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Spring 2014 - ABD TEST 5 - URINARY SYSTEM ✔️ > Pathology > Flashcards

Pathology Flashcards

0
Q

Elevation of CREATINE differentials?

A

Renal failure
Chronic nephritis
Renal obstruction
Diabetes

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1
Q

Elevation of BUN differentials?

A 
Renal failure
Parenchymal disease
Renal obstruction
Dehydration
Diabetes
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2
Q

Elevated with infection or inflammation?

A

Total WBC count

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3
Q

Decreased with hemorrhage?

A

Hematocrit

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4
Q

Indications for renal imaging…

A 
Abn lab values - BUN &/or CREAT
Abn urinalysis
Pain
Difficulty with urination
Repeat UTI
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5
Q

Most common renal mass is a __________.

A

Simple renal cyst

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6
Q

Simple renal cysts occurring in __________% of adults over __________ yrs old.

A

50%

50 yrs old

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7
Q

Simple renal cysts are not significant unless they __________ or __________ or __________.

A

Distort the calyces

Produce pain

Hydronephrosis

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8
Q

Simple renal cysts are __________.

A

Asymptomatic

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9
Q

Simple renal cysts sonographically?

A 
Well defined
Well circumscribed
Anechoic
Smooth walls
Through transmission - enchacement
No color within
Spherical
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10
Q

Types of renal cysts?

A

Peripelvic
Parapelvic
Exophytic
Milk of calcium

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11
Q

Describe peripelvic cysts…

A

Develop from lymphatic system
Small, multiple, bilateral
Originate in the renal sinus/pelvis
Does not communicate with collecting system

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12
Q

Describe parapelvic cysts…

A

Renal hilum
Originates from parenchyma & protrudes into renal sinus
Does not communicate with renal collecting system
Close proximity to renal pelvis & major calyces
Not related to dilatation of calyces or ureters

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13
Q

Parapelvic cysts may mimic __________.

A

Hydronephrosis

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14
Q

Parapelvic cysts sonographically?

A

Well defined mass - solitary & large
May have irregular border
**May obstruct the kidney

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15
Q

Which cyst can obstruct the kidney? Peripelvic or parapelvic?

A

Parapelvic obstructs NOT peripelvic

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16
Q

Describe a cortical cyst…

A

Small cortical cysts may be difficult to differentiate from pyramids

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17
Q

Describe an exophytic cyst…

A

Projected out away from the kidney

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18
Q

Describe a milk of calcium cyst…

A

Fluid level within a cyst

Very rare

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19
Q

What diseases & syndromes present with cystic areas of the kidney?

A 
Von Hipple-Lindau
Tuberous Sclerosis
Acquired cystic disease of dialysis
IPKD
APKD
Multicystic Dysplastic Kidney
Medullary Cystic Disease
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20
Q

Cysts with Von Hipple-Lindau…

A

Autosomal-dominant genetic
Tumors of the central nervous system & orbits
ABD cysts

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21
Q

Cysts with Tuberous Sclerosis…

A 
Autosomal genetic - multiple system
Multiple renal cysts
Multiple angiomyolipomas
Mental retardation
Seizures/epilepsy
Cutaneous/skin lesions
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22
Q

Acquired cystic disease of dialysis…

A

Increased incidence of cysts, adenoma, renal carcinoma

Bleeding can cause flank pain

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23
Q

What is IPKD?

A

Infantile Polycystic Kidney Disease

Also called Autosomal Resessive Polycyctic Kidney Disease or Potter Type I

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24
Q

What is APKD?

A

Adult Polycystic Kidney Disease

Also called Autosomal Dominant Polycystic Kidney Disease or Potter Type II

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25
Q

Congenital Cystic Disease…

A 
Autosomal Resessive Polycystic Kidney Disease
Rare
Chromosome 6
Dilation of renal collecting tubules
Renal failure
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26
Q

Perinatal ARPKD?

A

Leads to renal failure and demise

Oligohydramnios

Enlarged echogenic kidneys

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27
Q

Neonatal/Infant ARPKD?

A

More common in females

Bilateral enlarged echogenic kidneys with cysts (3B’s-BIG, BRIGHT, BILATERAL)

Infants often die with complications of renal failure & hepatic disease

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28
Q

Juvenile ARPKD?

A

Lack of corticomedullary differentiation

Small cysts in the medulla

Hepatic fibrosis & splenomegaly

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29
Q

Describe ADPKD…

A 
Common
Men & women
Most common is chromosome 16
Bilateral
Multiple cysts (in other organs also)
Dialysis
Associated with liver cysts
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30
Q

Clinical findings of ADPKD?

A 
Flank pain
Hypertension
Mass
Hematuria
Headache
UTI
Renal insufficiency
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31
Q

Fetus ADPKD sonographically?

A

Moderately enlarged hyperechoic kidneys

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32
Q

Adult ADPKD sonographically?

A 
Bilateral renal enlargement
Loss of shape
Multiple cysts
Normal renal parenchyma can be displaced with cysts
Can become infected or hemorrhagic
May lead to renal failure
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33
Q

Describe Multicystic Dysplastic Kidney…

A

Non-hereditary
Renal dysplasia
Unilateral

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34
Q

__________A the most common palpable mass & cystic disease in neonates.

A

Multicystic Dysplastic Kidney

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35
Q

Multicystic Dysplastic kidney may lead to __________, __________, __________, and __________.

A

Infection
Hypertension
Hematuria
Flank pain

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36
Q

Multicystic Dysplastic Kidney sonographically…

A 
Enlarged kidneys
Multiple cysts
Ureteral atresia
Ureteropelvic obstruction
If bilateral, not compatible with life
Non functioning kidney
Compensatory hypertrophy of the other kidney
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37
Q

Describe nephronophthisis…

A

Autosomal resessive/dominant forms
Salt wasting nephropathy
Bilateral

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38
Q

Describe medullary cystic disease…

A 
Tubular atrophy
Glomerular sclerosis
Multiple small cysts
Loss of cortico-medullary junction
Renal failure
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39
Q

Types of renal calcifications…

A

Urolithiasis
Neohrolithiasis
Nephrocalcinosis

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40
Q

Describe urolithiasis…

A 
Combo of chemicals in urine
Kidney stones anywhere in the urinary tract
Common
Causes obstruction
Severe back pain
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41
Q

Describe nephrolithiasis…

A

Kidney stones within the kidney
Men
Renal calculi appear as reflective echogenic foci
Staghorn calculus-large stones in the central portion

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42
Q

Urolithiasis-Nephrolithiasis sonographically?

A

Renal stones are echogenic with shadowing

Color Doppler - TWINKLING artifact

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43
Q

Treatment of urolithiasis-nephrolithiasis…

A

*renal acidosis

Extracorporeal shockwave lithotripsy
Percutanceous nephrolithotomy
Ureteroscopic stone removal

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44
Q

__________ Is an accumulation of calcium within renal parenchyma (medullary & cortical).

A

Nephrocalcinosis

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45
Q

Nephrocalcinosis sonographically?

A

Diffuse foci calcium
Bilateral
Very echogenic pyramids
Loss of cortico-medullary junction

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46
Q

__________ Is calculi within the cortex.

A

Cortical nephrocalcinosis

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47
Q

Describe medullary sponge kidney…

A

Rare birth defect
Benign
Calcium stones
Dysplastic dilatation of tubules

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48
Q

Types of malignant renal tumors…

A 
Renal cell carcinoma
Transitional cell carcinoma
Squamous cell carcinoma
Lymphoma
Metastases
Wilm's tumor
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49
Q

__________ Is the most common renal tumor.

A

Renal cell carcinoma

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50
Q

Renal cell carcinoma is __________ as common in females as in males.

A

Twice

*6th to 7th decade of life

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51
Q

Clinical findings of renal cell carcinoma…

A

Hematuria
Flank pain
Palpable mass
Unexplained weight loss

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52
Q

Renal cell carcinoma deals with __________ system.

A

Staging-Robson

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53
Q

Progression of Staging-Robson system…

A
  1. Confined to kidney
  2. Spread to perinephric fat but within Gerota fascia
  3. Perinephric involvement with spread to renal vein &/or IVC
  4. Perinephric involvement with regional lymph node enlargement
  5. Perinephric involvement with venous & lymph
  6. Invasion of adjacent structures
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54
Q

What is renal cell carcinoma also called?

A

Hypernephroma

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55
Q

Renal cell carcinoma sonographically…

A

Echogenic mass
Complex
Calcification
Highly vascular - “basket sign”

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56
Q

__________ Is most common tumor of the collecting system.

A

Transitional cell carcinoma

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57
Q

Describe transitional cell carcinoma…

A 
Often multiple
Higher in males
Hypoechoic mass in the renal pelvis
Invasive
Pain secondary to obstruction
Hematuria
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58
Q

Describe renal lymphoma…

A 
Secondary to non-hodgkins or hodgkins
Bilateral invasion
Multiple nodules
Enlarged kidneys
No definite mass
59
Q

Metastases…

A

Common primaries - melanoma, lymphoma

CA of: lung, breast, colon, cervix, pancreas

60
Q

Wilm’s tumor…

A 
Also called nephroblatoma
Associated with Beckwith-Wiedemann
Sporadic aniridia (no color in the eyes)
Omphalocele
Palpable mass
Nausea & vomiting
Gross hematuria
61
Q

__________ Is the most common solid renal mass of childhood.

A

Wilm’s tumor

62
Q

Wilm’s tumor may invade the venous extending into the __________ and __________.

A

IVC and rt atrium

*mets to lung

63
Q

Wilm’s tumor venous obstruction may lead to __________, __________, or __________.

A

Leg edema

Varicocele

Budd-Chiari

64
Q

Name the 6 benign solid tumors…

A 
Angiomyolipoma
Adenoma
Lipoma
Oncocytoma
Nephroma
Fibroma
65
Q

All tumors are treated as __________ until proven otherwise.

A

Malignant

66
Q

Describe angiomyolipoma (AML)…

A

MOST COMMON benign renal tumor - muscle and fat
Renal hamartoma
May be hemorrhagic
Focal, solid, echogenic mass in the cortex

**KNOW THIS!!!

67
Q

Describe an adenoma…

A 
Benign renal tumor
Tubular epithelial
Incidental finding
Well defined mass in renal cortex
Calcifications
Cannot differentiate from RCC
68
Q

Describe a lipoma…

A 
Fat cells
Females
Asymptomatic
Hematuria
Well defined echogenic mass
Connective tissue tumor
69
Q

Describe an oncocytoma…

A 
Benign and well defined
Large epithelial cells
Males over 65
Also in parathyroid, thyroid, adrenals
Asymptomatic
Hematuria and pain
"SPOKE WHEEL" pattern with a central scar (stellate scar)
70
Q

With renal disease, you examine the __________.

A

Renal parenchyma

71
Q

Name 6 inflammatory renal diseases…

A 
Acute pyelonephritis
Acute tubular necrosis
Pyonephrosis
Glomerulonephritis
Fungal-candidiasis 
Abscesses
72
Q

Inflammatory cystic disease can be inflammatory or __________.

A

Necrotic

73
Q

Describe inflammatory or necrotic cystic disease…

A 
Pain
Hematuria, proteinuria, pyuria
WBC in urine, WBC elevated
Internal echoes
Thicken walls
74
Q

Renal infection progression? Describe it sonographically.

A

Pyelonephritis to bacterial nephritis to abscess

Shaggy borders
Loss of ability to distinguish cortex from medulla

75
Q

Describe acute pyelonephritis…

A

Inflammation involving pyelocaliceal lining
Infection can begin in bladder and spread
May appear normal on US

76
Q

Describe emphysematous pyelonephritis…

A 
Life threatening infection
Air in parenchyma - "comet tail" artifact
Bacteria - escherichia coli
Diabetic
Enlarged inflamed kidneys
77
Q

Describe chronic pyelonephritis…

A

May lead to renal failure
Decreased renal size
Cortical thinning

78
Q

Describe xanthogranulomatous pyelonephritis…

A 
Uncommon
Chronic obstruction and infection
Large non functioning kidney
Staghorn calculus
Females
79
Q

Clinical findings of acute tubular necrosis…

A 
Flank pain
Vomiting
Hematuria
Infection
Leukocytosis
Decreased blood flow
Enlarged kidney
80
Q

Describe acute tubular necrosis…

A

Acute renal failure
May be reversed
Bilateral enlarged kidneys with hyperechoic pyramids

81
Q

Describe pyonephrosis…

A

Pus within the obstructed collecting system

Requires drainage

82
Q

Describe acute glomerulonephritis…

A

Necrosis in the glomeruli
Enlarged, poorly functioning, bilateral
Increased cortical echoes
Symptoms - nephrotic syndrome, HYPERTENSION, anemia, edema

83
Q

Clinical findings of acute focal bacterial nephritis…

A

Fever
Pain
Pyuria
Increased BUN, albumin, total plasma proteins

84
Q

Describe acute interstitial nephritis…

A

Infections such as scarlet fever and diphtheria
Enlarged kidneys
Increased echogenicity
Symptoms - uremia, proteinuria, hematuria, rash, fever

85
Q

Describe lupus nephritis…

A 
Systematic lupus erythematosis
CONNECTIVE TISSUE disorder
Females
Increased cortical echogenicity
Renal atrophy

Symptoms - hematuria, proteinuria, hypertension, renal vein thrombosis, renal insufficiency

86
Q

Describe fungal candidiasis…

A

Focal abscesses - fungal balls on US

87
Q

Clinical findings of renal abscesses…

A

Acute onset
Fever, chills
Increased WBC
Pyuria

88
Q

Renal abscesses sonographically…

A

Complex pattern due to debris

Gas may produce a dirty shadow

89
Q

What is schistosomiasis?

A

Parasitic infection

Other countries in Africa

90
Q

What is renal failure?

A

Kidneys inability to filter

91
Q

Renal failure will have increased __________ and __________.

A

BUN and CREATINE

92
Q

Pre renal failure causes?

A 
Nephroschlerosis
Infarction
Renal artery stenosis
CHF
Thrombosis of the renal vein
93
Q

What causes renal failure?

A

Acute tubular necrosis - MOST COMMON

94
Q

Describe acute renal failure…

A 
Functions of the kidneys decreases
Common condition
Abrupt transient - comes and goes
Oliguria
Decreased profusion
Acute azotemia - BUN & CREAT increase
95
Q

Describe chronic renal failure…

A

Functions of the kidneys decreased
Obstructive nephropathies
Parenchyma disease
Nephrons destroyed

96
Q

What is glomerulonephritis?

A

Chronic failure of the nephrons

97
Q

What is renal vascular disease?

A

Chronic failure of the renal vascular system

98
Q

What is chronic pyelonephritis?

A

Chronic failure of the interstitial

99
Q

Chronic renal disease sonographically…

A

Diffusely echogenic kidney

Decreased size

100
Q

Describe renal medical disease type I & II…

A

Type I - increased echogenicity, decrease in corticomedullary junction, as progressing to chronic: kidney size decreases

Type II - distortion of normal anatomy, focal lesions

101
Q

Clinical findings of hydronephrosis…

A

Non specific complaints to severe pain
Acute urinary retention
Increased BUN & CREAT - azotemia

102
Q

What is hydronephrosis?

A

Separation of renal sinus by fluid filled areas

Differentiate from extra renal pelvis

103
Q

With hydronephrosis, scan the is if the __________ are __________.

A

Ureters are obstructed

104
Q

Hydronephrosis can be caused by __________.

A

Overhydration

105
Q

With hydronephrosis, __________ scanning is important.

A

Post void

106
Q

Describe intrinsic hydronephrosis…

A

Stricture - narrowing
Renal calculi
Bleeding
Pyelonephrosis

107
Q

Describe extrinsic hydronephrosis…

A 
Pregnancy
Pelvic mass
Bladder neck obstruction
Trauma
Prostate hypertrophy
Urethritis
108
Q

Describe congenital hydronephrosis…

A

Ureteropelvic obstruction
Posterior urethral valve
Retro caval ureter

109
Q

Describe hydronephrosis grade I, II, III…

A

Grade I - small separation of the calyceal pattern (splaying)

Grade II - bear claw effect with fluid extending into the calyceal system

Grade III - massive dilation with loss of renal parenchyma

110
Q

Describe obstructive hydronephrosis…

A

RI of renal vessels may increase

No ureteral jet on the affected side

Bilateral indicates obstruction in the lower urinary system - enlarged prostate, bladder tumor, urethral valve syndrome

111
Q

Describe nonobstructive hydronephrosis…

A

Reflux, infection, distended bladder, pregnancy

Check for jets

112
Q

False positive hydronephrosis differentials…

A 
**Extra renal pelvis
Parapelvic cysts
Reflux
Multi cystic
Renal artery aneurysm
Overextended bladder
113
Q

False negative hydronephrosis differentials…

A

Staghorn calculus
Polycystic disease
Severe dehydration

114
Q

Describe renal artery stenosis…

A 
Presents with HYPERTENSION
Arteriosclerosis
Fibromuscular hyperplasia
Direct and indirect Doppler - "banana peel"
**check AO also
115
Q

__________ Is an increase in velocity in the main renal artery.

A

Renal artery stenosis

116
Q

Renal artery stenosis is __________ cm/sec.

Important

A

> 150-190

117
Q

Renal artery stenosis may happen in __________ one renal artery.

A

More than

118
Q

For renal artery stenosis, RI of __________ is the upper limit of normal.

Important

A

.070

119
Q

Describe NORMAL renal artery intrarenal Doppler…

A

Rapid systolic upstroke and early diastolic peak

120
Q

Describe ABNORMAL renal artery intrarenal Doppler…

A 
Absence of systolic peak
Prolonged upstroke
Decreased peak systolic (> .19)
Dampening of the waveform
**Tardus-parvus --> decreased acceleration and peak
121
Q

What is the RAR formula?

Important

A

RAR = renal artery peak systolic velocity
—————————————-
aortic peak systolic velocity

122
Q

Abnormal RAR is __________.

Important

A

> 3.5

123
Q

For renal Doppler __________ is the gold standard.

A

Renal arteriography

124
Q

Describe renal vein thrombosis…

A

Enlarged kidneys
Dilation of the renal vein proximal to the obstruction
Decreased flow

125
Q

Describe renal infarction…

A

Tissue necrosis - wedged shaped
Results from thrombus, tumor, or obstruction
Irregular masses
Lumpy bumpy renal contour

126
Q

Renal transplant complications…

A 
Rejection
Acute tubular necrosis
Hemorrhage
Infarction
Recurrent glomerulonephritis
Rupture
Renal emphysema
127
Q

Renal transplant consists of surgery of __________ and surgery to __________.

A

Surgery of donor kidney

Surgery to place the kidney in the iliopelvic region

128
Q

Renal transplant has a __________ hr baseline check-up

A

48

129
Q

Renal transplant: serial check-ups every __________ months

A

3-6

130
Q

What is Dopplered after a renal transplant?

A 
Main renal artery
Segmental or intralobar
Arcuate
Renal vein
Iliac artery
131
Q

After a renal transplant, there should be a __________ structure, __________ pyramids, and __________ appears as parallel lines posterior to the kidney.

A

Smooth structure
Sonolucent pyramids
Psoas muscle

132
Q

Describe renal transplant rejection…

A

Hyperacute within hrs
Acute within days to months
Chronic within months
Immunologic

133
Q

Renal transplant rejection sonographically…

A 
Enlargement and decreases echo of the pyramids
Hyperechoic cortex
Localized anechoic areas
Distortion of the renal outline
Patchy sonolucent areas
134
Q

Renal transplant rejection has little differentiation between __________ and __________ with small __________ margins.

A

Parenchyma and sinus

Irregular margins

135
Q

Post transplant failure could lead to what diseases?

A 
Acute tubular necrosis
Cyclosporine toxicity
Malignancy
Extraperitoneal fluid
Hematoma
Perinephric abscess
LYMPHOCELE - common complication
Obstructive nephropathy
Graft rupture 
Arteriovenous malformations
136
Q

Describe transplant Doppler…

A 
Low filter
Small scale
RI > .90 indicates acute rejection
RI < .70 unlikely to indicate rejection
No flow indicates occlusion
137
Q

What is a hematoma?

A

ABD collection of blood
Drop in hematocrit
Well defined sonolucent area

138
Q

Describe a renal hematoma…

A

Decrease in hematocrit

Hematuria

139
Q

Describe bladder diverticulum…

A

Herniation of the bladder wall
Congenital or acquired
Neck connecting adjacent fluid filled structure

140
Q

What is the MOST common cause of urethral obstruction in boys/male infants? Describe it.

A

Posterior urethra valves syndrome (PUV) - flap of tissue covers the opening in the area of the urethra

141
Q

What is a ureterocele?

A

Urethra obstruction

Cystic dilation of the distal ureter

142
Q

What is cystitis?

A

Bladder inflammation

Thickening of the bladder wall

143
Q

Describe bladder tumors…

A 
Transitional cell carcinoma
Gross hematuria
Focal bladder wall thickness
Color Doppler for increased vascularity
Evaluate kidneys
144
Q

Describe ureteral jets…

A

Phenomenon describing urine entering the bladder
Absence is a sign of obstruction
“Candle sign” - low continuous jet indicating partial obstruction

Spring 2014 - ABD TEST 5 - URINARY SYSTEM ✔️ (2 decks)

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