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2240 > pathology of urinary system > Flashcards

pathology of urinary system Flashcards

1
Q

What is ectopic kidney

A

Ectopic kidney: abnormally positioned kidney that may be found in various locations (from the true pelvis (pelvic kidney) to above the diaphragm (intrathoracic))
Usually functional

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2
Q

the most common type of fusion abnormality is ?

A

horseshoe kidney

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3
Q

describe horseshoe kidney

A

Most common type of fusion anomaly
Both poles mal-rotated, lower poles are joined
Obstruction is common at ureteropelvic junction
Complete fusion of kidneys can occur, but rare = one big bizarrely shaped structure
Radiographic Appearance:
Kidneys joined at lower pole, showing a horseshoe shape

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4
Q

is pathology is defines as the abnormal flow of urine from bladder back into ureters

A

vesicoureteral reflux VUR

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5
Q

describe VUR

A

Abnormal flow of urine from the bladder back into the ureters
Usually pediatric (congenital), but can be from nerve damage or urethral blockage
Due to failure of the vesico-ureteral valve linking ureter to bladder
May be unilateral or bilateral
May cause swelling in the ureter and kidney
Urinary tract infection (UTI) is a common symptom of VUR

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6
Q

radiographic appearance of VUR

A

Radiographic Appearance:
Voiding cysto-urethrogram show reflux under fluoro
May show hydroureter, hydronephrosis or pyelonephritis

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7
Q

describe ureterocele

A

Stenosis of distal ureter leads to prolapse into the bladder
The prolapsed section then becomes abnormally dilated
Often leads to hydronephrosis
Intravenous urography
US

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8
Q

radiographic appearance of ureterocele

A

Radiographic appearance:
Intravenous urography
Dilated ureter
Radiolucent halo of prolapsed contrast filled ureter in contrast filled bladder
Cobra head sign (distal ureters look like cobra)
If contrast in bladder but not ureterocele, is a radiolucent mass
Ectopic ureterocele (in duplication) appears as filling defect

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9
Q

what has the cobra head sign

A

ureterocele

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10
Q

what pathology may cause back pain and pus in urine

A

pyelonephritis

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11
Q

describe pyelonephritis

A

flammation of kidney
May be acute or chronic
May be from bloodstream or lymphatics, but usually due to bacterial infection that moves up the urethra into the bladder, then up the ureter from the bladder to the kidney
Often occurs due to urinary tract obstruction (eg, a stone) which prevents frequent urination
Back pain, pus in urine (pyuria)
May become emphysematous pyelonephritis in diabetic patients = necrotizing infection that can permanently damage or destroy kidney
Diagnosis = urinalysis, US, MRI, CT, X-ray image

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12
Q

what is modality of choice for pyelonephritis

A

CT-Abscess (well defined dense area)
Hydronephrosis (enlarged kidney due to urine pressure)
Gas bubbles if emphysematous

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13
Q

radiographic appearance of pyelonephritis CT+ Urography

A

Radiographic Appearance:
CT: modality of choice
Abscess (well defined dense area)
Hydronephrosis (enlarged kidney due to urine pressure)
Gas bubbles if emphysematous
Urography:
Enlarged kidney
Kidney stone
Rounded or clubbed calyces
Gas bubbles if emphysematous

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14
Q

inflammation of urinary bladder is ?

A

Cystitis

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15
Q

describe Cystitis + radiographic appearance

A

Inflammation of urinary bladder
May be caused by bacterial infection, instrumentation, catheterization, or sexual intercourse
More common in women – shorter urethra
Keep urine bags lower than patient’s bladder to prevent retrograde flow and infection potential
In diabetics, emphysematous cystitis can occur, gas bubbles in wall
Dysuria = painful urination
Radiographic Appearance:
Voiding cystogram demonstrates decreased bladder size and irregularity of bladder wall with chronic cystitis
CT - bladder wall filled with gas

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16
Q

whats another name for kidney stones

A

renal calculi

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17
Q

describe renal calculi

A

Form in kidney
Made of calcium, uric acid, cystine (amino acid) or struvite (a phosphate = staghorn calculus)
Asymptomatic until move and lodge in ureter
May end up in bladder, may pass

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18
Q

80% of all renal stones contain what to be radiopaque

A

calcium

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19
Q

radiographic appearance of renal calculi

A

Radiographic Appearance:
80% of renal stones contain enough calcium to be radiopaque
Common exams to assess are CT and ultrasound
KUB - radiopaque calcium renal stones
CT - demonstrates location of stone
Contrast CT - noncalcium stones cause filing defects
US - an echogenic region with acoustic shadowing

20
Q

what can mimic kidney stones

A

phelboliths

21
Q

describe phleboliths + radiographic appearance

A

Calcified clot within a vein that appear radiographically as rounded densities
Common in lower part of pelvis
Mimic kidney stones
Radiographic Appearance:
Tend to be calcified around the outside
Tend to be lateral and below ischial spines

22
Q

what pathology can cause severe pain that can present sudden and without warning

A

renal colic

23
Q

describe renal colic

A

Severe pain that can present suddenly and without warning
Usually caused by stone(s) stuck in the kidney, renal pelvis or ureter
Pain is caused by dilatation, stretching and spasm of the ureter
Hematuria (blood in the urine) often present

24
Q

what often causes Hematuria(blood in urine)

A

renal colic

25
Q

radiographic appeaance of renal colic

A

Stone(s) present in kidney, renal pelvis or ureter (or other appearance if different cause)

26
Q

dilation/distention of renal pelvis+ calyces as urine is trapped is what pathology

A

hydronephrosis

27
Q

describe hydronephrosis

A

Dilation/ distention of the renal pelvis and calyces as urine is trapped
Caused by obstruction, such as calculi in ureter, urethral strictures, pelvic tumors, enlarged prostate
Bilateral hydronephrosis is most often indicative of obstruction at the base of urinary bladder or urethra
Hydronephrosis can completely and permanently destroy kidney function

28
Q

radiographic appearance of hydronephrosis

A

Urography, CT, US
Enlarged/ dilated renal calyces and pelvis

29
Q

what causes dilation of ureter that is caused by obstruction like renal calculi

A

hydroureter

30
Q

describe hydroureter + radiographic appearance

A

Dilation of the ureter caused by obstruction such as renal calculi
Unilateral = blockage above bladder
Bilateral = blockage at or below bladder

Radiographic Appearance:
Urography
Dilated ureter(s)

31
Q

what is the treatment procedures for renal calculi

A

-Hydrate and wait (manage pain)
-Lithotripsy (extracorporeal shock wave)
-Laser lithotripsy (laser wave)
-Chemolysis (medication introduced to break up stone)
-Surgery

32
Q

what is percutaneous nephrolithotomy lithotripsy

A

Small incision, tube passed through to stone, to visualize then remove or break up
Follow up in fluoro department

33
Q

Cystoscopic retrieval (ureteroscopy basket)

A

-under fluro guidance
-Basket extraction
-Stent insertion

34
Q

renal cyst

A

Common fluid filled benign mass, usually unilocular (one chamber/compartment, but may have septations)
May be unifocal (one site) or multiple, in one or both kidneys
Some have wall calcification
Often incidental finding
Radiographic Appearance:
US – modality of choice - fluid filled mass
CT also good - round hypodense region
Non-contrast CT shows same HU as water, contrast CT shows lack of contrast enhancement
Other conditions, some malignant, can mimic cyst, so may need biopsy for definitive diagnosis

35
Q

what is An inherited disorder in which multiple cysts of varying size cause lobulated enlargement of kidneys and progressive renal impairment due to compression of nephrons

A

polycystic kidney disease

36
Q

radiographic appearance of polycystic kidney disease

A

CT - cysts appear similar to simple cysts, but there are many. Some become hemorrhagic and become hyperdense
IVU - demonstrates enlarged kidney and mottled presence of multiple lucent lesions, like swiss cheese

37
Q

Adenocarcinoma: 
Renal Cell Carcinoma

A

Also called renal cell adenocarcinoma:
Adenocarcinoma = any malignancy that involves glandular tissue in epithelium
Most common cancer of the kidneys is RCC, also called hypernephroma
Often only symptom is painless hematuria

38
Q

radiographic appearance of Adenocarcinoma: RCC

A

Radiographic Appearance:
CT is modality of choice:
Enhanced CT will show contrast uptake into the tumor (cyst will not), but less than normal parenchyma
Localized bulging and renal enlargement
Distortion of kidney shape
US: solid mass with internal echoes

39
Q

bladder tumor arising from epithelium

A

bladder carcinoma

40
Q

describe bladder carcinoma

A

Bladder tumor arising from epithelium
Males over 50
Often only symptom is painless hematuria
Tumor (open arrows)projects in
Prostatic hypertrophy (black arrows) elevates the floor (included in the next ppt presentation)

41
Q

radiographic appearance of bladder carcinoma

A

Historically cystograms /IVU were used to diagnose bladder cancer
CT is better because it can help stage the cancer
CT & MRI: mass projecting into bladder lumen
Thickening of bladder wall
KUB may show calcifications in and on tumor

42
Q

slow progression over months, slow damage

A

chronic renal failuar

43
Q

chronic renal failuar

A

Chronic Renal Failure: slow progression over months, slow damage
May be pre-renal, intrarenal (intrinsic), or post-renal
US recommended, shows kidney decreased in size

44
Q

acute renal failure

A

Acute Renal Failure: quick onset, sudden damage
Rapid deterioration of kidney function, nitrogen containing wastes accumulate in blood
May be pre-renal, intrarenal (intrinsic), or post-renal
US recommended, shows dilation of ureters, pelves from hydronephrosis

45
Q

causes of chronic renal failure

A

-diabetes melitus
-hypertension
-chronic glomerulonephritis
-pyelonephritis or other infections
-obstruction of urinary tract
-hereditary lesions
-vascular disorders
-medication or toxic agents

46
Q

renal hypertention

A

Also called renovascular hypertension = elevated blood pressure caused by narrowing in the arteries that deliver blood to the kidney
Asymptomatic other than REALLY high blood pressure as kidneys produce a hormone to increase the pressure (to try and get more blood) and retain water and salt
High blood pressure damages the nephrons (kidney filtering units)
Usually controlled by blood pressure medication
Angioplasty, stenting or surgery can be done for the blood vessels in the kidney

47
Q
A

2240 (3 decks)

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