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Pediatric and Superficial Structures > Pediatric Urinary System, Adrenals, and Retroperitoneum > Flashcards

Pediatric Urinary System, Adrenals, and Retroperitoneum Flashcards

1
Q

At what age are kidneys a similar size to adults?

A

> 15 yrs

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2
Q

SF of pediatric kidneys

A
  1. Prominent renal pyramids
  2. Increased echogenicity of cortex
  3. Irregular renal outlines due to lobulations
  4. Should not be a difference of >2cm between kidneys
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3
Q

What is another term for renal junctional defect?

A

Interrenucular defect - prominent renal lobulation

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4
Q

SF of renal junctional defect?

A

Triangular echogenic indentation of cortex

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5
Q

What are column of bertin?

A

Extension of the cortex that separates the pyramids - cortical tissue invaginating renal sinus

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6
Q

What should the renal pelvis typically measure?

A

<10mm

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7
Q

What is another name for bilateral renal agenesis?

A

Potter syndrome

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8
Q

What should you suspect with a “lying down adrenal sign”?

A

No kidney within the renal fossa - absent kidney

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9
Q

What is the most common palpable mass in neonates and most common renal anomaly diagnosed in infants?

A

Hydronephrosis

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10
Q

What is hydronephrosis most commonly caused by?

A

Obstruction - UPJ

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11
Q

Signs and symptoms of hydro?

A
  1. Palpable abdominal mass
  2. Flank pain
  3. Hematuria
  4. UTI’s (often recurring)
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12
Q

Hydronephrosis grading?

A

Grade 1: Small, fluid-filled separation of the renal pelvis

Grade 2: Dilation of some but not all calyces; renal sinus orientation still concave

Grade 3: Complete pelvocaliectasis; calyx presentation is changed in convex.

Grade 4: Prominent dilation of collecting system; thinning of renal parenchyma; no differentiation between the collecting system and renal parenchyma

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13
Q

What is a common NON-obstructive cause of hydro?

A

VUR - vesicoureteral reflux

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14
Q

What is the most common site of obstruction in the kidneys?

A

UPJ obstruction

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15
Q

Is UPJ obstruction more common in males or females?

A

Males

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16
Q

What is the second most common cause of pediatric hydronephrosis in peds?

A

Distal ureteral obstruction

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17
Q

Signs and symptoms of distal ureteral obstruction?

A

Recurring UTI’s

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18
Q

What is the most common congenital anomaly of GU tract?

A

Duplicated collecting system - the 3rd most common cause of hydro

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19
Q

What is a common complication of a duplicated collecting system?

A

Ureterocele

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20
Q

Is duplicated collecting system more common in males or females and is it unilateral or bilateral?

A

Females - bilateral

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21
Q

What is a common location of the kidneys with horseshoe kidney?

A

Lower and are medially rotated - anterior to the Ao

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22
Q

What is known as a fold or flap of tissue in the urethra causes the obstruction?

A

PUV

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23
Q

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

A

PUV

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24
Q

What are PUV associated with?

A

Prune Belly Syndrome

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25
Q

SF of PUV?

A
  1. Bilateral hydro w/ parenchymal thinning
  2. Possible dysplastic kidneys with increased
    parenchymal echogenicity and cysts
  3. Bilateral tortuous dilated ureters
  4. Thick bladder walls
  5. Key hole sign: visualization of dilated posterior urethra
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26
Q

What abnormality is associated with the “key hole sign” ?

A

PUV

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27
Q

What is prune belly also called?

A

Eagle Barrett

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28
Q

Classic triad of prune belly?

A
  1. Absent abdominal muscles
  2. Urinary tract abnormalities
  3. Cryptorchidism
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29
Q

SF of prune belly?

A
  1. Flaccid dilated bladder
  2. Small cystic dysplastic kidneys or hydronephrotic kidneys
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30
Q

What is the cause of medullary cystic disease in young adults?

A

Metabolic dysfunction

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31
Q

What are the two types of medullary cystic disease?

A
  1. Medullary sponge kidney AKA renal collecting tubular ectasia
  2. Juvenile nephronopthisis AKA uremic medullary kidney disease
32
Q

12 year old patient presents with bilateral echogenic renal pyramids. What is the likely diagnosis?

A

Medullary sponge kidney

33
Q

Patient presents with small echogenic kidneys and a loss of the CMJ. What is the likely diagnosis?

A

Juvenile nephropthisis AKA uremic medullary kidney disease

34
Q

What is the most common cystic dysplasia?

A

MCDK

35
Q

What is the 2nd most common cause of an abdominal mass in newborns after hydro?

A

MCDK

36
Q

What is the etiology of MCDK?

A

Complete ureteral obstruction in utero

37
Q

T or F? MCDK does not have communication between cysts?

A

TRUE

38
Q

What are the two types of polycystic kidney disease?

A

Infantile PKD (ARPKD) and Adult PKD (ADPKD)

39
Q

SF of infantile PKD?

A

Bilateral, echogenic, enlarged kidneys

40
Q

What abnormality is associated with infantile PKD?

A

Hepatic fibrosis - can later on cause renal failure or liver failure

41
Q

What is the most common SF of ADPKD?

A

Renal enlargement - usually bilateral

42
Q

What is known as cystic dilation of bowman’s capsule and normal tubules?

A

Glomerular cystic disease

43
Q

What is the most common malignant renal tumour in peds?

A

Nephroblastoma/Wilm’s tumour

44
Q

What is the most common SOLID abdominal tumour in children?

A

Nephroblastoma/Wilm’s tumour

45
Q

What pathology is associated with anirida and BWS?

A

Nephroblastoma/Wilm’s tumour

46
Q

Nephroblastoma’s frequently invade what structures?

A

IVC and renal vein - mets occurs to liver and lungs

47
Q

SF of nephroblastoma?

A
  1. Large well-circumscribed smooth homogenous mass
  2. Hyperechoic
  3. May contain hypoechoic or cystic areas
48
Q

What is a precursor to Wilm’s tumour?

A

Nephroblastomatosis

49
Q

SF of multilocular cystic nephroma?

A
  1. Mass with multiple cysts that have septations
  2. Normal renal parenchyma may be present elsewhere and is sharply demarcated from the mass
50
Q

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

A

Mesoblastic nephroma

51
Q

T or F? Mesoblastic nephroma’s have malignant potential?

A

TRUE

52
Q

SF of mesoblastic nephroma?

A
  1. Resembles Wilm’s tumour
  2. Homogenous / hyperechoic
  3. May be heterogeneous w/ areas of necrosis & hemorrhage centrally (usually 5-8cm)
53
Q

What is RCC associated with (2)?

A
  1. Tuberous sclerosis
  2. Von-hippel lindau
54
Q

AML’s can be associated with what?

A

Tuberous sclerosis

55
Q

SF of chronic pyelonephritis?

A
  1. Small kidney,
  2. Increase echogenicity
  3. Irregular shape due to focal parenchymal loss & scarring
56
Q

Renal scarring is typically due to what?

A

Chronic infection

57
Q

What pathology is known as a deposit of calcium in the kidney?

A

Nephrocalcinosis

58
Q

SF of renal vein thrombosis?

A
  1. Enlarged kidneys
  2. Possible thrombus in renal vein or IVC
59
Q

What is the most common urinary tract infection in children?

A

Cystits - 10x more common in girld

60
Q

SF of cystitis?

A

1.Bladder wall thickening (>3mm when full bladder or 5mm when empty)

  1. Typically diffuse but can be focal/asymmetrical (suggestive of a mass.. f/u after treatment to see if resolved)
  2. Hyperemia of bladder wall
61
Q

The urachus is a tubular structure continuous with what?

A

Anterior bladder extending to the umbilicus

62
Q

What is the most common urachal variant?

A

Patent urachus - patent lumen causing urine to drain from umbilicus

63
Q

Urachal sinus vs diverticulum

A

Sinus - urachus CLOSES at bladder but not umbilicus

Diverticulum - urachus CLOSES at umbilicus but not bladder

64
Q

What is a malignant mass of the urinary bladder?

A

Rhabdomyosarcoma - homogenous mass adherent to bladder wall

65
Q

Shape of the R adrenal vs L adrenal?

A

Rt - pyramid shaped

Lt - crescent shaped

66
Q

How to determine a hemorrhage vs neuroblastoma?

A

Hemorrhage - will change and resolve

Neuroblastoma - will remain unchanged and grow larger

67
Q

What stands for CAH?

A

Congenital Adrenal Hyperplasia

68
Q

Female patient presents with virilism. Ultrasound shows enlarged adrenal glands with a cerebriform pattern. What is the most common diagnosis?

A

CAH

69
Q

What is the most common adrenal tumour in childhood?

A

Neuroblastoma

70
Q

Neuroblastoma’s are uncommon after what age?

A

8

71
Q

What is the term for a mature neuroblastoma and considered less malignant?

A

Ganglioneuoma

72
Q

SF of neuroblastoma?

A
  1. Echogenic mass with poorly defined borders
  2. Calcifications, hypoechoic areas of necrosis
  3. Displacement of the kidney (downward and outward)
73
Q

What is known as a “functioning tumours originating in chromaffin tissue of the medulla”

A

Pheochromocytoma

74
Q

Signs and symptoms of pheochromocytoma?

A
  1. Urinary catecholamine excretion (important in stress response)
  2. Hypertension
  3. Headaches
  4. Palpitations
  5. Diaphoresis
75
Q

What muscle is a common location for hemorrhage, abscess or changes related to neoplasm?

A

Psoas

76
Q

Where are retroperitoneal lymph nodes most commonly located near?

A

Ao/IVC

77
Q

Enlargement of lymph nodes in the retroperitoneum are most commonly associated with? (3)

A
  1. Neuroblastoma
  2. Lymphoma
  3. Wilm’s tumour

Pediatric and Superficial Structures (23 decks)

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