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Renal > Imaging and revision > Flashcards

Imaging and revision Flashcards

1
Q

what level does the renal arteries come off the aorta

A

L2 (above gonadal)

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2
Q

what level do the gonadal arteries come off the aorta

A

L2 (below renal)

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3
Q

what level does the coeliac trunk and SMA come off the aorta

A

L1

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4
Q

what level does the IMA come off the aorta

A

L3

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5
Q

what level does the abdominal aorta bifurcate

A

L4

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6
Q

what level are the renal hilums at

A

left L1

right L1/2

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7
Q

what are the contents of the renal hilum

A

posterior- renal pelvis
middle- renal artery
anterior- renal vein

lymphatic
nerves
renal sinus fat

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8
Q

which renal vein is longer

A

the left- passes across the aorta anteriorly to join the right sided IVC

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9
Q

what is USS good at detecting in the kidneys

A 
renal size 
cortical scarring 
distention 
calculi 
abnormalities
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10
Q

what is CT good at showing in the kidneys

A

vascular assessment

most pathologies

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11
Q

what are the negatives of CT

A

high dose radiation

contrast induced nephropathy (rise is serum creatinine and urea 3 days after exposure)

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12
Q

is CT with/ without contrast best to detect calculi

A

without

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13
Q

are the kidneys bound by mesentery

A

no are retoperitoneum

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14
Q

how can you reduce the risk of CT induced nephropathy

A

hydration

eGFR<60

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15
Q

what is MRI good at showing in the kidneys

A

renal lesions
vascular assessment
most pathologies

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16
Q

what are the negatives of MRI

A

nephrogenic systemic fibrosis (initial skin erythema, pruritis, pain, later involves other organs, with time skin thickens)

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17
Q

what are the subdivision of the ureter

A

abdominal, plevic and intravesicle

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18
Q

where do the ureters narrow

A 
pelviureteric junction (renal pelvis and ureter)
pelvic brim(crosses over the common iliac artery bifurcation0 anterior and medial to SI joint) 
vesicoureteric junction (enters bladder)
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19
Q

what muscle does the abdominal ureter follow

A

medial aspect of the psoas

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20
Q

where does the pelvic ureter turn medially

A

the level of the ischial spines

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21
Q

what part of the bladder does the ureters enter

A

the posterolateral angles

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22
Q

what ureter abnormalities can you get

A

bidif
duplex (two into bladder)
ectopic ureter
retrocaval ureter (behind IVC)

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23
Q

what is the workhorse for assessing the collecting system, ureter and bladder

A

CT urogram

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24
Q

what is the posterior wall of the bladder loosely attached to in females

A

anterior vagina and cervix

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25
Q

do you need a full/empty bladder to assess outline w/ USS

A

full

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26
Q

what can USS of the bladder detect

A

diverticula, wall irregularities, internal calculi, outline and volumetric measurement

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27
Q

what is cystography good for

A 
(been replaced by CT urogram) 
leak through bladder tear
internal calculi
wall irregularities
diverticula
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28
Q

what is the gold standard for local bladder tumour staging

A

MRI

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29
Q

where in bladder does the urethra originate

A

antero-inferior wall of bladder

30
Q

what are the subdivisions of the male urethera

A

prostatic
membranous
bulbous
penile

31
Q

what is a urethrogram and what is it used for

A

retrograde filling of urethra
strictures
trauma
diverticula

32
Q

what is the primary imaging choice for testes, scrotum, uterus, ovaries and prostate

A

USS

33
Q

what is a hysterosalpingogram used for

A

infertility- tubal patency

uterine anomalies

34
Q

what is an MRI used to image in the genitalia

A 
prostate cancer (local staging) 
abnormalities not characterisable by USS
35
Q

what usually causes renal colic

A

ureteric calculus

36
Q

what else can stimulate renal colic

A

pyelonephritis (do USS to exclude ureteric obstruction) or gynaecological disease (do USS to visualise pathology)

37
Q

what investigations into colic if the patient is pregnant

A

USS/ MRI

38
Q

what tests can detect real calculi

A

KUB x ray (only shows dense minority- not sensitive or specific as other causes of calcification), CT and MRI
(calculi are usually calcium dense)

39
Q

what is the definitive test to confirm a symptomatic ureteric calculus

A

non contrast enhanced CT (shows nearly all regardless of size or calcium content)
also shows signs of obstruction (perinephric stranding, hydroureteronephrosis)

40
Q

what happens to most calculi

A

are passed spontaneously

41
Q

what can cause macroscopic haematuria

A 
calculi
infection 
tumour (renal cell carcinoma, transitional cell carcinoma)
urethritis/ prostatitis 
trauma 
clotting disorders
42
Q

what investigation into haematuria in over 50s

A 
ct urography (kidneys, collecting systems and ureters)
cytoscopy (bladder and urethra)

ureteroscopy (tumours)

43
Q

what is the most sensitive way of detecting renal parenchymal tumours, urothelial tumours of the collecting systems or ureters

A

second CTU following contrast

44
Q

what investigations for haematuria in under 50s

A

incidence low so not CTU
USS of kidneys for calculi and renal parenchymal tumours
cystoscopy for bladder TCC, caclui or tumours/ evidence of urethritis or prostatitis
CTU only when US and cytoscopy normal and haematuria persists

45
Q

when is MR urography used

A

when CTU contraindication (contrast allergy, renal impairment, pregnancy)

46
Q

why are renal masses <3cm followed up not operated on

A

as very rarely metastasise

47
Q

what are renal masses containing fat

A

benign angiomyolipomas

48
Q

what are fluid dense renal masses

A

cysts

uniform cysts are benign

49
Q

what renal cysts are malignant

A

complex cysts containing solid areas/ thick septa

50
Q

are solid renal masses >3cm often benign/malignant

A

malignant

51
Q

what features of a renal mass can MR detect

A

size, presence of fat/fluid, internal architecture

52
Q

what is used for renal tumour staging

A

CT

  • local extent
  • modal disease
  • metastatic disease
53
Q

what mets do you get in the lung form renal tumours

A

cannonball mets

54
Q

what are the types of renal impairement

A 
pre renal (dehydration, hypotension, renal artery stenosis) 
renal (parenchymal disease, drugs, toxins)
post- renal (obstruction)
55
Q

what is used to detect renal artery stenosis

A

MR

56
Q

what is used to detect renal disease

A

USS to guide biopsy

57
Q

what often accompanies obstruction

A

hydronephrosis

58
Q

what is epididymo-orchitis

A

inflammation of the epididymis and/or testes caused by virus/ bacteria
can be complicated by abscess formation/ ischaemia

59
Q

what test for epididymo-orchitis

A

usually hypervascular on US

60
Q

who gets testicular torsion

A

young males

61
Q

what test for torsion

A

usually avascular or US

62
Q

what are causes of a painless scrotum swelling

A 
hernia, variocoele, hydrocoele, epididymal cyst 
testicular tumour (rare)
63
Q

what is a variocoele

A

dilated scrotal venous plexus

64
Q

what is a hydrocoele

A

when (black anechoic on USS) fluid surround the testes

65
Q

what is a testicular seminoma

A

intra testicular soft tissue mass

66
Q

what is the best imaging for ureteric/ renal injury

A

CT

67
Q

what type of bladder rupture needs surgery

A

intraperitoneal (extra peritoneal more common and treated conservatively)

68
Q

how is bladder rupture diagnosed

A

cystography/ CT cystography (contrast leaks through tear)

69
Q

when do you not catheterise

A

in urethral injury (meatal blleding, cant pass urine) (call urologists)

70
Q

what relieve ureteric obstruction

A

nephrostomy

71
Q

what is the definitive test for scrotal disease

A

USS

Renal (27 decks)

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