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Ob/Gyne 2 > Module 9 : Fetal GU Pathology > Flashcards

Module 9 : Fetal GU Pathology Flashcards

1
Q

what do the ureteric buds become

A
  • ureters
  • renal pelvis
  • calyces
  • collecting tubules
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2
Q

what do the ureteric buds come from

A
  • the wolffian ducts
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3
Q

what structure gives origin to the nephrons

A
  • metanephros
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4
Q

what is the nephrons

A
  • glomeruli

- loop of Henle

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5
Q

when does fetal urine production begin

A
  • 11 weeks LMP
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6
Q

what produces amniotic fluid prior to 11 weeks

A
  • produced by membranes and a bit by the lungs
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7
Q

where are the primitive kidneys located

A
  • the pelvis
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8
Q

what does a failure of migration of the kidneys cause

A
  • ectopic kidneys
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9
Q

what view is usually used to image the kidneys, what view is added when pathology is seen

A
  • transverse

- sagittal

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10
Q

what is normal kidney length equal too

A
  • gestational age
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11
Q

up to 20 weeks gestation what can mild fetal renal pelvis dilation be up to

A

5mm

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12
Q

from 20 weeks to term what can mild fetal renal pelvis dilatation be up to

A

8mm

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13
Q

what is the cloaca

A
  • terminal end of the hind gut

- divided into two segments

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14
Q

where are the two compartments of the cloaca

A
  • urinary

- rectal

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15
Q

what does the caudal end of the cloaca form

A
  • urethra and bladder neck
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16
Q

what is the rest of the bladder formed by

A
  • allantois which ends at the urachus
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17
Q

where do the mesonephric (ureters) enter the bladder

A
  • posterior wall of bladder at trigone
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18
Q

what shape is the bladder in the transverse plane

A
  • triangular
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19
Q

prior to 8 weeks LMP what state are the fetal genitals in

A
  • ambiguous
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20
Q

when do normal male genitalia formed and why

A
  • 8-10 weeks LMP

- when testosterone is present

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21
Q

what develops without the presence of testosterone

A
  • female genitalia are developed due to maternal estrogens
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22
Q

up to what week can we not identify gender of baby

A
  • 8 weeks
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23
Q

what sign means baby girl

A
  • hamburger sign
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24
Q

what sign means baby boy

A
  • turtle sign

+ needs to include penis

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25
Q

what is bilateral renal agenesis associated with

A
  • GU abnormalities
  • GI abnormalities
  • cardiac abnormalities
  • sirenomelia-mermaid syndrome
  • teratogens
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26
Q

what are teratogens

A
  • warfarin
  • cocaine
  • maternal diabetes (type 1)
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27
Q

why can unilateral renal agenesis be missed on ultrasound

A
  • patients asymptomatic

- kidney will become enlarged because doing all the work

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28
Q

what is bilateral renal agenesis

A
  • absent kidneys
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29
Q

what shape do the adrenals assume with bilateral renal agenesis

A
  • discoid shape

- can be mistaken for kidneys

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30
Q

what 4 other sonographic features are present with bilateral kidney agenesis

A
  • absent bladder
  • oligohydramnios - anhydramnios
  • small AC
  • IUGR
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31
Q

what is potters syndrome

A
  • refers to bilateral renal agenesis
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32
Q

what does potters sequence refer to

A
  • consequence of severe oligohydramnios
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33
Q

physical appearance of potters syndrome

A
  • pulmonary hypoplasia
  • abnormal hand and foot positions
  • facial anomalies
  • IUGR
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34
Q

what are the facial anomalies of potters syndrome

A
  • beaked nose
  • low set ears
  • prominent epicanthic folds
  • hypertelorism
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35
Q

what is one tool that can help us diagnose unilateral kidney agenesis

A
  • color doppler

- only one renal artery

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36
Q

sonographic appearance of adrenals with renal agenesis

A
  • laying down adrenal gland

- adrenals can be mistaken for kidney as they occupy the space where the kidneys should be

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37
Q

what is the definition of hydronephrosis

A
  • distention of the renal pelvis and calyces with urine due to obstructions
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38
Q

how many renal abnormalities will be hydro and how many are associated with syndromes

A

75%. 20%

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39
Q

is hydro more commonly unilateral or bilateral

A
  • unilateral
40
Q

three causes of hydro

A
  • obstruction
  • reflux
  • ureterocele
41
Q

4 things to determine when assessing hydro

A
  • bilateral vs unilateral
  • degree of hydro
  • level of obstruction
  • evaluate for other abnormalities
42
Q

3 levels of obstruction for hydro

A
  • hydronephrosis only/only kidneys are dilated
  • dilated ureters with hydro
  • dilated bladder and keyhole appearance
43
Q

hydro only / only kidneys are dilated

A
  • UPJ obstruction
44
Q

dilated ureters with hydro

A
  • UVJ obstruction
45
Q

dilated bladder and keyhole appearance

A
  • PUV (posterior urethral valve obstruction)

- typically males

46
Q

grade I hydro

A
  • renal pelvis only

- pelviectasis

47
Q

grade II hydro

A
  • renal pelvis and calyces visible
48
Q

grade III hydro

A
  • renal pelvis and calyces dilated
49
Q

grade IV hydro

A
  • parenchymal thinning

+ when a nephrostomy tube needs to be put in

50
Q

what is the most common urinary obstruction in neonates

A
  • UPJ (ureteropelvic junction) obstruction
51
Q

characteristics of unilateral UPJ obstruction

A
  • normal bladder and amniotic fluid
52
Q

characteristics of bilateral UPJ obstruction

A
  • oligohydramnios

- hydronephrosis of varying degrees

53
Q

characteristics of severe UPJ obstruction

A
  • renal parenchymal may be destroyed
54
Q

sonographic difference between bilateral UPJ obstruction and duodenal atresia

A
  • they will be on different levels in the transverse plane
55
Q

3 pitfalls of UPJ

A
  • extra renal pelvis
  • prominent renal veins
  • reflux
56
Q

what is an extra-renal pelvis

A
  • normal renal pelvis is outside of the kidney

- extra renal pelvis is under 1.5cm it may mmimic a small hydronephrosis

57
Q

what is reflux

A
  • urine is retrograding from the bladder up, the ureter into the kidney
  • transient = kidney dilation comes and goes
58
Q

what is a UVJ obstruction usually caused by

A
  • due to duplicated collecting system with an ectopic ureter location from the upper pole of the kidney
59
Q

UVJ on ultrasound

A
  • dilated upper pole of the kidney with a dilated tortuous ureter
  • lower pole of the kidney is normal
60
Q

what structure may the ureter may mimic

A
  • bowel
61
Q

how to differentiate between bowel and ureter

A
  • bowel is medial in the abdomen

- ureter would be lateral in the abdomen

62
Q

what is an ectopic ureter associated with

A
  • ureterocele in bladder
63
Q

definition of ureterocele

A
  • cystic dilation of the intravesicular portion of the ureter
64
Q

what is a ureterocele associated with

A
  • dilation of the upper pole of the kidney in duplicated collecting system
65
Q

definition of a PUV

A
  • PUV membranes that occur in the prostatic urethra of a male fetus that obstruct the retrograde flow of urine
66
Q

sonographic appearance of PUV

A
  • large distended bladder
  • oligohydramnios
  • hydronephrosis
  • males only
67
Q

three sonographic appearances of bladder rupture

A
  • ascites apparsa
  • bladder wall appears thickened
  • moderate uretero-pelvicalyceal dilatation
68
Q

what might PUV be a precursor to

A
  • prune belly syndrome (eagle-barrette syndrome)
69
Q

what is eagle- Barrett syndrome

A
  • undescended testicles (cryptorchidism)
70
Q

characteristics of eagle - Barrett syndrome

A
  • very large bladder with abdominal distention
  • lack of abdominal musculature
    + after birth abdomen looks like prune form stretching
  • ureters may be tortuous and dilated
  • kidneys
    + normal
    + hydronephrotic
    + dysplastic
71
Q

what is bladder exstrophy associated with

A
  • cloacal exstrophy
72
Q

what is a cloacal exstrophy

A
  • lower abdominal wall defect

- involving the lower GI tract, bladder and genitalia

73
Q

what is the OEIS complex

A
  • omphalocele
  • exstrophy of bladder
  • imperforate anus
  • spinal abnormalities
74
Q

4 renal cystic disease

A
  • infantile polycystic kidney disease (ARPKD)
  • adult polycystic kidney disease (ADPKD)
  • muulticystic dysplastic kidney kidney
  • obstructive cystic renal dysplasia
75
Q

what is infantile polycystic kidney disease

A
  • aka IPKD / ARPKD
  • autosomal recessive disorder
  • primary defect of collecting ducts
  • multiple small cysts under 1-2mm ( to small to see on sonography )
76
Q

what is the sonographic appearance of IPKD

A
  • GROSSLY ENLARGED ECHOGENIC KIDNEYS
  • but retain reniform shape
  • absent bladder
  • severe oligohydramnios
77
Q

is IPKD unilateral or bilateral

A
  • always bilateral
78
Q

3 diagnostic criteria of IPKD

A
  • bilateral enlarged echogenic kidneys
  • oligohydramnios
  • absent bladder
79
Q

4 subtypes of IPKD

A
  • perinatal
  • neonatal
  • infantile
  • juvenile
80
Q

why do IPKD kidney appear echogenic

A
  • all of the interfaces between the small cysts
81
Q

what 3 syndromes is IPKD associated with

A
  • mucked - gruber syndrome
  • Roberts syndrome
  • trisomy 13
82
Q

three sonographic signs of meckel gruber

A
  • IPKD
  • polydactyl
  • encephalocele
83
Q

3 sonographic signs of reverts syndromes

A
  • IPKD
  • phocomelia (hands and feet attached to truck with single bone)
  • cleft palate
84
Q

DDX of IPKD

A
  • benign glomerulosclerosis
85
Q

what is benign glomerluosclerosis

A
  • large echogenic kidneys
  • echogenic pyramids and normal fluid
    • diagnosed under a microscope
86
Q

characteristics of adult polycystic kidney disease

A
  • aka ADPKD, APKD
  • rarely seen in antenatal sonography
  • fetus is assessed if parent has disease
87
Q

sonographic appearance of APKD

A
  • enlarged kidneys with cyst
  • may be hyperehoic
  • amniotic fluid is normal
  • fetal bladder is present
  • scan parents as well
88
Q

characteristics of multi cystic dysplastic kidney

A
  • aka MCDK
  • multiple cystic lesions which due not communicate
  • kidneys lose reniform shape
89
Q

what is prognosis of MCKD

A
  • unilateral is good prognosis
  • bilateral is rare
    + fatal due to lack of amniotic fluid
    + associated with potters sequence
90
Q

does MCKD have a genetic predisposition

A
  • no
91
Q

two types renal tumors

A
  • nephroblastoma

- mesoblastic nephroma

92
Q

what is a nephroblastoma

A
  • aka wilms tumor
  • solid mass
  • not commonly identified in utero
93
Q

what is a mesoblastic nephroma

A
  • most common congenital renal tumor
94
Q

2 adrenal pathologies

A
  • neuroblastoma

- hemorrhage

95
Q

6 pathologies of genitalia

A
  • hydroceles (male)
  • cryptorchidism (male)
  • hydrometrocolpos (female)
  • ambiguous genitalia
  • x linked syndromes
    + turners, noonans, hemophilia
  • ovarian cysts (female)

Ob/Gyne 2 (19 decks)

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