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Abnormal OB > Test 3 > Flashcards

Test 3 Flashcards

1
Q

in the 7th week, what does metanephros develop from?

A
  • metanephric diverticulum (uteric bud)

- metanephric mass of the intermediate mesoderm

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2
Q

what is the uteric bud?

A

outgrowth of the mesonephric bud

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3
Q

what does the uteric bud give rise to?

A
  • ureter
  • renal pelvis
  • calyces
  • collecting tubules
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4
Q

by when dp the kidneys ascend to the adult position?

A

11 weeks

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5
Q

when do the kindeys start to produce urine?

A

11 weeks

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6
Q

at the 9th week what does the cloaca divide into?

A
  • rectum posteriorly

- urogenital sinus anteriorly (female and most of male urethra, urinary bladder)

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7
Q

what is the bladder continuous with?

A

allantois

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8
Q

what does the allantois become?

A

a fibrous cord, the urachus, which extends from the apex of the bladder to the umbilicus

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9
Q

when is renal architecture finalized?

A

between 5-15 weeks of intrauterine development

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10
Q

what does the urachus become?

A

medial umbilical ligament

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11
Q

what does the bladder form from?

A

devlops from part of the upper part of urogenital sinus

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12
Q

when are female and male genitalia identical?

A

befpre 11 weeks

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13
Q

in males, when does testicular descent occur?

A

after 25 weeks gestation

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14
Q

what does evaluation of the AVF provide important info on?

A

fetal renal and placenta function

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15
Q

when does fetal urine production become a major source of amniotic fluid?

A

after 16 weeks

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16
Q

what is fetal lung development affected by?

A
  • amniotic fluid adequancy
  • available thoracic space
  • neuromuscluar functions
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17
Q

what growth factors is lung development regulated by?

A

fluid volume and hyperoxia to cause cellular proliferation and differentiation

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18
Q

what is an important component of amniotic fluid?

A

fetal urine

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19
Q

during fetal development what is the kidney a major source of?

A

proline

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20
Q

what is proline?

A

aids in the formation of collagen and mesenchyme in the lung

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21
Q

what is one of the most frequent sites of congenital anaomalies?

A

urinary tract

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22
Q

what does VATER stand for?

A
  • vertebral defect
  • anal atresia
  • tracheo-esophageal fistula
  • radial defects and renal anomlaies
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23
Q

what does VACTERL stand for?

A
  • vertebral defects
  • anal atresia
  • cardiac defects
  • tracheo-esophageal fistula
  • radial defects and renal anomlaies
  • limb abnormalities
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24
Q

Bilateral renal agenesis is a_____congenital anomaly

A

lethal

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25
Q

describe bilateral renal agenesis?

A
  • male predomincance
  • uteric bud fails to develop
  • nephrons do not form
  • no urine is produced
  • severe olighydraminos
  • pulmonary hypoplasia is the major cause of death
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26
Q

what is potter sequence or syndrome?

A

case that presents with oligohydramnios or anhydramnios regardless of the source of the loss of amniotic fluid. (bilateral renal agenesis)

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27
Q

what is potter syndrome characterized by?

A
  • renal failure
  • severe oligohydramnios
  • face
  • limb deformities
  • IUGR
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28
Q

what does the face look like with potter syndrome?

A
  • beaked nose
  • low set ears
  • prominent epicanthic folds
  • hypertelorsim
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29
Q

what are the sonographic findings for bilateral renal agenesis?

A
  • no visualization of fetal kidneys
  • no visulization of fetal bladder
  • before 16 wks, AVF is not dependant upon fetal renal function and fetal urine may be normal
  • after 16 wks, severe olgohydramnios
  • lying down adrenal gland
  • absent rena; arteries using color doppler
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30
Q

what may be mistaken for kidneys?

A

bowel or adrenal glans in the renal fossae

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31
Q

what may mimic the bladder?

A

urachal diverticulum

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32
Q

what excludes bilateral renal agenesis?

A

visualization of a normal fetal bladder

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33
Q

is unilateral or bilateral renal agenesis more common?

A

unilaterl (4x)

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34
Q

what is unilateral renal agenesis associtaed with?

A
  • normal AVF

- normal visualization of bladder

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35
Q

what is a pitfall when imaging kidneys?

A

renal in far field because acoustic shadowing from the spine in TRV

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36
Q

if a kidney is not found in the renal fossa what will the other one look like?

A

contralateral kidney may be enlarged

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37
Q

what may happen with unilateral renal agenesis?

A

Vesicoureteral reflux may occur

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38
Q

what are associated abnormalities with unilateral renal agenesis?

A
  • genital
  • cardiac
  • skeletal
  • GI
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39
Q

where may renal ectopia be placed?

A
  • pelvic
  • crossed
  • crossed fused
  • horeshoe
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40
Q

what is the most common renal ectopia?

A

pelvic kidney

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41
Q

the ectopic kidney may be __________

A

hypoplastic or dysplastic

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42
Q

what is horse shoe kidney?

A

bridge of renal tissue connecting the lower poles

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43
Q

what does horseshoe kidney have a higher incidence in?

A
  • vesicoureteral reflux
  • renal calculi
  • urinary tract infections
  • hydronephrosis
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44
Q

what is horsehoe kidney frequently associated with?

A
  • urogenital
  • cardiac
  • skeletal
  • CNS
  • chromosomal
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45
Q

what is the most common neoplasm in the fetus and newborn?

A

congenital mesoblastic nephroma

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46
Q

what is congenital mesoblastic nephroma?

A

benign hamartoma composed of mesochymal tissue

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47
Q

what is wilms tumor?

A

Wilms tumour is a malignant lesion that is extremely rare and composed of epithelial tissue

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48
Q

what is the classification of renal cytic disease?

A
  • dysplastic cysts
  • hereditary cysts
  • non-dysplastic non-hereditary cysts
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49
Q

what results from early severe obstruction?

A

Multicystic dyspastic kidney and dysplastic kidney

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50
Q

dysplasia

A

abnormality of development or an epithelial anomaly of growth and differentiation

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51
Q

what is the most common form of cystic disease in childhood?

A

multi-cystic dysplastic kidney

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52
Q

what is multi-cystic dysplastic kidney associated with?

A

atretic ureter and pelvoinfundibular atresia

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53
Q

what is atresia?

A

a condition in which a body orifice or passage in the body is abnormally closed or absent

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54
Q

what does multi-cystic dysplastic kidney look like?

A

kidney is replaced by multiple cysts of varying size and no normal renal tissue present (kidney not functional)

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55
Q

where are the multiple cysts seen of varying sizes?

A

right paraspinous location

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56
Q

what does multi-cystic dysplastic kidney look like with other structures?

A

no normal appearing kidney

-the contralateral kidney, bladder and amniotic fluid are all normal

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57
Q

what is the MCDK main distinguishing feature?

A

the pattern of renal cysts. randomly distributed, non communicating and of variable size

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58
Q

what is important to assess with MCDK?

A

contralateral kidney

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59
Q

how often is multicystic renal dysplasia bilateral?

A

19%-24% of cases

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60
Q

what implies lethal renal disease?

A

MCDK is present with nonvisualization of the fetal bladder and severe oligohydramnios

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61
Q

what can unilateral obstructive cystic renal disease caused by?

A

uteropelvic or vesicourethral junction obstructon

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62
Q

what can bilateral obstructive cystic renal disease caused by?

A

severe bladder outlet obstruction, usually urethral atresia or posterior urethral valves

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63
Q

what is the severity of Obstructive Cystic Renal Dysplasia related to?

A

the timing and severity of the obstruction to urine flow

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64
Q

what is the sonographic appearance of cystic renal dysplasia?

A
  • variable
  • most typical finding, small echogenic kidney with one or several small subcapsualr cortical cysts plus evidence of urinary obstruction
  • renal cysts may change in time
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65
Q

what must happen between an autosomal recessive disorder?

A

two copies of an abnormal gene must be present in order for the disease or trait to develop

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66
Q

what does Infantile Autosomal Recessive Polycystic Kidney Disease involve?

A

kidneys and liver

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67
Q

what is Perinatal Infantile Autosomal Recessive Polycystic Kidney Disease?

A

severe renal disease, minimal hepatic fibrosis and early death from pulmonary hypoplasia

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68
Q

what is Juvenile Autosomal Recessive Polycystic Kidney Disease?

A

minimal renal disease, marked hepatic fibrosis and longer survival

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69
Q

what are the sonographic findings of Autosomal Recessive Polycystic Kidney Disease?

A
  • both kidneys are symmetrically enlarged and show increased echogenicity
  • rena function is impaired
  • severe oligohydramnios and bladder may not be seen.
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70
Q

do the size of the kidneys and cysts correlate with renal function

A

no

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71
Q

what is an indication of infantile polycystic kidney disease?

A

an elevated KC/AC ratio

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72
Q

what can IPKD be associated with?

A

meckel gruber syndrome

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73
Q

what is autosomial dominant?

A

A single abnormal gene on one of the first 22 non-sex (autosomal) chromosomes from either parent can cause an autosomal disorder

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74
Q

is adult autosomal dominant polycystic kidney disease unilateral or bilateral?

A

bilateral

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75
Q

what is the most common finding for adult autosomal dominant polycystic kidney disease?

A

Nephromegaly with or without an increase in renal echogenicity
-AFV is usually normal

76
Q

what do simple renal cysts show as?

A

small solitary, unilocular cyst near the periphery of the kidney

77
Q

when are simple renal cysts seen?

A

early as 14-16 weeks

78
Q

when do simple renal cysts disolve?

A

20-24 weeks gestation

79
Q

what does Mild Pyelectasis present as?

A

mild dilation of the renal pelvis

80
Q

what is the most common fetal urinary tract abnormality detected with prenatal U/S?

A

hydronephrosis

81
Q

what is the most common cause of fetal hydronephrosis?

A

obstruction

82
Q

Measurement of the antero-posterior renal pelvic diameter (RPD) on a transverse scan of fetal abdomen is the most common to evaluate and classify

A
  • renal pelvic dilation(mild to moderate marked)
  • calyceal dilation
  • parenchymal atrophy
83
Q

what is the RPD at 18-23 weeks?

A

over 5mm

84
Q

what is the RPD in the 3rd trimester?

A

over 7mm

85
Q

what is grade 0 of hydronephrosis?

A

no hydronephrosis, intact central renal complex

86
Q

what is grade 1 of hydronephrosis?

A

only dilated renal pelvis, there is some fluid in the renal pelvis

87
Q

what is grade 2 of hydronephrosis?

A

dilated renal pelvis and a few calices are visbale

88
Q

what is grade 3 of hydronephrosis?

A

all the calices are dilated

89
Q

what is grade 4 of hydronephrosis?

A

further dilation of renal pelvis and calices with thin renal parenchyma

90
Q

what is the most common cause of neonatal hydronephrosis?

A

UPJ obstruction (it is most often unilateral)

91
Q

what are most UPJ obstructions due to?

A

musclular abnormality in the uretral wall rather than the result of anatomic lesion such as abberant vessel or kink

92
Q

what are the sonographic findings of unilateral UPJ obstruction?

A
  • dilation of the renal pelvis with or without dilation of calyces
  • the ureter, bladder, and AFV appear normal
  • bilateral UPJ is associated with variable degrees of oligohydramnois and a variable prognosis depending on the severity and duration of renal obstruction
93
Q

what is the second most common cause of fetal and neonatal hydronephrosis?

A

uretro-vesical junction obstruction

94
Q

what are the sonographic findings of unilateral UVJ obstruction?

A
  • variable degrees of uretral dilation and hydronephrosis
  • AFV and bladder are normal
  • with bilateral UVJ obstruction variable severity of oligohydramnios depending on the obstruction
95
Q

what is a secondary cause of UVJ obstruction?

A

uterocele

96
Q

what is a uterocele?

A

Uterocele is a prolapse of the distal ureteric mucosa into the urinary bladder causing a cystic dilation of the prolapsed segment in the bladder.

97
Q

what does a simple uterocele look like?

A

if the ureter is normally located in the bladder wall

98
Q

what does a ectopic uterocele classified as?

A

if the ureter inserts into the bladder in an ectopic location

99
Q

what is ectopic uterocele associated with?

A

renal duplication. usually associated with focal or segmented hydronephrosis involving the upper pole of the duplex kindey

100
Q

what does a uterocele look like?

A

thin walled cystic structure can be seen in bladder in associated wth hydrouterer and /or hydronephrosis

101
Q

where is the hydrouterer?

A

located posteriorly and should be seen to communicate with the renal pelvis and/or bladder

102
Q

what is posterior urethral valve?

A

obstructive developmental anaomaly in the urethra and genitourinary system of male newborns

103
Q

what appears with posterior urethra valve?

A
  • extra flaps of tissue in the urethra

- these extra flaps of tissue block the normal flow of urine

104
Q

what is a common cause of bladder outlet obstruction?

A

posterior urethral valve

105
Q

what is the most specific sonographic sign for posterior urethral valves?

A

key hole sign

106
Q

what does the key hole sign describe?

A

dilated urinary bladder with a dilated proximal urethra

107
Q

what is non visualization of the bladder mostly due to?

A

specific fetal renal abnormalities and must be bilateral

108
Q

what causes failure to produce urine?

A
  • bilateral renal ageneisis
  • bilateral multicystic kidneys
  • bilateral severe renal dysplasia
  • bilateral severe UPJ obstruction
  • autosomal recessive polycystic disease
  • severe intrauterine growth
109
Q

what cuases the failure to produce urine?

A
  • bladder extrophy
  • cloacal extrophy
  • bilateral single system ectopic uteres
110
Q

what is a sign of bladder putlet obstruction?

A

an abnormal large fetal bladder

111
Q

what is the most common cause of megacystitis?

A

posterior urethral valves

112
Q

what does fetal megacystitis refer to?

A

the presence of an unusually large bladder in a fetus

113
Q

what is the bladder diameter in the 1st trimester?

A

over 7mm

114
Q

what is the bladder diameter in the 2nd trimester?

A

over 30mm

115
Q

what is the bladder diameter in the 3rd trimester?

A

over 60 mm

116
Q

what is the main underlying mechanism of bladder megacystitis?

A

either a diatal stenosis for reflux

117
Q

what anamalies are associated with bladder megacystits?

A
  • posterior urethral valves
  • chromosomal anomalies
  • oligohydramnois
  • Megacystis microcolon intestinal hypoperistalsis (MMIH) syndrome (Berdon syndrome)
  • megacystis megaureter syndrome
  • prune belly syndrome
118
Q

what is a persistant cloaca?

A

a confluence of the rectum, vagina, and urethra into a single common channel.

119
Q

who does cloacal malformation occur in?

A

girls

120
Q

what defect is the most formidable technical challenges in pediatric surgery

A

cloacal malformation

121
Q

what is bladder exstrophy?

A

anterior abdominal wall and anterior wall of bladder fail to form

122
Q

what is bladder extrophy associated with?

A
  • seperation of the pubic bones
  • low set umbilicus
  • abnormal genitalia
123
Q

what does bladder exstrophy look like sonographically?

A
  • fluid filled bladder not isentified

- mucosa my be seen as irregular mass on the anterior abdominal wall, inferior to umbilicus

124
Q

what is bladder exstrophy mostly associated with?

A

OEIS complex

125
Q

what is the second common cause of urethral level obstruction and causes the most severe form of urinary obstruction?

A

urethral atresia

126
Q

what are the sonogrpahic signs of urethral atresia?

A

megacystis associated with anhydramnois

127
Q

what is prune belly syndrome also known as?

A

eagle barrett syndrome

128
Q

what is prune belly syndrome?

A
  • absent anterior abdominal musculature
  • undescended testes
  • urinary tract abnormalities
129
Q

what are te characteristiics for prune belly syndrome?

A

bladder distention interfaces with the descent of the testes and is responsible for cryptorchisism

130
Q

what is the classic triad for prune belly syndrome?

A
  • absent abdominal musculature
  • undescended testis
  • urinary tract abnormalities
131
Q

what else is associated with prune belly syndrome?

A
  • very large bladder
  • dilated prostatic urethra
  • ureters tortous and dilated
  • kidneys normal, hyponephrotic or displastic
132
Q

what us hydrocele?

A

It is the accumulation of fluid in the tunica vaginalis, which surrounds the testes.

133
Q

when are small hydroceles common and is a normal finding?

A

in the 3rd trimester

134
Q

what do large hydroceles suggest?

A

an open or unclosed processus vaginalis and should be evaluated postnatally for inguinal hernia

135
Q

majority of fetal ovarian cysts are what?

A

benign and functional

136
Q

in the second half of pregnancy the main sources of fluid production are from what?

A

urine and lung secretions

137
Q

what are the main sources of fluid clearance?

A
  • fetal swallowing of fluid and passing it back into mothers blood stream
  • direct flow across the amnion into placental blood vessels
138
Q

when is stomach documented?

A

2nd or 3rd trimester

139
Q

what is a small or absent fetal stomach associated with?

A
  • aneuploidy
  • tracheosophageal fistula
  • oligohydramnios
140
Q

what is esophageal atresia?

A

a congenital absence of a segment of the esophagus most often associated with tracheoesophageal fistula

141
Q

what is the most common esophageal atresia?

A

fistula connecting the distal portion of the esophagus with the trachea (90%)

142
Q

when should esophageal atresia be suspected?

A

when an empty or small fetal stomach is seen in the presence of polyhydramnois

143
Q

what is a direct sign of esophageal atresia? (upper neck puch sign)

A

visualization of the proximally dilated esophagus

144
Q

the grouping of anomalies with esophageal atresia is known as what?

A

VACTERL

145
Q

what are reasons for an absent stomach?

A
  • normal stomach that recently emptied
  • herniated stomach into chest
  • displaced stomach into abdominal wall defect
  • esophageal atresia
  • aneuploidy
  • anhydrmnois
  • microgastia
146
Q

abnormal gastric dilation is most commonly seen in association with what?

A

duodenal atresia

147
Q

what does diagosing a dilated stomach require?

A

dilated for 30 min

148
Q

what is the most common site of intestinal atresia?

A

duodenal

149
Q

what is the doubel bubble sign?

A

2 fluid filled bubbles

  • dilated stomach
  • silated prox duodenum
150
Q

when is polyhydramnois frequently presented?

A

late 2nd trimester

151
Q

what is the most common etiology hypothesized for jejunoilieal atresia?

A

isolated vascular compromise

152
Q

what is diagnosis of Jejunal-ileal obstruction?

A

dilated loops of bowel

153
Q

what is the top normal lumen diameter used to diagnose bowel dilation?

A

7mm

154
Q

what is the apple peel sign?

A

subtype of jejunal-ileal obstruction, agenesis of the mesentery and is more often familial

155
Q

what is a common underlying etiology for ileal obstruction?

A

cystic fibrosis

156
Q

of all the large bowel atresias, which is the most common?

A

anorectal atresia

157
Q

what have the highest incidence of associated anomalies?

A

anorectal malformation

158
Q

what is the sonographic diagnosis of anorectal atresia?

A

dilated loops of small or colon in the absence of polyhydramnois

159
Q

what is the management of anorectal atresia?

A

fetal echocardiogram

genetic counselling

160
Q

what is echogenic bowel associated with?

A
  • aneuploidy
  • cystic fibrosis
  • meconium peritonitis
  • congenital viral infection
161
Q

when is echogenic bowel normal?

A

normal in the 3rd trimester

162
Q

what is the most common anomaly of abdominal wall?

A

omphalocele

163
Q

what is omphalocele identified by?

A

herniation of abdominal organs (live and bowel) into the base of the umbilical cord

164
Q

what is omphalocele associated with?

A
  • heart defects

- chromosome anomalies (tri-18 most common)

165
Q

what is omphalocele mostly associated with?

A

pentalogy of cantrell and beckwith-wiedemann syndromes

166
Q

what is the sonographic diagnosis of omphalocele?

A
  • ventral mass seen at the cord insertion site
  • may be small or large (bowel and liver) and appear solid
  • COVERED BY A MEMBRANE
  • ascites may be seen in peritonel membrane
167
Q

what is pentalogy of cantrell?

A
  • ectopia cordis
  • heart defects
  • diaphragmatic hernia
  • pericardial defect
  • omphalocele
168
Q

what is beckwith-wiedemann syndrome?

A
  • macrosomia
  • macroglossia
  • omphalocele
  • renal neoplasm
  • gigantism
169
Q

what is Gastroschisis?

A

a cleft defect of the anterior abdominal wall with extrusion of abdominal organs into the amniotic cavity

170
Q

where is Gastroschisis most commonly located?

A

right of midline at umbilical level and usually only contains small bowel

171
Q

what are complications reuslting from bowel malformation and associated with bowel obstruction?

A

neonatal morbidity and mortality

172
Q

what is the increase incidence of gastroschisis?

A

teenage mothers

173
Q

what are associated GI abnormalities with gastroschisis?

A

atresias, stenosis, perforations, or volvus

174
Q

what is located in the fetal abdomen?

A
  • umbilical vein
  • liver
  • IVC
  • descending aorta
  • spleen
  • fetal stomach
175
Q

when can hepatomegaly be seen in what?

A

severe hemolytic disease
splenomegaly
hydrops

176
Q

do we routinely evaluate the spleen?

A

no

177
Q

what is splenomegaly associated with?

A

severe hemolytic disease due to isoimmunization and infection

178
Q

what is asplena associated with?

A

situs inversus

179
Q

what is heterotaxy sydrome?

A

a disorder that results in certain organs forming on the opposite side of the body

180
Q

what are choledochal cysts?

A

congenital sacculations of the common bile duct

181
Q

what is the most common type of choledochal cyst?

A

saccular cystic dilation of the CBD

182
Q

when are fetal adrenal glands imaged?

A

after 20 weeks gestation

183
Q

what is the appearance of adrenal glands?

A

hypoechoic and the central medulla is moderately echogenic

184
Q

what is a neuroblastoma?

A

malignant tumour of the adrenal gland

185
Q

what is the most common neonatal tumor?

A

neuroblastoma

186
Q

what does a neuroblastoma appear as?

A

complex masses and often areas of calcification

Abnormal OB (7 decks)

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