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MIDS 127 - abdo > Pediatric Urinary System & Adrenal Glands > Flashcards

Pediatric Urinary System & Adrenal Glands Flashcards

1
Q

What is the average renal length for: 0-2 months?

A

5.0cm

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2
Q

What is the average renal length for: 2-6 months?

A

5.7cm

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3
Q

What is the average renal length for: 6-12 months?

A

6.2cm

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4
Q

What is the average renal length for: 1-5 yrs old?

A

7.3cm

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5
Q

What is the average renal length for: 5-10 yrs old?

A

8.5cm

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6
Q

What is the average renal length for: 10-15 yrs old?

A

10cm

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7
Q

What is the average renal length for: +15 yrs?

A

Same as adult; 10-12cm

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8
Q

Renal pelvises in children are _____ _______ the renal sinus and should measure less than ______ mm.

A

half outside, 10

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9
Q

Cause of Renal Size Variation: ENLARGED BILATERAL KIDNEY

A

Congenital: Duplication, cystic disease, storage disease
Acute: Pyelonephritis, glomerular, nephritis
Neoplastic: Nephroblastomatosis, bilateral Wilms tumor, leukemia, TB, hamartoma
Vascular: Renal vein clot, acute tubular necrosis, sickle cell anemia
Obstructive: Congenital or acquired

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10
Q

Cause of Renal Size Variation: ENLARGED UNILATERAL KIDNEY

A

Congenital: Duplication, cystic disease, cross-fused ectopia, horseshoe kidney
Infectious: Acute pyelonephritis, abscess
Neoplastic: Mesoplastic nephroma, Wilms tumor, angiomyolipoma or hamartoma, sarcoma, lymphoma
Vascular: Renal vein clot, transplant complication
Traumatic: Contusion, hematoma
Obstructive: Genital, acquired

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11
Q

Cause of Renal Size Variation: SMALL BILATERAL KIDNEY

A

Congenital: Aplasia, hypoplasia
Acute: Pyelonephritis, glomerular nephritis
Infectious: Chronic pyelonephritis, reflux nephropathy with infarction
Vascular: Renal vein clot, arterial occlusion
Atrophic: Chronic obstruction, chronic recurrent infarction, chronic failure, dysplasia
Obstructive: Congenital or acquired

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12
Q

Cause of Renal Size Variation: SMALL UNILATERAL KIDNEY

A

Congenital: Agenesis, hypoplasia
Infectious: Chronic, chronic reflux with infection
Vascular: Venous clot, arterial obstruction
Atrophic: Chronic obstruction, chronic infection and infarction, dysplasia

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13
Q

What is another name for Agenesis?

A

Potter Syndrome

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14
Q

What can Potter Syndrome cause?

A

Oligohydramnios, pulmonary hypoplasia, and absent bladder in utero

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15
Q

For Agenesis, is it more common to be unilateral or bilateral?

A

Unilateral

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16
Q

What is the most common palpable mass in the neonate?

A

Hydronephrosis

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17
Q

Hydronephrosis is most commonly caused by:

A

Obstruction

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18
Q

What is the most common renal anomaly diagnosed in infants in children?

A

Hydro!

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19
Q

What are the SS of hydronephrosis?

A

Palpable abdo mass, flank pain, hematuria, UTIs

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20
Q

Vesicouretral Reflux is graded how?

A 
Grade I (least severe, only ureters affected) 
to V (severe dilatation of ureter and kidney with loss of papillary impressions)
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21
Q

Is Vesicoureteral Reflux (VUR) an obstructive or non-obstructive form of hydronephrosis?

A

A non-obstructive form

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22
Q

Where is the most common site of obstruction?

A

The UPJ (uteropelvic junction)

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23
Q

UPJ obstruction is most common in _____ .

A

males

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24
Q

What is the second most common cause of pediatric hydronephrosis?

A

Distal ureter obstruction - megaureter

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25
Q

What is the most common place, sex, and complication for a Duplicated Collecting System?

A

The upper pole, women, ureterocele

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26
Q

What is the most common congenital anomaly of the GU tract?

A

Duplicated collecting system

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27
Q

Duplicated Collecting System looks like: a duplex kidney, two renal sinuses, longer length of kidney. True or false?

A

True

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28
Q

What is the most common cause of urethral obstruction in boys?

A

PUV (posterior uretheral valves)

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29
Q

Prune Belly syndrome is associated with…

A

PUV

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30
Q

Describe Prune Belly Syndrome (aka Eagle-Barrett)

A

Large dilated tortuous ureters, large bladder, patent urachus, dilated prostatic urethra, VUR) and undistended testicles

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31
Q

Prune Belly Syndrome is more common in girls. True or false.

A

False. It is most common in boys.

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32
Q

Multicystic Dysplastic Kidney Disease is the fourth most common cause of an abdo mass in newborn after hydronephrosis. True or false?

A

False. It is the second most.

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33
Q

MCDK will ______ or _______.

A

Curl up or atrophy (get so shrunken that we won’t see the kidney).

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34
Q

SS, complications, SA, DD of MCDK.

A

SS: large mass at birth, unidentifiable kidney later in life
Complications: reflux, UPJ obstruction in opposite kidney, increased risk of malignancy
SF: multiple cysts of varying sizes, no communication between cysts
DD: hydro

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35
Q

Dysplastic kidneys are most associated with…

A

Urinary tract malformations and obstructions

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36
Q

Hypoplastic Kidneys: etiology and SF.

A

Etioloy: Renal infarction caused by unsuspected chronic atrophic pyelonephritis
SF: small kidneys

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37
Q

Dysplastric Kidneys: SF, associations

A

small kidneys with los of CMJ and pyramids seen in normal neonates, potential cysts, renal pelvic might be dilated, associated with urinary tract malformations - obstruction, prune belly syndrome

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38
Q

Infantile Polycystic Kidney Disease is also known as… (ARPKD)

A

Autosomal Recessive Polycystic Kidney Disease

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39
Q

Infantile Polycystic Kidney Disease (aka ARPKD) is most common in ….

A

females

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40
Q

Infantile Polycystic Kidney Disease is associated with _____ ____ ______.

A

Congenital Hepatic Fibrosis. All surviving ARPKD patients develop it. They will get liver symptoms (portal hypertension) and visible liver cysts seen by ultrasound.

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41
Q

Sonographic findings for ARPKD?

A

Symmetrically enlarged kidneys, cysts are MICROSCOPIC, multiple bright echoes in the pyramids and medulla, hard to differentiate between textures of renal sinus/medulla/cortex

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42
Q

Adult Polycystic Kidney Disease has an increased risk of _____.

A

RCC

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43
Q

Glomerular Cystic Disease is hard to differentiate between _____ & ______ and _____ of _____ ______.

A

ADPKD, ARPKD, hamartomas of tuberous sclerosis

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44
Q

MedullarySponge Kidney is associated with:

A

Beckwidth-Wiedemann syndrome, PCKD, Caroli disease, and congenital hepatic fibrosis

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45
Q

Juvenile Nephronophthisis (SS, SF)

A

SS: metabolic dysfunction
SF: normal or small kidneys with increased parenchymal echogenicity and loss of CMJ, potentially cysts in CMJ

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46
Q

Renal Cysts are associated with: (2 items)

A

Tuberous Sclerosis, von Hippel-Lindau disease

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47
Q

Simple cysts are common in children. True or false?

A

False, they are rare.

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48
Q

Tuberous Schlerosis results in _____ cystic kidneys.

A

Bilateral

49
Q

Acquired cysts can be caused by _________.

A

Hemodialysis

50
Q

What is the most common malignant renal tumour in the peds pop?

A

Wilms Tumour (Nephroblastoma)

51
Q

What is the most common solid abdominal tumour in children?

A

Wilms Tumour (Nephroblastoma)

52
Q

What is the peak age for Wilms Tumour?

A

3-4 yrs

53
Q

What are the signs and symptoms of Wilms Tumour?

A

SS: Palpable mass, pain, fever, malaise, weight loss, hematuria, hypertension

54
Q

Wilms Tumour causes mets most commonly to the ______ & _______. (Two L words)

A

Liver & lungs

55
Q

Nephroblastoma (also Wilms Tumour) is most COMMONLY associated with:

A

Aniridia (absent iris)

56
Q

Describe the sonographic feature of Wilms Tumour (Nephroblastoma)

A

Large well-circumscribed smooth homogenous mass. Echogenicity slightly greater than the liver. Typically have a normal extension of tissue over the mass. May have calcifications.

57
Q

Nephroblastomatosis is a precursor of _____ ________.

A

Wilm’s tumour

58
Q

Nephroblastomatosis is found 100% in patient’s with _______ (bilateral or unilateral) Wilms Tumour.

A

Bilateral

59
Q

The two forms of Nephroblastomatosis are:

A

Diffuse: thick rim of hypoechoic or anechoic subcapsular tissue with irregular central contours and smooth outer martins, enlarged kidneys OR replacement of renal parencyma

Multifocal form: microscopic tissue to large masses (any type of echogenicity)

60
Q

Nephroblastomatosis can be found in cases of:

A

Beckwith-Wiedemann syndrome, aniridia

61
Q

Multilocular Cystic Nephroma is malignant or benign?

A

Benign

62
Q

Multilocular Cystic Nephroma is also called:

A

Benign Cystic Nephroma, Cystic Wilms Tumour

63
Q

What is the SF of a Cystic Wilms Tumour?

A

Multiple thin-walled cysts of septations within cysts, normal renal parencyhma is sharply demarcated from the mass

64
Q

Mesoblastric Nephroma is also known as:

A

Fetal Renal Hamartoma, mesenchymal hamartoma of infancy, benign Wilms tumour

65
Q

What is the most common abdominal neoplasm seen in the NEONATE?

A

Mesoblastric Nephroma

66
Q

Mesoblastric Nephroma starts off as malignant.

A

Incorrect. It begins as benign, but then has the potential to be malignant.

67
Q

Describe the sonographic appearance of Mesoblastric Nephroma.

A

Homogenous mass with slightly increased echogenicity, may be heterogenous with areas of necrosis and hemorrhage centrally

68
Q

What is the key difference between Wilm’s Tumour and Benign Wilms Tumour (aka Mesoblastric Nephroma)?

A

Wilm’s Tumour is shown with aniridia, benign Wilms Tumour is not.

69
Q

RCC (association, SF)

A

Associated with tuberous sclerosis and von Hippel-Lindau disease
SF: isoechoic or slightly hypoechoic mass

70
Q

Angiomyolipoma (association,SS, bilateral/unilateral?)

A

Associated with tuberous sclerosis
SS: seizures, red popular rash over nose and cheeks, heart failure
Increased incidence of RCC
Bilateral

71
Q

Sonographic findings of Angiomyolipoma?

A

Bilateral.

Cortical homogenous hyperechoic mass.

72
Q

Ultrasound is _____ sensitive for the detection of acute inflammatory changes in the cortex.

A

not

73
Q

Is an abscess (hypo) or (hyper) echoic?

A

Hypoechoic, with thick and irregular walls

74
Q

Renal scarring has a ________ line.

A

echogenic

75
Q

Nephrocalcinosis appears in…

A

Premature babies with low low birth weight

76
Q

Nephrocalcinosis is associated with?

A

Increased urine calcium

77
Q

‘Increased echogenicity of renal pyramids (with or without shadowing), may present with diffuse cortical nephrocalcinosis, echogenic kidneys with a loss of corticomedullary junction’

What does this sonographic appearance represent?

A

Nephrocalcinosis

78
Q

Renal Artery Thrombosis occurs in paeds most commonly due to…

A

Complication of umbilical artery catheterization

79
Q

You won’t necessarily see it on an ultrasound, infant pt presents dehydrated or septic, has hematuria, proteinuria, low platelet count - what is it?

A

Renal Vein Thrombosis

80
Q

What is the most common urinary tract infection in children?

A

Cystitis

81
Q

Cystitis is more common in boys. True or false?

A

False.

82
Q

What is the sonographic feature of cystitis?

A

Bladder wall thickening, greater than 3mm full bladder, 5mm when empty. Typically diffuse but can be focal/asymmetrical

83
Q

What are the 4 urachal variants?

A

Patent/Fistula
Cystic
Sinus
Diverticulum

84
Q

What is the sonographic appearance of the patent/fistula urachal?

A

Hypoechoic tract above bladder and extending to umbilicus, may have fluid on either end

85
Q

What is the sonographic appearance of a urachal cyst?

A

Mass is continous with bladder and typically cystic, both ends closed which traps in urine

86
Q

What is the sonographic appearance of an urachal sinus?

A

Closes at the bladder but NOT umbilicus

87
Q

What is the sonographic appearance of an urachal diverticulum?

A

Closes at the umbilicus but not the bladder

88
Q

What are the signs and symptoms of Rhabdomyosarcoma?

A

Hematuria, dysuria, retention, UTI

89
Q

What are the sonographic findings of Rhabdomyosarcoma?

A

Homogenous polypoid mass adherent to the bladder wall

90
Q

What is the normal length for a neonate adrenal gland?

A

0.9-3.6cm and width 0.2-.05cm

91
Q

What causes the adrenal glands to become elongated, and to increase in thickness and flattening?

A

Renal agenesis/hypoplasia/ectopic

92
Q

What are the signs and symptoms of Hemorrhage (Adrenal Glands) in a neonate?

A

Palpable mass, anemia, hypotension, scrotal discoloration

93
Q

Hemorrhage in the Adrenal Glands is most commonly bilateral. True or false?

A

False. It is often unilateral.

94
Q

What is the sonographic appearance of an acute Adrenal Gland Hemorrhage?

A

Echogenic mass in suprarenal area but will become more anechoic as it liquefies

95
Q

Hemorrhage have follow up exams in 305 day intervals to oberseve if there is a change in the appearance or size of mass.

Results for: Hemorrhage vs. Neuroblastoma

A

Hemorrhage - appearance changes, resolves

Neuroblastoma - appearance stays the same, mass gets bigger

96
Q

Cysts are common in the paeds pop for the adrenal glands. True or false?

A

False, they are rare.

97
Q

Cysts are _lateral in the adrenal glands (paeds).

A

Unilateral

98
Q

Abscesses may form in neonatal period from neonatal ________.

A

sepsis

99
Q

Congenital Adrenal Hyperplasia is also known as:

A

Adrenogenital syndrome

100
Q

CAH (Adrenogenital syndrome) increases which steroid?

A

ACTH (Adrenocorticotropic hormone)

101
Q

What are the signs and symptoms of Adenogenital Syndrome (CAH)?

A

Virilism in newborn females (including ambiguous external genitalia), premature masculinization in males

102
Q

What is the sonographic findings of CAH (Adrenogenital Syndrome)?

A

Increased adrenal size to bigger than or equal to 20mm length and bigger than or equal to 4mm width.

Adrenal have brain like pattern

103
Q

Other than _______, adrenal gland tumours in children are rare.

A

Neuroblastomas

104
Q

What is the most common adrenal tumour of childhood?

A

Neuroblastoma

105
Q

What is the most common malignancy in infants less than 1 y/o?

A

Neuroblastoma

106
Q

What is the second most common abdominal mass in childhood?

A

Neuroblastoma

107
Q

Almost all neuroblastomas include the ____ _____ in the first year of life.

A

adrenal gland

108
Q

The _______ (younger/older) the patient is, the more likely a neuroblastoma will be _____ (inside/outside) the adrenal gland.

A

Older, outside

109
Q

What is the clinical presentation for a neuroblastoma?

A

Within the first year of life, uncommon after 8 years old

110
Q

What are the signs and symptoms of a neuroblastoma?

A

Palpable abdominal mass, fever, weight loss, abdominal distension, irritability, hypertension, anemia

111
Q

What is the sonographic findings for a Neuroblastoma?

A

Echogenic mass with poorly defined borders, calcifications, hypoechoic area of necrosis, and displaces the kidney

112
Q

Adrenocortical Carcinoma (CP, SS, SF)

A

More common in adults than paeds.
SS: virilsing symptoms, abdo mass, deepened voice, hypertension, seizures
SF: echogenic and complex mass (areas of necrosis and hemorrhage), calcifications, thick and echogenic capsule like rim - also common to have vascular extension into IVC, hepatic veins, right atrium of heart

113
Q

What is a Pheochromocytoma?

A

A functioning tumour originating in chromaffin tissue of the adrenal medulla.

114
Q

What are the signs and symptoms of Pheochromocytoma?

A

Urinary catecholamine excretion, hypertension, headaches, palpitations, diaphoresis (excessive sweating)

115
Q

Multiple tumours of _________ are commonly found in children.

A

Pheochromocytoma

116
Q

Pheochromocytoma is common to be associated with other family members when diagnosed in a child. True or false.

A

True.

117
Q

Pheochromocytoma (SF)

A

Varied appearance - egg shell calcification, areas of hemorrhage/necrosis

118
Q

Adrenal Gland mets are often _________ (unilateral/bilateral) and _______ (small/large), and solid.

A

Bilateral, large

MIDS 127 - abdo (14 decks)

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