TEST 1---ALL POWERPOINTS Flashcards
When a patient has increased creatine, what are we looking for?
- nonfunctioning kidneys VS hydro.
- mechanical-such as obstruction VS medical cause
- Surgicial VS Non-Surgical
What is the column of bertin?
a lateral indentation of renal sinus
Where is a column of bertin typically located?
At junction of upper and middle thirds
What must be present to say a kidney has hydro?
Pelvicaliectasis (Pelvicaliectasis means that both the pelvis and renal calyces are dilated)
What are some causes of hydronephrosis?
- stones in ureter
- tumors in or near ureter
- narrowing of ureter
- Neurogenic bladder
- Cancer of bladder
What are the symptoms of acute hydronephrosis?
excruciating intermittent flank pain.
What is the column of bertin?
a lateral indentation of renal sinus
Where is a column of bertin typically located?
At junction of upper and middle thirds
What must be present to say a kidney has hydro?
Pelvicaliectasis (dilation of pelvic and calcyces.
What are some causes of hydronephrosis?
- stones in ureter
- tumors in or near ureter
- narrowing of ureter
- Neurogenic bladder
- Cancer of bladder
What are the symptoms of acute hydronephrosis?
excruciating intermittent flank pain.
What are some symptoms of chronic hydronephrosis?
asymptomatic or dull, aching discomfort in the flank of affected side.
TRUE OR FALSE
UTIS, a fever, and N/V are all associated with hydro.
TRUE
When suspecting hydro, what else should we look for that may be dilated?
Ureter
If the ureter is dilated, we should try to follow it to the level of obstruction
T/F
True
Sonographically, what should we do when fiinding a dilated ureter with hydronephrosis?
Put on color to r/o prominent vessels
Is UPJ obstruction more often found in men or women?
Men
What is the most common cause of pediatric hydronephrosis?
Uteropelvic junction obstruction (UPJ)
True or False
The right kidney is affected twice as often as left in UPJ obstruction?
FALSE
The LEFT kidney is affected twice as much.
What are some symptoms of UPJ obstruction?
chronic back or flank pain
What are some causes of UPJ Obstruction?
- renal stones
- compression of ureter
- tumor
- kinking of ureter
Where is a UVJ obstruction usually located?
at the junction of ureter and bladder
Describe what Infantile Polycystic Kidney disease would look like on ultrasound?
multiple tiny cysts and an echogenic kidney!
Is multicystic dysplastic kidney usually unilateral or bilateral?
unilateral
it is fatal if bilateral.
Is acute renal failure reversible?
yes
Is chronic renal failure reversible?
no
What exactly is acute renal failure?
the sudden loss of the kidneys ability to concentrate urine, excrete wastes, or conserve electrolytes.
What lab values will be increased with Acute Renal Failure?
creatinine and BUN
What are a few causes of Acute Renal Failure?
- dehydration
- burns
- septic shock
- Urinary tract obstruction
- malignant HTN
What are the symptoms of acute renal failure?
- decreased urine output
- swelling of various types
- N/V
- Mental Status changes
What will acute renal failure look like on US?
normal or enlarged echogenic kidneys with possible hydro
What is the most common cause of Chronic Renal Failure?
diabetes and hypertension
What are some symptoms of Chronic Renal Failure?
- Weightloss
- N/V
- Fatigue
- Hypotension
- Hyerkalemia (potassium levels)
- Drowsiness, confusion and delirium
What is the sonographic findings of Chronic Renal Failure over time?
- Kidneys become smaller
- Increased echogenicity
With ________ disease, the kidneys cannot function enough to sustain daily life and are
ESRD (end-stage renal disease)
When a patient has hematuria, what should we look for?
- mass
- stone
- severe infection
What is the common cause of a patient over 40 years of age with hematuria?
Urinary tract cancer or prostatis disease
What is a common cause of a patient under 40 years of age with hematuria?
GU infection or stones and calcifications
What are some common causes of someone with hematuria and PAIN?
stones, renal vein thrombosis, or renal cancer.
If we see a bladder mass what should we do???
- determine the side
- have the patient roll up to see if it moves
Give some examples of obstructive hydronephrosis?
- stones
- masses
- decreased ureteral jet
Give some examples of nonobstructive hydronephrosis?
- infection
- distended bladder
- pregnancy
- normal jet
Sonographically, what would a stone look like on ultrasound?
- echogenic foci
- posterior shadowing
- TWINKLE ARTIFACT
What can we do to better image the shadowing of a stone?
higher frequency and harmonics
Where are the lower poles of a horshoe kidney used joined at?
midline of the abdomen
If there are cysts in the kidney where else should we check for cysts?
in the liver.
If we come across something that looks like a cyst with septations, what is important to note about the mass?
Tell the thickness of the septations and if there is a presence of blood flow.
T/F
It isn’t necessary to put color on a complex renal cyst.
FALSE FALSE FALSE!
Always put color.
What is a common finding with a ruptured renal cyst?
pericystic fluid.
What is papillary necrosis?
destruction of cells at the apex of pyramids
that is the ducts that empty the kidneys
A patient with that has been diagnosed with ______ or __________ is at risk for papillary necrosis
sickle cell or diabetes
Sonographically what does papillary necrosis look like?
cystic spaces at corticomedullary junction.
What will Autosomal Recessive Polycystic Kidney Disease look like on ultrasound?
Large echogenic kidney with small cysts and splenomegaly.
What will Autosomal Dominant Polycystic Kidney Disease look like in adults on ultrasound?
Bilateral large kidneys with cysts
at risk for hemorrhage
What will Autosomal Dominant Polycystic Kidney Disease look like in fetus’ on ultrasound?
enlarged and echogenic kidneys
What decade is Autosomal Dominant Polycystic more commonly found in?
4th or 5th decade
With Multicystic Dysplastic Kidney Disease is usually bilateral or unilateral?
unilateral
What will Multicystic Dysplastic Kidney Disease look like on ultrasound?
echogenic kidney filled with cysts
What does nephrocalcinosis look like on ultrasound?
echogenic renal medulla.
What is the most common cause of nephrocalcinosis?
hyperparathyroidism and medullary sponge kidney
What does a renal cell carcinoma look like on ultrasound?
- iso-hypoehoic mass that seems to blend in.
- vascularity
- calcification
what is a tumor of the collecting system called?
transitional cell carcinoma
What will a squamous cell carcinoma look like on ultrasound?
a large mass in the renal with hydronephrosis
Will an angiomyolipoma have blood flow?
yes, it is composed of fat cells and vessels
What will an angiomyolipoma look like on ultrasound?
hyperechoic (from the fat cells) with posterior enhancement. Usually in the cortex
People with ___________ are also known have multiple angiomyolipomas
tuberous sclerosis
Angiomyolipomas are at risk for ____ and hemorrhage.
rupture
What will lipomas look like on ultrasound??
hint=lipo indicates fat cells
hyperechoic and well defined
An oncocytoma can often mimic a ___________ carcinoma
renal cell carcinoma
this is because they have the same appearance and both have blood flow
Is an oncocytoma benign or malignant?
benign.
Sonographicallly what will an oncocytoma look like on ultrasound?
- central scar
- variable size
- bulls-eye look
- blood flow
With hypertensive Nephropathy what will the kidney look like?
small with internal scarring from infection
What is the telescoping of segments of bowel into each other called?
intussusception
Who is at risk for intussusception?
between 6 months-2 years
What is the most common cause of small bowel obstruction in children?
intussusception
Where is the most common location for intussusception to occur?
ileocolic junction where the small intestines meet large intestines
What are some symptoms of intussusception?
- abdominal pain
- RED JELLY-LIKE STOOL
- palpable sausage shaped abdominal mass
50% of patients will have these symptoms
What will intussusception look like on ultrasound?
bulls-eye target sign, echogenic center.
*it can have a psuedo kidney appearance.
What scanning plane is best to image intussusception?
an oblique sagittal plane
Name some predictors of intussesception.
- free fluid
- dilated fluid filled bowel (small bowel obstruction)
- fluid trapped in wall of colon
- vascularity
Where is the pylorus in relation to the other surrounding organs??
between right kidney and gallbladder
What happens when the pylorus becomes stenotic?
it becomes enlarged and restricts movement of food from stomach to duodenum
True or False
It is common to get pyloric stenosis over 6 months of age
False!
When is pyloric stenosis usually diagnosed?
between 6-8 weeks but accuracy decreases before 21 days
True/false
First born males are the most at risk for pyloric stenosis
True
What are some symptoms for pyloric stenosis?
- projective vomiting
- dehydration
- weight loss
- excessive hunger
What are some questions you would ask of a patient having a pyloric stenosis scan done?
- symptoms and duration of symptoms
- any weight loss
- whens the last time the baby threw up or ate
In transverse the pyloric will look like a cervix
T/F
true
What is the correct measurements of a pyloric scan?
3-4 mm wall thickness
14-17 mm length
What is a staghorn calculi and what is it associated with?
a stone that fills the renal pelvis
associated w/ nephrolithiasis
Cigarette smoking is a definite risk factor for which malignant neoplasm?
Renal Cell Carcinoma
What would the lab values show in a patient with RCC?
elevated creatinine and BUN
What is the sonographic appearance of a Renal Cell Carcinoma?
hypo-iso- or hyper echoic to the renal parenchyma
large ones are heterogenous and hypoechoic to renal parenchyma
What is the most common malignant mass of the bladder in the United States?
Transitional Cell Carcinoma
What is the most common malignant mass of the bladder in the world?
Squamous Cell Carcinomas
What is common symptoms of someone with a angiomyolipoma?
palpable abdominal mass with hematuria or flank pain.
What is a mass in the liver that consists of blood vessels?
hemangioma
What are possible causes of a hematoma?
post-renal biopsy, trauma, RCC, hemorrhagic cyst, absess…
Hematomas varies in appearance.
New Blood appears______
New Blood = anechoic right as it happens then becomes echogenic.
Prolonged hydro destroys the tubules in the cortex resulting in renal parenchymal atrophy, scarring, or _____________,.
Irreversible kidney damage
What is an inflammation of the renal glomeruli?
Acute Glomerulonephritis
What are some symptoms of acute golmerulonephritis
foggy urine, recent fever, sore throat, joint pain, naueous ,
Papillary necrosis is commonly found around the ________ of the kidney
apex—-point of pyramids that point to the sinus
True / False
Pyelonephritis can turn into pyonephritis
TRUE
What does a fungal ball (ew……) look like on ultrasound?
echogenic, non shadowing, soft tissue mass in the renal collecting system
What is the most significant life threatening hepatobiliary disorder in children?
biliary atresia
What is the narrowing or obliteration of the bile ducts?
biliary atresia
What is the triangular cord sign associated with?
Biliary Atresia
What is the most common cause of hydro in babies is?
UPJ obstruction
What is the name for the junction between the bladder and ureter>
UVJ - uterovesicular juntion
Does renal failure come with a increase or decrease in BUN and Creatinine
increased
What is the difference in clinical symptoms between a patient who has a stone in the kidney versus a patient who has a stone in the ureter at the level of bladder?
stone in distal ureter- back pain
stone in kidney- asymptomatic
Can an angiomyolipoma have internal blood flow and why?
it is made of arterial vessels
What is the most common bladder malignancy in US?
Transitional Cell carcinoma
What might be the cause of hematuria in a patient with increased white blood count?
pyonephritis
The diagnosis of pyelonnephritis will include hydro
T/F
false
What is the most common cause of chronic renal failure?
Diabetes
What will a dilated ureter at the level of the bladder look like in transverse?
circular structure at the base of bladder
