study guide chapters 63 & 64 Flashcards
Kidneys should be sonographically documented in all fetuses starting at how many weeks?
13weeks ( I think she wants us to answer)
With TVS, fetal kidneys have been documented as early as 9 weeks of gestation
By 12 weeks of gestation, 86% of fetal kidneys may be imaged.
Fetal kidneys and bladder are seen by 13 weeks of gestation
protrution of the posterior wall of the urinary bladder is called what?
Exstrophy of the Bladder
No muscle or connective tissue forms in anterior abdominal wall to cover urinary bladder
Therefore, bladder is formed external to abdominal wall
Occurs primarily in males; incidence is 1 in 30,000 births
Is most likely sporadic occurrence and isolated
Sagittal view of abdominal pelvic region of fetus will reveal an anterior mass that appears as mound of soft tissue
A condition in which ovarian and testicular tissues are present?
True hermaphroditism
Internal and external genitalia variable
Most fetuses will have normal karyotype, but some are mosaics (46,XX/46,XY)
Sonographic appearance of complete renal agenesis?
Complete absence of kidney(s)
Sonographic Findings
Severe oligohydramnios after 13 to 15 weeks’ menstrual age
Persistent absence of urine in fetal bladder (observe for period of 1 hour)
Failure to visualize kidneys or renal arteries (use color flow to outline renal arteries)
Abnormally small thorax
Bilateral renal agenesis is lethal disorder due to renal insufficiency and hypoplasia of lungs-could have potters face
unilateral agenesis, presence of at least one functioning kidney- excellent survival rates
Renal agenesis, oligo, pulmonary hyperplasia, Abnormal facies, malformed hands and feet, are found in which condition?
Potters sequence? ( I think she may want us to anwer this but could be anything that leads to severe oligo really- hands and feet part threw me off)
Which charateristic of multicystic dysplastic kidney disease is most common?
atleast one kidney with multi cysts of varying size, may effect a part or entire kidney. starts at periphery and enlarge and more cysts develop
posible enlargement of kidneys and AC. Distorted renal outline.
Unilateral: other kidney enlarged. ( but bladder and AFI normal)
Bilateral: Oligo and absence of bladder
Which of the following sites of hydronephrosis in the neonate is most common?( the level of blockage causing hydro most common maybe?)
Ureteropelvic Junction Obstruction
Occurs at junction between renal pelvis and ureter
Results in back up of urine into renal pelvis and calyces
Causes include: Abnormal bends or kinks in ureter Adhesions Abnormal valves in ureter Abnormal outlet shape at ureteropelvic junction Absence of longitudinal muscle
Finding of Hydronephrosis?
Hydronephrosis refers to dilatation of renal pelvis and calyces
Fetal hydronephrosis is most common fetal anomaly
Findings suggesting hydronephrosis include abnormal intrapelvic anteroposterior (AP) diameter measurement
Intrapelvic diameter >7 mm, consider mild hydronephrosis
Intrapelvic diameter measuring 7 – 15 mm, consider moderate hydronephrosis
Intrapelvic diameter measuring >15 mm, considered marked dilatation or severe hydronephrosis
Dilated bladder with a keyhole appearance?
Posterior Urethral Valve Obstruction
Sonographic features: Severe bladder dilatation Massive hydronephrosis with dysplastic changes in renal tissue Dilated tortuous ureters Oligohydramnios
Bladder wall severely thickened with dilated posterior urethra—“the keyhole sign”
Sonographic findings in prune belly syndrome?
Is characterized by three features:
Cryptorchidism
Agenesis or hypoplasia of abdominal wall muscle
Dilatation of collecting system
Sonographic Findings in Prune Belly Syndrome
Absent abdominal musculature
Undescended testes
Large urinary bladder
Dilated prostatic urethra
Dilated and tortuous ureters
Kidneys can be normal, hydronephrotic, or dysplastic
Is referred to as Eagle Barrett syndrome
Is rare condition seen mostly in males
Bladder wall thickness in a fetus is usually what?
2mm or less
The renal system fails to develop in which one of these conditions?
Renal agenesis
The permanent kidneys arise from the what?
Permanent kidneys develop from two different sources:
- Metanephric diverticulum or ureteric bud
- Metanephric mesoderm
the ureteric bud gives rise to?
Ureteric bud gives rise to: Ureter Renal pelvis Calyces Collecting tubules
The kidneys originally lie in which of the following conditions?
Initially lie very close together in pelvis
Gradually migrate into abdomen and become separated from one another
Normally complete migration by ninth week of gestation
What condition develops if the lumen of the allotonis persists?
If lumen of allantois persists while urachus forms, urachal fistula develops, which causes urine to drain from bladder to umbilicus
If only small part of lumen of allantois persists, is called urachal cyst or vesicoallantoic cyst
If larger portion of lumen persists, may cause urachal sinus to develop that may open at umbilicus or into urinary bladder
This condition is called patent urachus
Normal renal pelvis AP at 20 weeks?
4mm
4mm up to 3rd tri and 7mm from 3rd tri until term
an anechoic cystic structure within the fetal bladder is most likely?
Ureterocele
Cystic dilation of intravesical (bladder) segment of distal ureter
If duplex kidney associated, kidney will typically appear with hydroneprosis of upper pole
Not uncommon to see urine collection in lower pole due to reflux
Ureter associated with ureterocele commonly dilated, tortuous, and connected to bladder in abnormal location
The most likely cause of bilateral hydronephrosis is what?
? puv?
you can not exclude renal agenesis before how many weeks?
15-18 weeks bc AF is still produced by other sources until then
What are the songraphic findings of posterior urethral valve syndrome?
Sonographic features: Severe bladder dilatation Massive hydronephrosis with dysplastic changes in renal tissue Dilated tortuous ureters Oligohydramnios
Bladder wall severely thickened with dilated posterior urethra—“the keyhole sign”
