Pediatric Urinary System & Adrenal Glands Flashcards
1
Q
What is the average renal length for: 0-2 months?
A
5.0cm
2
Q
What is the average renal length for: 2-6 months?
A
5.7cm
3
Q
What is the average renal length for: 6-12 months?
A
6.2cm
4
Q
What is the average renal length for: 1-5 yrs old?
A
7.3cm
5
Q
What is the average renal length for: 5-10 yrs old?
A
8.5cm
6
Q
What is the average renal length for: 10-15 yrs old?
A
10cm
7
Q
What is the average renal length for: +15 yrs?
A
Same as adult; 10-12cm
8
Q
Renal pelvises in children are _____ _______ the renal sinus and should measure less than ______ mm.
A
half outside, 10
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
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
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
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
13
Q
What is another name for Agenesis?
A
Potter Syndrome
14
Q
What can Potter Syndrome cause?
A
Oligohydramnios, pulmonary hypoplasia, and absent bladder in utero
15
Q
For Agenesis, is it more common to be unilateral or bilateral?
A
Unilateral
16
Q
What is the most common palpable mass in the neonate?
A
Hydronephrosis
17
Q
Hydronephrosis is most commonly caused by:
A
Obstruction
18
Q
What is the most common renal anomaly diagnosed in infants in children?
A
Hydro!
19
Q
What are the SS of hydronephrosis?
A
Palpable abdo mass, flank pain, hematuria, UTIs
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)
21
Q
Is Vesicoureteral Reflux (VUR) an obstructive or non-obstructive form of hydronephrosis?
A
A non-obstructive form
22
Q
Where is the most common site of obstruction?
A
The UPJ (uteropelvic junction)
23
Q
UPJ obstruction is most common in _____ .
A
males
24
Q
What is the second most common cause of pediatric hydronephrosis?
A
Distal ureter obstruction - megaureter
25
What is the most common place, sex, and complication for a Duplicated Collecting System?
The upper pole, women, ureterocele
26
What is the most common congenital anomaly of the GU tract?
Duplicated collecting system
27
Duplicated Collecting System looks like: a duplex kidney, two renal sinuses, longer length of kidney. True or false?
True
28
What is the most common cause of urethral obstruction in boys?
PUV (posterior uretheral valves)
29
Prune Belly syndrome is associated with...
PUV
30
Describe Prune Belly Syndrome (aka Eagle-Barrett)
Large dilated tortuous ureters, large bladder, patent urachus, dilated prostatic urethra, VUR) and undistended testicles
31
Prune Belly Syndrome is more common in girls. True or false.
False. It is most common in boys.
32
Multicystic Dysplastic Kidney Disease is the fourth most common cause of an abdo mass in newborn after hydronephrosis. True or false?
False. It is the second most.
33
MCDK will ______ or _______.
Curl up or atrophy (get so shrunken that we won't see the kidney).
34
SS, complications, SA, DD of MCDK.
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
35
Dysplastic kidneys are most associated with...
Urinary tract malformations and obstructions
36
Hypoplastic Kidneys: etiology and SF.
Etioloy: Renal infarction caused by unsuspected chronic atrophic pyelonephritis
SF: small kidneys
37
Dysplastric Kidneys: SF, associations
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
38
Infantile Polycystic Kidney Disease is also known as... (ARPKD)
Autosomal Recessive Polycystic Kidney Disease
39
Infantile Polycystic Kidney Disease (aka ARPKD) is most common in ....
females
40
Infantile Polycystic Kidney Disease is associated with _____ ____ ______.
Congenital Hepatic Fibrosis. All surviving ARPKD patients develop it. They will get liver symptoms (portal hypertension) and visible liver cysts seen by ultrasound.
41
Sonographic findings for ARPKD?
Symmetrically enlarged kidneys, cysts are MICROSCOPIC, multiple bright echoes in the pyramids and medulla, hard to differentiate between textures of renal sinus/medulla/cortex
42
Adult Polycystic Kidney Disease has an increased risk of _____.
RCC
43
Glomerular Cystic Disease is hard to differentiate between _____ & ______ and _____ of _____ ______.
ADPKD, ARPKD, hamartomas of tuberous sclerosis
44
MedullarySponge Kidney is associated with:
Beckwidth-Wiedemann syndrome, PCKD, Caroli disease, and congenital hepatic fibrosis
45
Juvenile Nephronophthisis (SS, SF)
SS: metabolic dysfunction
SF: normal or small kidneys with increased parenchymal echogenicity and loss of CMJ, potentially cysts in CMJ
46
Renal Cysts are associated with: (2 items)
Tuberous Sclerosis, von Hippel-Lindau disease
47
Simple cysts are common in children. True or false?
False, they are rare.
48
Tuberous Schlerosis results in _____ cystic kidneys.
Bilateral
49
Acquired cysts can be caused by _________.
Hemodialysis
50
What is the most common malignant renal tumour in the peds pop?
Wilms Tumour (Nephroblastoma)
51
What is the most common solid abdominal tumour in children?
Wilms Tumour (Nephroblastoma)
52
What is the peak age for Wilms Tumour?
3-4 yrs
53
What are the signs and symptoms of Wilms Tumour?
SS: Palpable mass, pain, fever, malaise, weight loss, hematuria, hypertension
54
Wilms Tumour causes mets most commonly to the ______ & _______. (Two L words)
Liver & lungs
55
Nephroblastoma (also Wilms Tumour) is most COMMONLY associated with:
Aniridia (absent iris)
56
Describe the sonographic feature of Wilms Tumour (Nephroblastoma)
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
Nephroblastomatosis is a precursor of _____ ________.
Wilm's tumour
58
Nephroblastomatosis is found 100% in patient's with _______ (bilateral or unilateral) Wilms Tumour.
Bilateral
59
The two forms of Nephroblastomatosis are:
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
Nephroblastomatosis can be found in cases of:
Beckwith-Wiedemann syndrome, aniridia
61
Multilocular Cystic Nephroma is malignant or benign?
Benign
62
Multilocular Cystic Nephroma is also called:
Benign Cystic Nephroma, Cystic Wilms Tumour
63
What is the SF of a Cystic Wilms Tumour?
Multiple thin-walled cysts of septations within cysts, normal renal parencyhma is sharply demarcated from the mass
64
Mesoblastric Nephroma is also known as:
Fetal Renal Hamartoma, mesenchymal hamartoma of infancy, benign Wilms tumour
65
What is the most common abdominal neoplasm seen in the NEONATE?
Mesoblastric Nephroma
66
Mesoblastric Nephroma starts off as malignant.
Incorrect. It begins as benign, but then has the potential to be malignant.
67
Describe the sonographic appearance of Mesoblastric Nephroma.
Homogenous mass with slightly increased echogenicity, may be heterogenous with areas of necrosis and hemorrhage centrally
68
What is the key difference between Wilm's Tumour and Benign Wilms Tumour (aka Mesoblastric Nephroma)?
Wilm's Tumour is shown with aniridia, benign Wilms Tumour is not.
69
RCC (association, SF)
Associated with tuberous sclerosis and von Hippel-Lindau disease
SF: isoechoic or slightly hypoechoic mass
70
Angiomyolipoma (association,SS, bilateral/unilateral?)
Associated with tuberous sclerosis
SS: seizures, red popular rash over nose and cheeks, heart failure
Increased incidence of RCC
Bilateral
71
Sonographic findings of Angiomyolipoma?
Bilateral.
Cortical homogenous hyperechoic mass.
72
Ultrasound is _____ sensitive for the detection of acute inflammatory changes in the cortex.
not
73
Is an abscess (hypo) or (hyper) echoic?
Hypoechoic, with thick and irregular walls
74
Renal scarring has a ________ line.
echogenic
75
Nephrocalcinosis appears in...
Premature babies with low low birth weight
76
Nephrocalcinosis is associated with?
Increased urine calcium
77
'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?
Nephrocalcinosis
78
Renal Artery Thrombosis occurs in paeds most commonly due to...
Complication of umbilical artery catheterization
79
You won't necessarily see it on an ultrasound, infant pt presents dehydrated or septic, has hematuria, proteinuria, low platelet count - what is it?
Renal Vein Thrombosis
80
What is the most common urinary tract infection in children?
Cystitis
81
Cystitis is more common in boys. True or false?
False.
82
What is the sonographic feature of cystitis?
Bladder wall thickening, greater than 3mm full bladder, 5mm when empty. Typically diffuse but can be focal/asymmetrical
83
What are the 4 urachal variants?
Patent/Fistula
Cystic
Sinus
Diverticulum
84
What is the sonographic appearance of the patent/fistula urachal?
Hypoechoic tract above bladder and extending to umbilicus, may have fluid on either end
85
What is the sonographic appearance of a urachal cyst?
Mass is continous with bladder and typically cystic, both ends closed which traps in urine
86
What is the sonographic appearance of an urachal sinus?
Closes at the bladder but NOT umbilicus
87
What is the sonographic appearance of an urachal diverticulum?
Closes at the umbilicus but not the bladder
88
What are the signs and symptoms of Rhabdomyosarcoma?
Hematuria, dysuria, retention, UTI
89
What are the sonographic findings of Rhabdomyosarcoma?
Homogenous polypoid mass adherent to the bladder wall
90
What is the normal length for a neonate adrenal gland?
0.9-3.6cm and width 0.2-.05cm
91
What causes the adrenal glands to become elongated, and to increase in thickness and flattening?
Renal agenesis/hypoplasia/ectopic
92
What are the signs and symptoms of Hemorrhage (Adrenal Glands) in a neonate?
Palpable mass, anemia, hypotension, scrotal discoloration
93
Hemorrhage in the Adrenal Glands is most commonly bilateral. True or false?
False. It is often unilateral.
94
What is the sonographic appearance of an acute Adrenal Gland Hemorrhage?
Echogenic mass in suprarenal area but will become more anechoic as it liquefies
95
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
Hemorrhage - appearance changes, resolves
| Neuroblastoma - appearance stays the same, mass gets bigger
96
Cysts are common in the paeds pop for the adrenal glands. True or false?
False, they are rare.
97
Cysts are _lateral in the adrenal glands (paeds).
Unilateral
98
Abscesses may form in neonatal period from neonatal ________.
sepsis
99
Congenital Adrenal Hyperplasia is also known as:
Adrenogenital syndrome
100
CAH (Adrenogenital syndrome) increases which steroid?
ACTH (Adrenocorticotropic hormone)
101
What are the signs and symptoms of Adenogenital Syndrome (CAH)?
Virilism in newborn females (including ambiguous external genitalia), premature masculinization in males
102
What is the sonographic findings of CAH (Adrenogenital Syndrome)?
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
Other than _______, adrenal gland tumours in children are rare.
Neuroblastomas
104
What is the most common adrenal tumour of childhood?
Neuroblastoma
105
What is the most common malignancy in infants less than 1 y/o?
Neuroblastoma
106
What is the second most common abdominal mass in childhood?
Neuroblastoma
107
Almost all neuroblastomas include the ____ _____ in the first year of life.
adrenal gland
108
The _______ (younger/older) the patient is, the more likely a neuroblastoma will be _____ (inside/outside) the adrenal gland.
Older, outside
109
What is the clinical presentation for a neuroblastoma?
Within the first year of life, uncommon after 8 years old
110
What are the signs and symptoms of a neuroblastoma?
Palpable abdominal mass, fever, weight loss, abdominal distension, irritability, hypertension, anemia
111
What is the sonographic findings for a Neuroblastoma?
Echogenic mass with poorly defined borders, calcifications, hypoechoic area of necrosis, and displaces the kidney
112
Adrenocortical Carcinoma (CP, SS, SF)
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
What is a Pheochromocytoma?
A functioning tumour originating in chromaffin tissue of the adrenal medulla.
114
What are the signs and symptoms of Pheochromocytoma?
Urinary catecholamine excretion, hypertension, headaches, palpitations, diaphoresis (excessive sweating)
115
Multiple tumours of _________ are commonly found in children.
Pheochromocytoma
116
Pheochromocytoma is common to be associated with other family members when diagnosed in a child. True or false.
True.
117
Pheochromocytoma (SF)
Varied appearance - egg shell calcification, areas of hemorrhage/necrosis
118
Adrenal Gland mets are often _________ (unilateral/bilateral) and _______ (small/large), and solid.
Bilateral, large
