with previous Wilms’ or with a family history of Wilms’ tumor Can occur spontaneously Ultrasound is used to monitor the tumor size in patients undergoing chemotherapy then the appropriate time of surgery is determined
50
US findings of wilms tumor
Ultrasound findings Variable- homogeneous to complex May have calcifications within Liquefaction may represent necrosis and hemorrhage Sharply marginated and well defined, but bulky, with a hypoechoic to hyperechoic rim surrounding mass Can invade the renal vein, IVC, right atrium, and contralateral kidney Spreads through direct extension into renal sinus and peripelvic soft tissues, lymph nodes in the renal hilum, and paraaortic areas Documentation of tumor extension can have a significant bearing on the surgical approach
51
Malignant tumor arising in the sympathetic chain ganglia and the adrenal medulla Second most common abdominal tumor of childhood
neuroblastoma
52
describe neuroblastoma
Occurring between the ages of 2 months and 2 years of age May be detected on antenatal sonography or at birth About half of these tumors arise in the medulla of the adrenal gland, although tumors have been found in the neck, mediastinum, retroperitoneum, and pelvis Tumors that arise within the adrenal gland show an abdominal mass, hypertension, diarrhea, and bone pain if metastasis is involved.
53
US findings for neuroblastoma
Ultrasound findings Highly echogenic and poorly defined Intrinsic calcifications may be seen Smaller tumors- homogeneous and hyperechoic Larger tumors- more complex in appearance Adjacent kidney is displaced inferiorly and at times laterally Majority of patients present with mets because the disease spread early and wildly Evaluate the liver, around the aorta, celiac, and SMA for mets Intraspinal extension can occur (15% of patients)
54
Some info on adrenal hemorrhage
Predisposing factors-difficult delivery, large size, infants of diabetic mothers, stress and hypoxia at delivery, septicemia, and shock May have none of the above factors and still present with abdominal mass, jaundice and anemia Usually hemorrhage is found secondary to other complications- uncontrolled bleeding, jaundice, intestinal obstruction, hypertension, adrenal abscess, or impaired renal function
55
US findings for adrenal hemorrhage
Ovoid enlargement of the gland Anechoic to hyperechoic or may be mixed echogenicity- depending on age, extent, and severity of the process Can be mistaken for an adrenal neuroblastoma initially F/U will show decreasing size and subsequent calcification may be identified

SON131-Abd 2 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions