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DI4 > GU PATHOLOGIES AND RENAL IMAGING TECHNIQUES > Flashcards

GU PATHOLOGIES AND RENAL IMAGING TECHNIQUES Flashcards

1
Q

WHAT ARE THE THE ANATOMY THAT WE ARE LOOKING AT DURING RENAL IMAGING?

A
  1. Outline of the kidneys
  2. Outline of the bladder
  3. Track the running of the ureters- normally by the transverse processes ? any obvious stones
  4. Is the stomach and bowel gas normal in position- raised /pushed? Mass
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2
Q

WHAT ARE THE COMMON CLINICAL INDICATION FOR IMAGING THE RENAL TRACT?

A
  1. flank pain
  2. unable to pee
  3. blood in the urine
  4. pain during urinating
  5. pain in lumbar region
  6. lump
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3
Q

WHAT CAN BE VISUALISED ON A KUB PLAIN FILM X-RAY?

A
  1. Evaluate kidney size, location and morphology
  2. Visualisation of calcifications- calculi (kidney stone)
  3. Highlight other potential pathologies/incidental findings
  4. Spinal disease
  5. Metastases
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4
Q

WHAT ARE THE COMMON CLINICAL INDICATION ON PLAIN FILM KUB X-RAY?

A
  1. Haematuria (micro or macroscopic)
  2. ? Stones (urolithiasis)
  3. Post Surgery (stents)
  4. Loin pain
  5. Dysuria (pain while urinating)
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5
Q

WHAT IS THE TECHNIQUE FOR KUB PLAIN FILM X-RAY?

A
  1. The patient should lay in a supine position on the x-ray table.
  2. Median sagittal plane (MSP) perpendicular to the table-top.
  3. Anterior superior iliac spines (ASIS) ,must be equidistant from the table-top= no rotation

CENTRING POINT = level of the iliac crest - in the midline of the body

BREATHING TECHNIQUE = ARRESTED RESPIRATION

COLLIMATE TO INCLUDE:

  • Superiorly= Diaphragm
  • Inferiorly= Symphysis pubis
  • Laterally = Lateral properitoneal fat stripes
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6
Q

HOW DO WE CHECK FOR KIDNEY STONES?

A
  1. check the outline of the kidney
  2. track the ureters. ( near transverse process of the spine)
  3. check bladder
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7
Q

WHAT IS STAGHORN CALCULUS?

A
  1. generally an incidental finding
  2. patient generally does not experience any pain - the stone is not moving therefore it is not irritating the surrounding tissue.
  3. poor kidney function
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8
Q

WHAT IS THE IMPORTANCE OF RENAL STENT X -RAY?

A
  1. check if the stent is in the right place.
  2. sometimes the stent is placed over the left iliac crest as the patient has had a kidney transplant therefore their kidneys sit lower. - NO CONTRAST FOR NEW KIDNEY TRANSPLANT PATIENT
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9
Q

WHAT ARE THE COMMON INDICATIONS FOR A INTRAVENOUS UROGRAM (IVU)?

A
  1. Renal colic
  2. Haematuria
  3. Recurrent urinary tract infection
  4. Suspected urinary tract pathology
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10
Q

WHAT ARE SOME OF THE INCIDENTAL FINDINGS YOU WILL SEE FROM IVC PROCEDURE?

A
  1. duplex kidney - two kidneys that have fused together leading to the collecting system joining together - high chance of UTI
  2. horseshoe kidney - two kidneys have fused together at the lower pole ( smiley face) - common symptoms include: obstruction/ UTI
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11
Q

WHAT ARE THE BENEFITS OF USING ULTRASOUND IN RENAL IMAGING?

A
  1. It is effective in evaluating:
  • renal size,
  • masses,
  • renal obstruction,
  • bladder residual volumes
  • prostatic size.
  • Patency of vessels (Doppler)
  1. It is non-invasive and non-ionising radiation so can be used frequently.
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12
Q

WHAT ARE SOME OF THE DISADVANTAGES OF ULTRASOUND FOR RENAL IMAGING?

A
  1. cannot be used in areas with a lot of air - cannot be passed through a bowel full of air therefore anatomy underneath the bowel is hard to see.

2, low-quality imaging - non-specific

  1. very user dependant
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13
Q

WHAT ARE THE COMMON CLINICAL INDICATION FOR RENAL IMAGING USING ULTRASOUND?

A
  1. Renal parenchymal disease
  2. Renal obstruction & loin pain
  3. Haematuria (gross and microscopic)
  4. Hypertension
  5. Renal cysts & cystic disease
  6. Renal size measurement
  7. Bladder outflow obstruction
  8. UTI
  9. Bladder tumours (TCC)
  10. Renal transplant:
  11. Obstruction
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14
Q

WHAT IS THE PATIENT PREP FOR ULTRASOUND FOR RENAL IMAGING?

A
  1. Kidneys only:
    - No preparation is needed
  2. Kidneys & bladder:
    - Full bladder needed
    - 1 hour pre-scan give the patient at least 500-1000mls of fluid to drink
    - Patients must not void the bladder or else they will have to fill it again.
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15
Q

WHAT IS THE TECHNIQUE FOR RENAL ULTRASOUND OF THE KIDNEY?

A
  1. 3 – 7 MHz curvilinear transducer using warmed coupling gel.
  2. Scanned supine longitudinally in an oblique coronal plane, supplemented by transverse sections perpendicular to the axis – exact views are determined by the sonographer to ensure all aspects of the renal tissue is visualised.
  3. All paeds are scanned in the prone position
  4. Obese and bariatric patients are more difficult to visualise on US.
  5. Shouldn’t be more than 2cm size difference between each kidney with normal kidney length at 9cm
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16
Q

WHAT IS THE TECHNIQUE FOR RENAL ULTRASOUND OF THE BLADDER?

A
  1. 3 – 7 MHz curvilinear transducer using warmed coupling gel.
  2. Scanned suprapubically, sagittally and transversely – exact views are determined by the sonographer to ensure all aspects of the renal tissue is visualised.
  3. Always pre-filled bladder
  4. +/- post micturating scanning in same planes and measuring pre and post mict. volumes (calculates residual urine in bladder)
17
Q

WHAT IS THE PATIENT PREPARATION FOR ULTRASOUND RENAL BIOPSY?

A
  1. Blood tests prior to procedure (day case) – checks INR and clotting as risks of haemorrhage post procedure.
  2. Stop taking warfarin or other blood thinners before the Bx
  3. Bring all medication with you on the day of the procedure
  4. Do not drive (and have someone collect you).
  5. Blood pressure taken prior to the procedure – if it is too high then the Bx will be postponed.
  6. patient put into a gown
  7. Consent form completed
18
Q

WHAT IS THE PATIENT AFTERCARE FOR ULTRASOUND RENAL BIOPSY?

A
  1. No driving home or for 2 days post procedure
  2. No heavy lifting or strenuous exercise for 2 days
  3. Pain killers for any pain (not aspirin or NSAID such as ibuprofen) - can cause blood thinning
  4. Shower or bathe as normal.
  5. Attend Emergency Department immediately if:
    - Blood or clots in the urine,
    - Feel any new or severe back pain,
    - Feel faint or faint
  6. Results will be discussed at your next OP appointment.
19
Q

WHY DO WE USE CT IN RENAL IMAGING?

A

TO CHECK FOR:

  1. Renal colic/renal stone disease
  2. Renal tumour
  3. Renal/perirenal collection
  4. Loin mass
  5. Staging and follow-up of renal or transitional cell carcinomas
  6. CT angiography may be used to assess renal vessels for suspected renal artery stenosis or arterio-venous fistula or malformation.
20
Q

WHAT IS THE USE OF CT KUB?

A
  1. Useful to assess possible stone disease
  2. Allows for detection of:
    - Ureteral wall oedema
    - Perinephric oedema
    - Hydronephrosis
    - Renal sinus infiltration
21
Q

WHAT IS THE PREPARATION AND AFTERCARE FOR CTKUB?

A
  1. Patient prep:
    - No IV or oral contrast, some departments give the patient plain water to drink prior to the examination
    - LMP check
  2. Aftercare:
    - No aftercare required
22
Q

WHAT IS THE TECHNIQUE FOR CTKUB?

A
  1. The patient lies supine (Some departments use a prone position)
  2. Low radiation dose technique
  3. Scout/scanogram from top of diaphragms (xiphisternum to symphysis pubis)
  4. Scan is planned from top of kidneys to bladder base
  5. 3-5mm slice thickness
  6. Respiration phase- inspiration
23
Q

WHY DO WE USE IV CONTRAST IN CTKUB?

A

to check for blockage the by seeing if the contrast can flow normally around the necessary anatomy.

24
Q

WHAT ARE THE FOUR PHASES OFF ENHANCEMENT FOR A CT IVU?

A

4 phases of contrast enhancement:

  1. ARTERIAL- 25 seconds
  2. CORTICO-MEDULLARY- 40-70 seconds
  3. NEPHROGRAPHIC- 80-100 seconds
  4. EXCRETORY PHASE- 120-180 seconds
25
WHAT IS THE PATIENT PREP AND AFTERCARE FOR CT IVU?
1. Patient Prep: - 500mls water 30mins before injection is recommended to ensure a diuresis and collecting system dilatation. - Contrast check as per RCR guidelines - LMP check - Blood (eGfr) 2. Aftercare: - Remove canula - Sit patient outside as per department protocol
26
WHAT IS THE CT IVU TECHNIQUE?
1. Patient lies in supine position 2. Scanogram is obtained 3. Initial non-contrast scans of urinary tract 4. Low osmolar contrast material (70ml) is given as bolus intravenously (2-4mls/s) 5. Thin sections (usually 1 mm) thickness scans are obtained through the kidneys during nephrographic/ parenchymal enhancement phase (100 s following start of bolus injection) 6. 10 minutes after the initial contrast injection, a further 30mls of contrast is injected and 1mm slices are taken from the top of the kidneys to the base of the bladder. 7. Images are reviewed along with multiplanar reconstructions.
27
WHAT IS HYDRONEPHROSIS?
SWELLING OF ONE OR BOTH KIDNEYS
28
WHAT IS THE TECHNIQUE TO CHECK FOR RENAL MASS IMAGING IN CT?
1. Patient scanned supine 2. Scanogram obtained 3. Initial unenhanced scan using thin sections (usually 1 mm) thickness are obtained from diaphragm to lower poles of kidneys. 4. Low osmolar contrast material (LOCM) 300 (100ml) is given as bolus intravenously. 5. Contrast enhanced scan using thin sections (usually 1 mm) thickness are obtained from diaphragm to lower poles of kidneys. 30 second scan delay (arterial phase) 6. Delayed thin sections (1 mm) scans are acquired from upper pole of kidneys to bladder base. 70 second scan delay (venous phase)
29
WHAT IS THE TECHNIQUE FOR RENAL TRAUMA CT SCAN?
1. Patient lies supine 2. Undertake an abdomen-pelvis CT 3. Scanogram- top of diaphragm to symphysis pubis 4. 100mls of IV contrast given (2-4mls per second) after 60-70 second delay
30
WHAT IS PATIENT PREP FOR CT BIOPSY?
1. Bloods – eGfr, INR 2. Consent 3. Contrast enhanced CT should have been done 4. Entry site and trajectory should be planned from previous CT 5. Patient position is dependent on mass location (could be prone, supine or lateral) 6. The shortest pathway as possible should be chosen
31
WHAT IS THE CT BIOPSY TECHNIQUE?
1. Patient positioned onto table 2. Unenhanced scan 5-7mm slice thickness through kidneys 3. The slice depicting the mass is selected 4. Using table position laser lines a skin marker is attached 5. Limited scan through the mass is repeated 6. Needle entrance point is determined 7. Local anaesthetic administered to area 6. Puncture skin with scalpel 7. Determine angle of approach- needle is in subcutaneous tissue 8. Needle is then advanced 9. Acquire sample and process accordingly 10. Sample rolled onto a saline soaked gauze 11. Carefully assessed for glomeruli 12. Placed in a formalin saline solution
32
WHAT IS THE CT BIOPSY PATIENT AFTERCARE?
1. Flat onto back for 6 hours | 2. Close monitoring
33
WHAT ARE SOME OF THE COMPLICATION OF THE CT BIOPSY?
1. Haematuria 2. Haematoma (blood clotting) 3. Pain 4. Sepsis 5. Pneumothorax 6. Tumour seeding
34
WHAT ARE SOME OF THE USES OF MRI IN GU IMAGING?
1. Not commonly first choice of modality in GU imaging 2. Prostatic and endometrial imaging (reproductive – so not discussed here) 3. Renal masses (although CT & US more widely used) 4. Urinary tract obstruction unrelated to renal stones (CTKUB is superior for colic caused by stones) 5. Congenital anomalies 6. Complications in pregnancy (when not clearly seen on US) 7. Visualisation of renal arteries
35
WHAT IS THE PATIENT PREP AND AFTERCARE FOR MRI IMAGING OF GU?
1. Patient prep: - Contrast check as per RCR guidelines - MRI safety check questionnaire - Consent 2. After care: - No specific after care required

DI4 (6 decks)

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