chpt 63 fetal uriogenital Flashcards
1
Q
what are the three set of excretory organs that develop in the embryo
A
- pronephrous2. mesonephrous 3. metanephrous
2
Q
permanent kidney
A
metanephros
3
Q
The permanent kidney develops ?
A
early in the 5th week
4
Q
When does urine formation begin?
A
early in the first timester, around the 11th and 12th week
5
Q
urine is excreted into the _______ and forms major part of ____________.
A
amniotic cavity, amniotic fluid
6
Q
T or F; The kidney does not need to filtrate in utero? Why
A
True; because the placenta elimates waste from fetal blood
7
Q
T or F; The kidney lie far apart in the pelvis
A
false; kidney lie close together
8
Q
The kidneys migrate into the abdomen and seperate from one another around ______ week of gestation.
A
9th
9
Q
T or F; in some cases one kidney can stay in the pelvic cavity while the other migrates into the posterior flank of the abdomen
A
True
10
Q
pelvic kidney may appear in females as?
A
pelvic masses
11
Q
arterial supply to the kidney comes from?
A
arteries that arise from the aorta
12
Q
At least ______% of adult kidneys have two or four renal arteries
A
25%
13
Q
The female urinary bladder derives from?
A
hindgut
14
Q
hindgut is know as?
A
urogenital sinus
15
Q
the caudal end of the mesonephretic ducts opens into the?
A
cloaca; and parts are absorbed into the urinary bladder wall
16
Q
distingushing sexual characteristics begin during the _____ week and external genital organs are fully developed by the _____ week
A
9th week; 12th week
17
Q
fetal testis produce ? and cause?
A
they produce androgens; and cause masculinization of the external genitalia
18
Q
what elongates to form the penis?
A
phallus
19
Q
the ______ swelling grow toward the median plane and fuse to form the _______.
A
labioscrotal; scrotum
20
Q
The testis remain near the deep inguinal rings until ____ weeks
A
28th
21
Q
failure to complete the descend of the gonads is?
A
cryptorchidism
22
Q
the gonads descend through the ____ and enter the scrotum before birth.
A
ingunal canal
23
Q
uretha and vagina both open into the ____?
A
ureogenital sinus/ vestibule of the vagina
24
Q
the uerogenital folds become the ?
A
labia minora
25
the labioscrotal folds become the ?
labia majora
26
the phallus becomes the ?
clitoris
27
the formation of the uterus is dependent on?
the fusion of two paramesonephreic ducts (mullerian ducts)
28
what happens if fusion of the paramesonephrenic ducts is incomplete? compete failure of this fusion will cause?
1.duplication of the uterus or vagina may occur 2. duplication of the entire femal tract or bicornuate uterus(duplicaton of uterus and one vagina)
29
what is uterus didelphys?
double uterus and double vagina
30
If only one paramesanephric duct develops this will cause?
unicornuate uterus (single uterine tube and horn)
31
At least 86% of fetal kidneys may be image at ____ weeks
12th
32
kidneys should be documented in all fetuses songraphically at \_\_\_\_weeks.
18
33
When kidney appear enlarged and echogenic ?
infantile polycystic diseast (with oligohydraminos), adult polycystic disease (normal amniotic fluid volume), Meckel-Greuber, trisomy 13
34
The kidneys are hyperechoic with regard to surrounding tissues at \_\_\_\_weeks.
18-20
35
describe the kidneys songraphically at 25 weeks.
relatively homogeneous renal cortex and parenchyma, hypoechoic pyramids and calyces, and anechoic renal pelvis
36
Where should the kidneys be visualized?
adjacent to the spine
37
If kidney is not well seen the fetal pelvis should be scanned to rule out?
ectopic kidney
38
Is it possible to have a unilateral kidney agensis?
yes; the contralateral kidney will be enlarged to compensate
39
on transverse image the renal pelvis is measured? and
anterior to posterior diameter when the fetal spine is toward the maternal anterior wall
40
What is the upper normal limit for transverse scan of the kidney?
***_4mm up to 33 wks gestation and 7mm from 33 weeks of gestation until term_***
41
The ureters usually measure\_\_\_\_ in diameter and are filled with fluid.
less than 1 to 2 mm
42
T OR F; NORMAL URETER ARE ALWAYS SEEN
FALSE
43
DILATION OF THE POSTERIOR URETHRA IS HIGHLY SUSPICIOUS FOR ?
OBSTRUCTIVE PROCESS CALLED POSTERIOR URETHRAL VALVE SYNDROM (KEYHOLE BLADDER SIGN)
44
POSTERIOR URETHRAL VALVE SYNDROME OCCURS IN _______ AND IS MANIFESTED BY THE PRESENCE OF \_\_\_\_\_\_\_\_\_\_?
MALE FETUSES; A VALVE IN THE POSTERIOR URETHRA
45
WHAT IS A ROUND ECHO FREE AREA LOCATED CENTRALLY IN THE PELVIS?
BLADDER
46
HOW LONG DOES IT TAKE THE BLADDER TO FILL AND EMPTY?
30 MINUTES
47
EXTERNAL GENITALIA IS DIFFERENTIATED IN THE ______ TRIMESTER?
SECOND
48
In second trimester, identification of the female should only be documented when?
major and minor labia is seen
49
Abnormal congenital opening of the male urethra on the undersurface of the penis
Hypospadias
50
accumulation of serous fluid around the testicle, resulting from communication with the peroneal cavity and are generally benign
hydrocele
51
what is the critial marker in the assessment of renal function?
amniotic fluid
52
the fetal kidneys begin to excrete urine after the _____ week and do not become the major contributor of fetal urine until\_\_\_\_\_?
11th; 14-16 weeks
53
Name the two categories of Renal malformations?
1.congenital malformation 2. resulting from obstruction process
54
complete absence of the kidney
renal agenesis
55
letal disorder because of renal insuffiency and hypoplasia of the lungs
bilateral renal agensis
56
the presence of at leat one functioning kidney
unilateral renal agensis
57
what makes it difficult to image the kidneys
oligohydraminos
58
what determines if the kidneys are present or not?
presence or absence of the urinary bladder
59
unilateral renal agensis is estimated to occur in?
1 in 600-1000 births
60
bilateral renal agensis is referred to as?
Potters syndrome
61
what diseases are associated with potter's syndrome?
diesease associated with renal failure, oligohydraminos, pulmonary hypoplasia, abnormal facies, malformed hands and feet
62
T or F; Potter's syndrome can be uni or bilateral?
True
63
Potter's Type 1
autosomal recessive infantile polycystic kidney disease
64
Potter's type 2
Renal agensis; multicystic dyplastic kidney, renal dysplasia
65
Potter's type 3
autosomal dominate polycystic kidney disease
66
Potter's type 4
renal dysplasia; obstructive kidney disease
67
autosomal recessive disorder that affects the fetal kidneys and liver
***_infantile polycystic kidney disease_***
68
IPKD is characterized by?
development of small cyst on both kidneys and liver
69
most sever IKPD is associated with?
renal failure, oligohydraminos, and absent urinary bladder
70
71
What is a characteristic finding of Potter's syndrome 1?
symmetric enlargement of both kidneys secondary to renal collecting tube dilation
72
What occurs in most severe cases of IPKD?
renal failure
73
74
Intrauterine diagnosis of IPKD should only be considered when the following characteristics are found:
- family history of IPKD
- bilateral enlarged kidneys
- highly echogenic kidney texture
- significant oligohydramnios
- inability to ID the fetal bladder
75
When may enlargement of kidneys from Potter's syndrome 1 occur?
24th week, so serial studies are recomended
76
With Potters syndrome 1, why are kidneys so massively enlarged?
hundreds of dilated tubules
77
Multicystic Dysplastic Kidney Disease (MCKD) is characterized by:
78
What is the most common form of renal cystic disease in childhood and represents one of the most common abdominal masses in the neonate?
multicystic dysplastic kidney disease
79
T/F: Incidence of MCKD is found more often in females than males.
False, males
80
Although most cases of MCKD are unilateral, nearly ______ of cases are bilateral
1/4
81
Associated abnormalities of Potters syndrome 2 / MCKD may involve:
the contralateral kidney, heart, central nervous system, extremities, and GI syndromes
82
The prognosis for infants with MCKD varies based on
prenatal findings
83
When both kidneys are found to be multicystic, oligohydramnios and an absent bladder are expected;
a lethal condition exists for the neonate
84
If only one kidney is affected the other may enlarge as a result of:
compensatory hypertrophy
85
Describe the multicystic dysplastic kidney:
- composed of multiple smooth walled, non functioning, non communicating cysts of variable size and number
- kidney borders are difficult to define
- ureter and renal pelvis may be atretic and the renal artery is hypoplastic or absent
86
Adult dominant polycystic kidney disease (ADPKD) is associated with:
-cystic dilation of the nephrons and of the collecting tubule walls in both kidneys
87
What is the most common of the heredditary diseases?
Adult dominant polycystic disease
88
Prognosis of prenatal diagnosis of APKD depends on the progression of
cyst development leading to renal failure
89
The sonographic appearance of ADPKD is similar to what?
autosomal recessive polycystic renal diease (kidneys are symmetrically enlarged and echogenic)
90
T/F: ADPKD (potters syndrome 3) is nearly always bilateral
True
91
When does renal dysplasia occur secondary to renal obstruction?
in the 1st or early second trimester of pregnancy
92
Unilateral obstructive cystic disease can be caused by:
a uteropelvic or ureterovesical junction obstruction
93
bilateral obstructive dysplasia is caused by:
severe bladder outlet obstruction, usually urethral atresia or posterior urethral valves
94
Prognosis of Potter's syndrome Type 4 (obstructive cystic disease) depends on
unillateral or bilateral involvement
95
Bilateral involvement of PS4/ obstructive cystic disease indicates
a poor outcome resulting from renal failure and lung hypoplasia
96
Early son. findings of PS4/ obstructive cystic disease:
hydronephrosis or hydroureter..but as kidney stops functioning, the cortex becomes completely dysplastic and replaced with the multiple cortical cysts
97
How do dsyplastic kidneys appear?
small and echogenic with cortical peripheral cysts
98
If obstructive cystic disease is bilateral, look for
- early bladder outlet obstruction (keyhole bladder)
- bilateral hydronephrosis
- thick-walled bladder
- sever oligohydramnios
99
When does renal ectopia occur?
when the kidney lies outside of its normal position in the renal fossa..usually in pelvis
100
What is crossed renal ectopia?
- when the ectopic kidney lies on the opposite side of the abdomen relative to its utereral insertion into the bladder
- kidneys are usually fused together and found on right side of abdomen
101
Is crossed renal ectopia found more in males or females?
males
102
With horseshoe kidneys, if the spine is down;
the connecting isthmus may be seen anterior to Aorta
103
Where may the urinary tract by obstructed?
- ureteropelvic junction
- ureterovesical junction
- level of urethra (megacystistis)
104
Amount and degree of urinary tract obstruction depends on
the gestational age at which the obstruction began
105
If urinarytract obstruction occurs early,
a multicystic kidney may develop
106
If the obstruction occurs in the late first trimester or second trimester:
cystic dysplasia may result
107
Late obstruction produces:
hydronephrosis
108
What is the most common fetal anomaly?
fetal hydronephrosis
109
Up to 22 weeks, hydronephrosis looks
the measurements of the renal pelvis are uniform
110
After 22 weeks, how does hydronephrosis look?
the obstructed kidneys produce increased renal pelvic diameters and true hydronephrosis
111
Describe son appearance of hydronephrosis
- dilated renal pelvis, which often communicates with the calyces, is centrallly located and distended with urine
- remaining renal tissue may be ID'd in all but the most severe cases of hydronephrosis
112
Renal pelvis measurements in 2nd trimester:
4-10 mm
113
Renal pelvis measurements in 3rd trimester:
7-10 mm
114
What is an abnormal renal pelvis measeurment?
exceeding 10-15 mm in the AP direction in the transverse plane
115
What is the most common reason for hydronephrosis in neonates?
ureteropelvic junction obstruction
116
HOw many obstruction disorders are found during early childhood?
1/2, so early prenatal detection may improve long-term renal function
117
What are the causes of ureteropelvic junction obstructions?
- abnormal bends or kinks in ureter
- adhesions
- abnormal valves in ureter
- abnormal outlet shape at the ureteropelvic junction
- absence of the long muscle that is imperitive to the normal excretion of urine from kidney
118
UPJ obstruction is usually a _______ defect
unilateral ; amniotic fluid remains normal because of the normal contralateral kidney
119
What is a urinoma?
a large cyst in contact with spine associated with ureteropelvic junction obstruction
120
Uterovesical junction obstruction commonly presents with
dilation of lower end of ureter (megaureter)
121
What may megaureter result from?
- primary ureteral defect (stenotic ureteral valves or fibrosis)
- secondary to obstruction at another level (causing reflux of urine)
122
With obstructed urinary tract, the affected kidney shows what?
- dilation of the renal pelvis
- tortuous dilated ureter
- duplication of the renal collecting system
123
When a dilated upper renal pole is observed with abnormal lower pole:
an obstructed duplicated collecting system may be indicated
124
What is a ureterocele?
a cystic dilation of the intravesical (bladder) segment of the distal ureter
125
What is an ectopic ureter?
one thaat does not insert near the posterolateral angle of the trigone area of the bladder
126
Where does an ectopic ureter insert for females?
- vagina
- vestibule
- uterus
127
Where does an ectopic ureter insert in males?
- seminal vesicle
- vas deferens
- ejaculatory ducts
128
What is bladder outlet obstruction produced by?
a membrane within the posterior urethra
129
What does posterior urethral valve obstruction result in?
- hydronephrosis
- hydroureters
- dilation of the bladder and post. urethra
130
What causes the keyhole sign?
posterior urethral valve obstruction which causes urine to be unable to pass through the urethra into AF..bladder wall is severly thickened with a dilated posterior urethra
131
Oligohydramnios results in what lung and chest problems?
lungs are hypoplastic, chest circumference is severelyl depressed.
132
Severe oligohydramnnios is a classic finding of
complete obstruction form
133
What abnormalities should be considered in the female fetus with sonographic findings consistent with obstructive urinary tract abnormalities?
- sacrum anomaly (caudal regression)
- megacystis-microcolon intestinal hypoperistalsis syndrome
134
Prune belly syndrome is AKA
urethral obstruction malformation complex
135
Prune belly syndrome/ urethral obstruction malformation complex consists of:
- cryptorchidism
- agenesis of abdominal wall muscle
- megaureters
- bladder outlet obstruction caused by urethral anomalies, such as atresia, stenotic valves, or diverticulum
136
Son findings of prune belly syndrome:
- oligohydramnios
- mild to severe bilateral hydronephrosis
- fetal ascites
- hypoplastic lungs
- abdomen is extremely distended compared with small thoracic cavity
- dilated ureters ad bladder appear as numerous cystic lesions within distended abd. cavity
- bladder may be obstructed and massively dilated or may rupture and not be seen except thru ascites
137
Describe true hermaphroditism
- rare condition in which both ovarian and testicular tissues are present
- internal and external genitalia are variable
- most fetuses have normal karyotype
138
What karyotype does a female fetus with pseudohermaphroditism have?
46XX
139
The most common cause of pseudohermaphroditism in females is
congenital virilizing adrenal hyperplasia that causes masculinization of the external genitalia (enlarged clitoris, abnormalities of urogenital sinus, and partial fusion of the labia majora)
140
The male fetus with pseudohermaphrodistism has what karyotype?
46XY and testes
141
What does male psuedohermaphroditism look like?
variable external and internal genitalia depending on developement of the penis and genital ducts
142
What is hydrometrocolpos?
- collection of fluid in the vagina and uterus, sometimes seen in conjunction with a doube uterus and septated vagina
- sometimes fluid is so large that it extends into the abd. cavity or may cause compression of the ureters and hydronephrosis of kidneys
143
Son. findings of hydrometrocolpos
- hypoechoic "cystlike" mass posterior to the bladder in the area of the uterus
- may be predominately cystic, may contain midlevel echoes, or fluid-debris levels
144
Echoes within hydrometrocolpos may result from
mucous secretions
145
What do ovarian cysts in fetuses result from?
maternal hormonal stimulation and is usually benign
146
Differential considerations for ovarian cysts in fetuses:
- mesenteric cyst
- urachal cyst
- enteric duplication
147
Sonographic findings of fetal ovarian cysts?
multiseptated and bilateral
148
What happens when an ovarian cyst twists on itself?
- torsion
- rupture
- or intestinal obstruction
