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Genitourinary > Pelvocalyceal System And Ureter > Flashcards

Pelvocalyceal System And Ureter Flashcards

1
Q

Imaging method of choice for evaluation of hematuria and a screening examination of the pelvicalyceal system and ureters

A

CT urogram

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2
Q

CT urogram is limited by

A

Low spatial resolution

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3
Q

If contrast is contraindicated for MR, what can be utilised

A

Heavy T2WI - due to high signal from urine

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4
Q

Performed by cystoscopic catheterization of the ureteal orifice followed by contrast injection, is independent of renal function, provides high-quality images of the ureter and collecting system and is another alternative commonly utilized by urologists

A

Retrograde pyelopgraphy

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5
Q

Imaging choice if percutaneous nephrostomy catheter is present

A

Antegrade pyelography

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6
Q

Imaging method of choice for screening for hydronephrosis but is limited in its ability to demonstrate small uroepithelial tumors

A

Ultrasound

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7
Q

Collecting tubules of medullary pyramid coalesce into a variable number of papillary ducts that pierce the tip of the papilla and drain into the receptacle of the collecting system

A

Minor calyx

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8
Q

Projection of a papilla into the calyx produces what shape

A

Cup shape

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9
Q

Sharp-edged portion of the minor calyx projecting around the sides of a papilla is called

A

Fornix

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10
Q

Formed by the projection of two or more papilla into the calyx, usually found at the poles of the kidney

A

Compound calyces

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11
Q

Triangular in shape with its base within the renal sinus

A

Renal pelvis

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12
Q

Predominantly outside the renal sinus and is larger and more distensible than the more common intrarenal pelvis, which is surrounded by renal sinus fat and other structures

A

Extrarenal pelvis

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13
Q

Responsible for ureteral peristalsis

A

Outer circular muscularis and inner longitudinal muscle bundles

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14
Q

Lined by transitional epithelium

A

Pelvicalyceal system, ureters and bladder

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15
Q

Ureters enter the bladder at an ______ angle

A

Oblique

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16
Q

When the bladder wall contracts, ureteral orifices are closed or open?

A

Closed

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17
Q

Three main points of ureteral narrowing, where calculi are likely to become impacted

A

Ureteropelvic junction
Site at which the ureter crosses the pelvic brim
Ureterovesical junction

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18
Q

in ureteral duplication, what is more common, unilateral or bilateral?

A

unilateral

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19
Q

states that with complete ureteral duplication, the ureter draining the upper pole passes thru the bladder wall to insert inferior and medial to the normally placed ureter draining the lower pole

A

Welgert-Meyer rule

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20
Q

In females, ectopic ureter may insert into

A

lower bladder, upper vagina or urethra

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21
Q

in males, ectopic ureter may insert into

A

lower bladder, prosthetic urethra, seminal vesicles, vas deferent or ejaculatory duct

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22
Q

the upper pole ureter in ureteral duplication often ends as an

A

ectopic ureterocele

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23
Q

where does the lower pole ureter inserts in relation to the bladder trigone in ureteral duplication

A

in or near the normal location in the bladder trigone

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24
Q

lower ectopic ureter is susceptible to

A

vesicoureteral reflux

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25
Q

complications of complete ureteral duplication

A

UTI, vesicoureteral reflux, UPJ obstruction of lower pole system

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26
Q

lower pole system in ureteral duplication when displaced inferiorly commonly shows a _____ appearance

A

drooping lily appearance

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27
Q

True or false: bifid renal pelvis has no pathologic consequence

A

true

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28
Q

common congenital ureteral anomaly that may go undiagnosed until adulthood

A

ureteropelvic junction obstruction

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29
Q

Developmental variant in which the right ureter passes behind the IVC and aorta to return to its normal position

A

Retrocaval ureter

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30
Q

Retrocaval ureter is usually associated with

A

urinary stasis and proximal pyeloureterectasis

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31
Q

This anomaly is due to faulty embryogenesis of the IVC, with abnormal persistence of the right sub cardinal vein anterior to the ureter instead of the right supra cardinal vein posterior to the ureter

A

Retrocaval ureter

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32
Q

Most common etiology of renal calculi

A

calcium oxalate, calcium phosphate

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33
Q

unique form of calcium phosphate stones that tends to recur quickly if patients are not treated aggressively

A

Brushite

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34
Q

stones that are resistant to shock wave lithotripsy

A

Brushite

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35
Q

Stones that are formed in the presence of alkaline urine and infection

A

Struvite (magnesium ammonium phosphate)

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36
Q

Most common component of stag horn calculi

A

Struvite

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37
Q

Mildly radiopaque stones and are found only in patients with congenital cystinuria

A

Cystine stones

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38
Q

Radiolucent stones

A

Uric acid, xanthine and indinavir stones

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39
Q

CT attenuation of calculi

A

> 200 HU

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40
Q

CT attenuation of other collecting system lesions such as tutors, hematoma, fungus balls or sloughed papilla

A

<50 HU

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41
Q

Modality used to determine chemical composition of stones

A

Dual-energy CT

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42
Q

Common complaint of patients with urolithiasis

A

acute flank pain

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43
Q

most common cause of acute flank pain, caused by a calculus obstructing the ureter

A

renal colic

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44
Q

Modality of choice for detecting urolithiasis

A

non contrast enhanced CT

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45
Q

CT attenuation of calcium oxalate stones

A

1700-2800 HU

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46
Q

CT attenuation of calcium phosphate stones

A

1200- 1600 HU

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47
Q

CT attenuation of brushite stones

A

1700- 2800 HU

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48
Q

CT attenaution of uric acid stones

A

200-450 HU

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49
Q

CT attenuation of struvite stones

A

600-900 HU

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50
Q

CT attenuation of cystine stones

A

600-1100 HU

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51
Q

CT attenuation of indinavir calculus

A

15-30 HU

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52
Q

halo of soft tissue surrounding the calculus is called ____ which confirms the stone location within the ureter

A

tissue rim sign

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53
Q

what sign is present representing a thromboses vein, which is a tubular tail extending from the calcification

A

tail sign

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54
Q

Attenuation value of phleboliths

A

160 HU

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55
Q

High attenuation in renal pyramids is a sign of ______ and must not be mistaken for stones

A

dehydration

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56
Q

Stones that are less than ___mm in size are likely to pass spontaneously thru the ureter within 6 weeks

A

<6 mm

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57
Q

defined as dilatation of the upper urinary tract

A

hydronephrosis

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58
Q

Multiple or multolobulated cysts that occupy the renal sinus. Contains clear fluid and may be lymphatic or post traumatic in origin

A

Parapelvic cysts

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59
Q

Postcontrast MDCT signs of obstruction include

A
  • increasingly dense nephrogram with time
  • delay in appearance of contrast in collecting system
  • dilated pelvicalyceal system and ureter to the point of obstruction
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60
Q

complication that may result from rupture of fornix precipitated by contrast-induced diereses superimposed on the increase hydrostatic pressure of an obstructed pelvicalyceal system

A

pyelosinus reflux

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61
Q

infection in an obstructed kidney. it must be treated promptly by relief of obstruction by ureteral stent or nephrostomy tube placement and antibiotics

A

pyonephrosis

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62
Q

modality of choice for pyonephrosis

A

CT

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63
Q

common cause of hydronephrosis in children

A

vesicoureteral reflux

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64
Q

in adults, vesicoureteral reflux is usually associated with

A

neurogenic bladder or bladder outlet obstruction

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65
Q

modality of choice for vesicoureteral reflux

A

cystourography or radionuclide cystography

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66
Q

basic defect causing vesicoureteral reflux in children

A

abnormal ureteral tunnel at the UVJ

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67
Q

Sequelae of chronic vesicoureteral reflux

A

reflux nephropathy

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68
Q

due to an aperistaltic segment of the lower ureter 5-40 mm in length causing a functional obstruction and resulting in dilation of the proximal ureter. Ureter demonstrates smoothly tapered narrowing without evidence of mechanical obstruction

A

congenital megaureter

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69
Q

ureteral dilation in congenital megaureter exceeds

A

7 mm

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70
Q

also called Eagle-Barrett syndrome, a congenital disorder manifest by absence of abdominal wall musculature, urinary tract anomalies and cryptorchidism

A

Prune belly syndrome

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71
Q

nearly all patients with prune belly syndrome are male or female?

A

male

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72
Q

Ureteral defect in prune belly syndrome

A

markedly dilated and tortuous ureters, enlarged bladder, dilated posterior urethra

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73
Q

Associated with acute diuresis, diabetes insipidus and may cause mild to severe hydronephrosis

A

Polyuria

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74
Q

Most common cause of filling defects in contrast-filled collecting system or ureter

A

Calculi

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75
Q

Accounts for 85-90% of all uroepithelial tumors and is the second most common primary renal malignancy

A

Transitional cell carcinoma

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76
Q

Most common pattern of growth of TCC

A

papillary growth, that is exophytic, polypoid and attached to the mucosa by a stalk

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77
Q

Stippled pattern of contrast material within the intersticrs of the papillary lesion is characteristic of

A

Transitional cell carcinoma

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78
Q

Nodular of flat form oF TCC that tend to be infiltrating and aggressive

A

Nonpapillary tumors

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79
Q

Type of TCC that cause strictures of the collecting system or ureter rather than a focal mass

A

Nonpapillary

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80
Q

Most TCC occurs in what age and gender

A

Men,age 60 years old and older

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81
Q

Chemical agents used in the textile and plastic industries, drugs including cyclophosphamide and phenacetin, chronic urinary stasis (horseshoe kidney) and smoking play a role in the etiology of what tumor

A

TCC

82
Q

Standard tx for upper tract TCC

A

Total nephroureterectomy and excision of a cuff of the bladder surrounding the ureteral orifice

83
Q

3 typical appearance of TCC of the upper urinary tract

A

Focal intraluminal mass, thickening of wall and narrowing of lumen of ureter and renal parenchyma

84
Q

Attenuation of TCC

A

8 to30 HU

85
Q

MR appearance of TCC

A

T1- isointense compared to renal medulla

T2- isointense, outlined by high signal urine

86
Q

Appearance of Tcc on ultrasound

A

Slightly hypo or hyperechoic mass within the renal sinus, absent acoustic shadowing

87
Q

major predisposing factors for squamous cell carcinoma

A

chronic infection, calculi, phenacetin abuse

88
Q

true or false: metastasis is a rare cause of collecting system mass

A

true

89
Q

ischemic necrosis of the tips of the medullary pyramids. causes include infection, TB, sickle cell trait and disease, diabetes and analgesic nephropathy

A

papillary necrosis

90
Q

benign fibrous polyp covered by transitional epithelium. most common in young adult men

A

fibroepithelial polyp

91
Q

benign process of subcumucosal cyst formation associated with chronic urinary tract infection. multiple , small (2 to 3 mm) smooth, round filling defects in the ureter are characteristic. cysts in renal pelvis tend to be larger, up to 2cm

A

pyeloureteritis cystica

92
Q

rare inflammatory condition of the uroepithelium related to chronic urinary tract infection and calculi. squamous metaplasia with keratinization and desquamation results in irregular plaques in the renal pelvis, proximal ureter and bladder

A

leukoplakia

93
Q

clinical feature is passage of flakes or desquamated epithelium in the urine

A

leukoplakia

94
Q

leukoplakia is considered a premalignant condition in the ____

A

bladder, but not in the ureter

95
Q

rare granulomatous condition of the uroepithelium associated with chronic infection, especially due to E.coli. Smooth submucosal nodules composed of histiocytes produce multiple smooth nodules in the distal ureter and bladder. this condition is not premalignant but can be aggressive extending outside of the urinary system

A

malacoplakia

96
Q

fixed narrowing of the pelvicalyceal system

A

stricture

97
Q

True or false: a diagnosis of ureteral stricture should never be made unless dilation of the ureter or pelvis above the point of narrowing is present

A

true

98
Q

what type of tumor manifest as a stricture of the pelvis and ureter

A

squamous cell carcinoma

99
Q

extrinsic encasement of ureter by tumor or inflammatory processes is common cause of stricture which include

A

lymphoma, cervical carcinoma, colon carcinoma, endometriosis, Crohn disease, diverticulitis and PID

100
Q

uropethelium-lined cavities in the renal parenchyma that communicate via a narrow channel with the fornix of a nearby calyx

A

calyceal diverticuli

101
Q

minimum amount of contrast agent that is instilled into the bladder via catheter in CT cystogram

A

250 cc

102
Q

part of the bladder that is covered by peritoneum

A

superior and lateral walls

103
Q

lies superior to the urinary bladder and may cause mass impressions on the bladder dome

A

sigmoid colon, loops of small bowel and uterus in females

104
Q

extraperitoneal part of the urinary bladder

A

inferior

105
Q

urinary bladder is oval, with the floor parallel to and __ mm above the superior aspect of the symphysis pubis

A

5-10 mm

106
Q

anteriorly, the bladder is separated from the symphysis pubis by

A

fat in the extraperitoneal space of Retzius

107
Q

posteriorly, the bladder is separated from the uterus by the

A

uterovesical peritoneal recess in females and rectovesical peritoneal recess in males

108
Q

four layers of the urinary bladder wall

A

outer connective tissue adventitia, smooth muscle consisting of circular muscle fibers sandwiched between inner and outer layers of longitudinal fibers, submucosal connective tissue (lamina propria) and mucosa of transitional epithelium

109
Q

triangle at the bladder floor formed by the two ureteral orifices and the internal urethral orifice

A

trigone

110
Q

with voiding, the trigone descends ___ cm and transforms from a flat surface into a cone with the urethra and apex

A

1-2 cm

111
Q

congenital deficiency in the development of the lower anterior abdominal wall. bladder is open, and its mucosa is continuous with the skin

A

bladder exstrophy

112
Q

associated with bladder exstrophy

A

epispadias and wide diastasis of the symphysis pubis

113
Q

management of bladder exstrophy

A

urinary diversion, bladder augmentation and skin grafting

114
Q

vestigial remnant of the urogenital sinus and allantois, tubular structure that extends from the bladder dome to the umbilicus along the anterior abdominal wall

A

urachus

115
Q

obliterated residual of urachus

A

median umbilical ligament

116
Q

50% of urachal remnant conditions

A

patent urachus

117
Q

blind-ended dilation of the urachus at the umbilical end that may cause a persistent umbilical discharge

A

umbilical-urachal sinus

118
Q

presents as tubular structure in the midline abdominal wall extending caudally from the umbilicus

A

umbilical-urachal sinus

119
Q

an outpouching of the bladder in the anterior midline location of the urachus. this is seen in adults with bladder outlet obstruction as a fluid-filled sac extending cranially from the bladder in midline abdominal wall

A

vesical-urachal diverticulum

120
Q

develops if the urachus is closed at both ends but remains patent in the midline. imaging shows a fluid-filled cyst in the midline abdominal wall usually in the lower 3rd region of the urachus

A

urachal cyst

121
Q

urachal carcinoma is usually a ____ and represents 0.5% of bladder carcinoma

A

adenocarcinoma

122
Q

normal wall of a well-distended bladder should not exceed ___ mm in thickness

A

5-6 mm

123
Q

may cause uplifting of the bladder trigone, causing J-hooking of the distal ureters, seen in males, particularly those older than 50

A

BPH

124
Q

chronic bladder outlet obstruction results in

A

thickening and trabeculation of the bladder wall

125
Q

neurogenic bladder may be

A

spastic or atonic

126
Q

causes of neurogenic bladder

A

meningomyelocele, spinal trauma, DM, poliomyelitis, central nervous system tumor and MS

127
Q

causes of cystitis

A

infection (bacteria, adenovirus, TB, schistosomiasis), drugs (cyclophosphamide), radiation, and autoimmune reaction

128
Q

characterized by multiple fluid-filled submucosal cysts

A

cystitis cystica

129
Q

further progression of cystitis cystica with proliferation of mucus secreting glands in the lamina propria

A

cystitis glandularis

130
Q

cystitis glandularis may be a precursor of what type of Ca

A

adenocarcinoma

131
Q

usually associated with chronic irritation from indwelling catheters. Appears as grape-like cysts that elevate the mucosa

A

Bullous edema of the bladder wall

132
Q

chronic, idiopathic inflammation of the bladder found most often in women

A

interstitial cystitis

133
Q

characterized by hemorrhage into the mucosa and submucosa

A

hemorrhagic cystitis

134
Q

hemorrhagic cystitis is caused by

A

bacterial or adenovirus

135
Q

imaging features of cystitis

A

bladder wall thickening and edema

136
Q

infiltration of the bladder wall by eosinophils

A

eosinophilic cystitis

137
Q

form of bladder inflammation with gas within the bladder wall. associated with poorly controlled DM, bladder outlet obstruction and infection with E.coli, which ferment sugar in the urine to release carbon dioxide and hydrogen gasses

A

emphysematous cystitis

138
Q

gas within the bladder lumen is seen with

A

emphysematous cystitis, instrumentation and vesicocolic fistula

139
Q

pathophysiology of bladder wall schistosomiasis

A

laval cercariae penetrate the skin, enters the lymphatic vessels and circulate eventually to the portal venous system, adult females migrate to the vesical venous plexus and lay their eggs in the wall of urinary bladder and ureter. eggs incite a fibrosing granulomatous reaction that results in a beaded stenosis and irregular dilatation of the ureters and calcification of the eggs

140
Q

sequela of schistosomiasis in ureters

A

become aperistaltic, resulting in vesicoureteral reflux

141
Q

sequela of schistosomiasis in bladder

A

become shrunken, fibrotic and contracted

142
Q

complications of bladder schistosomiases

A

fistulas may develop in perineum and scrotum. renal disease may develop slowly due to functional obstruction and reflux

143
Q

KUB tb affects the primarily the ___ and ____ secondarily

A

kidneys primarily; ureters and bladder secondarily

144
Q

tuberculous infection of the bladder causes

A

wall thickening and reduced capacity

145
Q

calcifications in tb are seen in

A

proximal ureters and may eventually extend into the distal ureters and bladder. calcification of the bladder wall is uncommon and patchy

146
Q

bladder wall calcifications from cystitis include

A

postradiation cystitis, chronic infection, cyclophosphamide induced cystitis

147
Q

cystic dilatation of the intravesicular segment of the ureter caused by a congenital prolapse of the distal ureter into the bladder lumen at the normal insertion site of the ureter into the trigone

A

simple ureterocele

148
Q

characteristic appearance of simple ureterocele

A

cobra head or spring onion appearance

149
Q

usually associated with ureteral duplication

A

ectopic ureterocele

150
Q

ectopic ureterocele may insert where

A

distal to the external sphincter into the vestibule, uterus or vagina in females; inserts proximal to external sphincter in males

151
Q

ectopic ureterocele that cause incontinence is usually seen in males or females?

A

females

152
Q

most common urinary tract neoplasm

A

TCC

153
Q

hallmark of TCC is

A

multiplicity and recurrence

154
Q

4% of bladder malignancy that tends to develop in bladders chronically irritated by stones and infection and is highly associated with bladder schistosomiasis

A

squamous cell carcinoma

155
Q

malignancy that is associated with bladder exostrophy or urachal remnant

A

adenocarcinoma

156
Q

benign bladder tumors

A

leiomyoma, hemangioma, pheochromocytoma and neurofibroma

157
Q

most common in the bladder producing hematuria and signs of UTI

A

malacoplakia

158
Q

herniations of the bladder mucosa between interlacing muscle bundles

A

bladder diverticula

159
Q

most bladder diverticula are located

A

posterolaterally near the UVJ

160
Q

complications of bladder diverticula

A

urinary stasis, infection, stone formation, vesicoureteral reflux and bladder outlet obstruction

161
Q

vesicocolonic fistula commonly occur as a complication of

A

diverticulitis

162
Q

vesicoenteric fistula is almost always attributable to

A

Crohn disease

163
Q

80% of bladder ruptures, results from puncture of the bladder by a spicule of bone from a pelvic fracture

A

extraperitoneal bladder rupture

164
Q

in extraperitoneal bladder rupture, contrast extravasates into the extraperitoneal compartments, most commonly in the

A

retropubic space of Retzius

165
Q

results from blunt trauma applied to a distended bladder

A

intraperitoneal bladder rupture

166
Q

intraperitoneal bladder rupture may clinically mimic

A

acute renal failure

167
Q

contrast extravasation in intraperitoneal bladder rupture is seen in

A

paracolic gutters

168
Q

true or false: complete filling of the posterior urethra is not possible because contrast runs freely into the bladder

A

true

169
Q

in VCUG, anterior urethra normally distends fully because of resistance of the

A

external sphincter at the level of the urogenital diaphragm

170
Q

male urethra is divided into posterior and anterior portions by the

A

inferior aspect of the urogenital diaphragm

171
Q

posterior urethra in males consists of

A

prostatic urethra within the prostate gland, from the bladder neck to urogenital diaphragm, and short membranous urethra, which is totally contained within the 1 cm thick urogenital diaphragm

172
Q

anterior urethra of males consists of

A

extends from the urogenital diaphragm to the external urethral meatus, consists of bulbous urethra extending from the urogenital diaphragm to the penoscrotal junction, penile urethra extending to the urethral meatus

173
Q

anterior urethra in males is entirely contained within the

A

corpus spongiosum penis, except for the proximal 2 cm of bulbous urethra, called the pars nuda

174
Q

this unprotected part of anterior urethra is particularly susceptible to straddle injury

A

pars nuda

175
Q

runs vertically through the prostate over a length of 3-4 cm

A

prostatic urethra

176
Q

oval filling defect in midportion of posterior wall of prostatic urethra is called

A

verumontanum

177
Q

ejaculatory ducts open into the urethra on either side of the

A

verumontanum

178
Q

a mullerian remnant that is small, saccular depression in the middle of verumontanum

A

utricle

179
Q

distal end of verumontanum marks the beginning of ____ which extends to the apex of the cone of bulbous urethra

A

membranous urethra

180
Q

the voluntary external urethral sphincter within the urogenital diaphragm entirely surrounds the

A

membranous urethra

181
Q

pea-sized accessory sex glands within the urogenital diaphragm on either side of the membranous urethra. their ducts empty into the bulbous urethra 2 cm distally

A

cowper gland

182
Q

marks the division between the membranous and bulbous urethra

A

apex of the cone shape formed by the tapering bulbous urethra

183
Q

divides the bulbous and penile urethra that is marked by suspensory ligament of the penis, which causes a normal bend in the urethra

A

penoscrotal junction

184
Q

the entire anterior male urethra is lined by

A

glands of Littre

185
Q

visualization of glands of Littre represent

A

always abnormal; associated with chronic inflammation and urethral stricture

186
Q

reflux of contrast into prostatic ducts represent

A

abnormal; associated with prostatitis and distal urethral stricture

187
Q

female urethra varies in length from

A

2.5 to 4 cm

188
Q

female urethra is embedded in

A

anterior wall of vagina

189
Q

periurethral abscess usually develops on what part

A

ventral surface

190
Q

most common complication of urethral stricture

A

false passage

191
Q

most urethral carcinoma are

A

squamous cell

192
Q

urethral carcinoma commonly involve the

A

anterior urethra

193
Q

rare tumors of the posterior urethra are usually

A

TCC

194
Q

thick-valve membrane that extends obliquely across the lumen from verumontanum to the distal prostatic urethra obstructing the flow of urine

A

posterior urethral valve

195
Q

most common site of urethral injury in males secondary to trauma

A

prostatic and membranous urethra

196
Q

classification of posterior urethral injury: contusion without imaging finding

A

type 1

197
Q

classification of posterior urethral injury: stretch injury with elongation of urethra without extravasation

A

type 2

198
Q

classification of posterior urethral injury:partial disruption with extravasation of contrast agent from urethra with opacification of bladder

A

type 3

199
Q

classification of posterior urethral injury:complete disruption of urethra without opacification of bladder and with urethral separation of <2cm

A

type 4

200
Q

classification of posterior urethral injury: complete disruption of urethra without opacification of bladder and with urethral separation of >2cm

A

type 5

201
Q

commonly injured male urethral part in straddle injury

A

bulbous urethra

202
Q

autodigestion of urethra has been reported because of

A

drainage of pancreatic exocrine enzymes as a complication of pancreatic transplantation with pancreatic drainage into the bladder

Genitourinary (5 decks)

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