Urinary/Excretory System Flashcards
1
Q
4 things the urinary/excretory system includes
A
Two kidneys
Two ureters
Urinary bladder
Urethra
2
Q
Urine expelled from body via this system
A
Urinary/excretory system
3
Q
Two ductless endocrine glands that have no functional relationship with the urinary system but sit on top of the kidneys
A
Suprarenal/adrenal glands
4
Q
Bean-shaped bodies with convex lateral border and concave medial border
Slightly convex anterior and posterior surfaces
Divided into upper and lower poles
Left usually slightly longer and narrower than right
Situated retroperitoneal (behind the peritoneum) and are in contact with the posterior wall of the abdominal cavity
One lying on each side of and in the same coronal plane as L3
Superior aspect lies more posterior than inferior aspect
Each one lies in an oblique plane and is rotated about 30 degrees anteriorly toward the aorta (which lies on tip of the vertebral body)
Right slightly lower than/caudal to left because of the large space occupied by the liver
Supported in a fairly fixed position, partially through the fascial attachments and by surrounding organs
Have respiratory movement of approximately 1 in (2.5 cm) and normally drop no more than 2 in (5 cm) in change from supine to upright position
A
Kidneys
5
Q
How long, wide and thick are the kidneys?
A
Approximately 4 1/2 in (11.5 cm) long, 2-3 in (5-7.6 cm) wide and 1 1/4 in (3 cm) thick
6
Q
Where are the kidneys located in sthenic, hypersthenic and asthenic habitus?
A
Normally extend from level of the superior border of T12 to the level of the transverse processes of L3 in sthenic individuals; they’re higher in individuals with a hypersthenic habitus and lower in persons with an asthenic habitus
7
Q
Outer covering of the kidney, semitransparent membrane that’s continuous with outer coat of the ureter
A
Renal capsule
8
Q
Mass of fatty tissue each kidney is embedded in
A
Adipose capsule
9
Q
Sheath of superficial fascia that is attached to the diaphragm, lumbar vertebrae, peritoneum and other adjacent structures that the adipose capsule and kidney are enveloped in
A
Renal fascia
10
Q
Longitudinal slit on concave medial border of each kidney for transmission of blood and lymphatic vessels, nerves and ureter; expands into body of kidney to form renal sinus
A
Hilum
11
Q
Hilum expands into body of kidney to form a central cavity
Fat-filled space surrounding renal pelvis and vessels
A
Renal sinus
12
Q
Outer layer of renal tissue
A
Renal cortex
13
Q
Inner layer of renal tissue that consists of renal pyramids
A
Renal medulla
14
Q
8-15 cone-shaped segments of collecting tubules
A
Renal pyramids
15
Q
Extensions of cortex between renal pyramids
A
Renal columns
16
Q
Essential microscopic components of the kidneys
Each kidney contains approximately 1 million of these tubular structures
A
Nephrons
17
Q
2 things the nephrons are composed of
A
Renal corpuscle
Renal tubule
18
Q
Double-walled membranous cup of the renal corpuscle
A
Glomerular/Bowman capsule
19
Q
Cluster of blood capillaries in glomerular/Bowman capsule
Formed by a minute branch of the renal artery entering the capsule and dividing into capillaries which turn back, and as the ascend, unite to form a single vessel leaving the capsule
Thin inner wall of the capsule closely adheres to the capillary coils and is separated by a comparatively wide space from the outer layer, which is continuous with the beginning of a renal tubule
Filter for blood, allowing fine particles and water to pass into the capsule
Change from filtrate to urine is caused in part by the water and the usable dissolved substances being absorbed through the epithelial lining of the tubules into the surrounding capillary network
A
Glomerulus
20
Q
Vessel entering glomerular capsule
A
Afferent arteriole
21
Q
Vessel exiting capsule
After exiting the glomerular capsules, these arterioles form the capillary network surrounding the straight and convoluted tubules, and these capillaries reunite and continue on to communicate with the renal veins
A
Efferent arteriole
22
Q
2 parts of the renal corpuscle of the nephrons
A
Glomerular/Bowman capsule
Glomerulus
23
Q
Part of nephrons continuous with glomerular capsule in the cortex of the kidney and then travels a circuitous path through the cortical and medullary substances
A
Renal tubule
24
Q
3 things the renal tubule becomes
A
Proximal convoluted tubule
Neuron loop/loop of Henle
Distal convoluted tubule (opens into the collecting ducts)
25
Converge toward the renal pelvis and unite along their course to form a central tubule within the pyramid
Opens at renal papilla and rains into minor calix
Collecting ducts
26
Cup-shaped stems arising at the sides of the papilla of each renal pyramid
Each encloses one or more papilla, so there are usually fewer of these than pyramids
Calyces
27
Beginning branches of calyces (numbering 4-13) that unite to form two or three larger tubes = major
Minor calyces
28
Unite to form the expanded, funnel-shaped renal pelvis
Major calyces
29
Wide upper portion lies within hilum and its tapering lower part passes through the lower hilum to become continuous with the ureter (ureteropelvic junction [UPJ])
Renal pelvis
30
How long are ureters?
10-12 in (25-30 cm) long
31
Descend behind the peritoneum and in front of the psoas muscle and transverse processes of the L-spine
Convey the urine from the renal pelves to the bladder by slow, rhythmic peristaltic contractions
Supposed to have one on each side, may have two on each side
Ureters
32
Where are the ureters located?
Pass inferiorly and posteriorly in front of the sacral wing and then curve anteriorly and medially to enter the posterolateral (back/lateral) surface of the urinary bladder at approximately the level of the ischial spine
33
Musculomembranous sac that serves as a reservoir for urine
Located immediately posterior and superior to pubic symphysis (anterior rectum in males and anterior to vaginal canal in females; apex is anterosuperior aspect and adjacent to the superior aspect of the pubic symphysis)
Varies in size, shape and position according to its content; freely moveable and held in position by the folds of the peritoneum (when empty, located in the pelvic cavity; as it fills, it gradually assumes an oval shape while expanding superiorly and anteriorly into the abdominal cavity)
Adult one can hold approximately 500 mL of fluid when completely full; urge for micturition (urination) occurs when about 250 mL of urine is in the bladder
Ureters enter the posterior wall at the lateral margins of the superior part of its base and pass obliquely through the wall to their respective internal orifices (these two openings are about 1 in (2.5 cm) part when this is empty and 2 in (5 cm) when this is distended; the openings are equidistant from the internal urethral orifice which is situated at the neck of the this)
Urinary bladder
34
Lowest, most fixed part of the urinary bladder; rests on male’s prostate or female’s pelvic diaphragm
Neck
35
Triangular area of bladder base between three openings
Two for ureters and one internal urethral orifice
Mucosa over this is always smooth, whereas the remainder of the lining contains rugae when the bladder is empty
Trigone
36
Conveys urine out of the body
Narrow musculomembranous tube with a sphincter type of muscle at the neck of the bladder
Female: passes along the thick anterior wall of the vagina to the external urethral orifice, which is located in the vestibule about 1 in (2.5 cm) anterior to the vaginal opening
Male: extends from the bladder to the end of the penis
Urethra
37
What is the length of the urethra in males and females?
Arises at the internal urethral orifice in the urinary bladder and extends approximately 1 1/2 in (3.8 cm) long in females, 7-8 in (17.8-20 cm) long in males
38
3 portions of the male urethra
Prostatic
Membranous
Spongy
39
Portion of male urethra that is 1 in (2.5 cm) long; reaches from the bladder to the floor of the pelvis and is completely surrounded by the prostate
Prostatic
40
Portion of male urethra that passes through the urogenital diaphragm; slightly constricted and about 1 1/2 in (1.3 cm) long
Membranous
41
Portion of male urethra that passes though the shaft of the penis, extending from the floor of the pelvis to the external urethral orifice
Spongy
42
Small glandular body surrounding the proximal part of the male urethra; situated just posterior to the inferior portion of the pubic symphysis
Considered part of the male reproductive system, but because of its close proximity to the bladder, is commonly described with the urinary system
Conical base is attached to the inferior surface of the urinary bladder and its apex is in contact with the pelvic diaphragm
Measures about 1 1/2 in (3.8 cm) transversely, 3/4 in (1.9 cm) anteroposteriorly at its base and vertically about 1 in (2.5 cm) long
Secretes a milky fluid that combines with semen from the seminal vesicles and vas deferens which enter the urethra via ducts in the prostatic urethra
Prostate
43
2 filling techniques of contrast media for urinary system radiography
Antegrade
| Retrograde
44
Contrast enters in normal direction of flow
Antegrade
45
Contrast enters against direction of flow, backwards
Retrograde
46
Why don't you use barium during urinary system radiography?
Nonionic media less likely to cause adverse reactions; don’t use barium because it gets hard in water
47
3 characteristic reactions to contrast media
Feeling of warmth
Flushing
A few hives
48
3 occasional reactions to contrast media
Nausea
Vomiting
Edema of respiratory mucous membranes
49
9 steps of patient preparation for urinary system radiography
Clear demonstration of urinary system requires intestinal tract to be free of gas and fecal matter
Bowel preparation not attempted in infants and kids; adult preparation depends on patient condition
When time permits, low residue diet for 1-2 days before exam
Light evening meal on day before exam
Non-gas forming laxative, when indicated, the day before exam
Nothing by mouth after midnight the day before the exam
Patient should be well hydrated, imporatnt for patients with diabetes, multiple myeloma or high uric acid levels which put patient at increased risk for contrast medium-induced renal failure if dehydrated
For retrograde urography, patient should drink 4-5 cups of water several hrs before exam
No preparation usually required for exams of the lower urinary tract
50
4 urinary system procedures
Intravenous urography (IVU)
Retrograde urography
Cystography
Cystourethrography
51
Shows function and structure of urinary system (kidneys)
Function: ability of kidneys to filter contrast medium from the blood and concentrate it with the urine
Structures: usually visualizes as the contrast follows the excretion route of the urine
Intravenous urography (excretory urography) [IVU]
52
7 indications of IVU
Evaluation of abdominal masses, renal cysts and tumors
Urolithiasis
Pyelonephritis
Hydronephrosis
Trauma effects
Preoperative evaluation of the function, location, size and shape of the kidneys and ureters
Renal hypertension
53
Calculi or stone of the kidney or urinary tract
Urolithiasis
54
Infection of the upper urinary tract, which can be acute or chronic
Pyelonephritis
55
Abnormal dilation of the pelvicaliceal system
Hydronephrosis
56
2 contraindications of IVU
Ability of the kidneys to filter contrast from blood
| Patient’s allergic history (use non-ionic contrast or other modalities)
57
7 risk factors of IVU
```
Asthma
Previous contrast reaction
Circulatory or cardiovascular disease
Elevated creatinine level
Sickle cell disease
Diabetes mellitus
Multiple myeloma
```
58
What is a normal glomerular filtration rate (GFR) and renal dysfunction?
120-125 mL/min
| 90 mL/min
59
Best indicator of renal function
Glomerular filtration rate (GFR)
60
What is a normal creatinine level?
0.6-1.2 mg/100 mL
61
What is the amount of contrast for IVU for the average adult patient?
Perform venipuncture and administer 30-100 mL of contrast for adult patient of average size
62
4 projections for IVU
AP
AP oblique RPO and LPO
Lateral right or left
Lateral dorsal decubitus
63
CR for AP IVU
Perpendicular to IR at level of iliac crests
64
IR/collimation for IVU
14 x 17 in (35 x 43 cm) lengthwise
65
What are the structures shown on AP IVU?
KUB filled with contrast
66
9 evaluation criteria for AP or PA IVU
Entire renal outlines
Bladder and pubic symphysis (separate image needed if bladder not included)
No motion
Exposure technique clearly showing contrast in renal area, ureters and bladder
Centered vertebral column
Prostatic region inferior to pubic symphysis on older males
Time marker
PA showing lower kidneys and entire ureters (bladder included if patient size permits)
Superimposing intestinal gas in AP moved for PA
67
4 evaluation criteria for IVU AP bladder
Bladder
No rotation of pelvis
Male prostate
Postvoid images clearly labeled and showing only residual contrast
68
Patient and part position for AP oblique RPO and LPO IVU
Supine, turn the patient so the midcoronal plane forms an angle of 30 degrees from the IR plane
Center spine to grid and IR at the level of the iliac crests
69
CR for AP oblique RPO and LPO IVU
Perpendicular to the center of the IR at the level of the iliac crests, entering about 2 in (5 cm) lateral to the midline on the elevated side
70
What are the structures shown on AP oblique RPO and LPO IVU?
KUB filled with contrast; elevated kidney is parallel with IR, down-side kidney is perpendicular
71
7 evaluation criteria for for AP oblique RPO and LPO IVU
Patient rotated about 30 degrees
No superimposition of kidney remote from the IR on the vertebrae
Entire down-side kidney
Bladder and lower ureters on 14 x 17 in (35 x 43 cm) IR if patient size permits
Exposure technique that shows the anatomy
Evidence of proper collimation
Time marker
72
Patient and part position for lateral right or left IVU
Right or left lateral recumbent
Flex patient’s knees and adjust body so the midcoronal plane is centered to the midline of the grid
Center IR at the level of the iliac crests
73
CR for lateral right or left IVU
Perpendicular to IR, entering the MCP at the level of the iliac crest
74
2 structures shown on lateral right or left IVU
KUB filled with contrast
| Show conditions such as rotation or pressure displacement of kidney and to localize calcareous areas and tumor masses
75
6 evaluation criteria for lateral right or left IVU
Entire urinary system
Bladder and pubic symphysis
No rotation of patient (check pelvis and lumbar vertebrae
Evidence of proper collimation
Exposure technique clearly showing contrast in renal area, ureters and bladder
Time marker
76
Patient and part position for lateral dorsal decubitus IVU
Supine with side of interest against vertical grid
Adjust height of vertical grid so the long axis of the IR is centered to the MCP of the patient
Position patient so a point at about the level of the iliac crests is centered to the IR
77
What are the structures shown on lateral dorsal decubitus IVU?
UPJ in presence of hydronephrosis; easier to screen kidneys and ureters for abnormal anterior displacement
78
7 evaluation criteria for lateral dorsal decubitus IVU
Patient elevated so entire abdomen is invisible
Entire urinary system
Bladder and pubic symphysis
No rotation of patient (check pelvis and lumbar vertebrae
Evidence of proper collimation
Exposure technique clearly showing contrast in renal area, ureters and bladder
Time marker
79
Tomography performed immediately after contrast administration
Demonstrates renal parenchyma (nephrons and collecting tubes)
Indications: renal hypertension and renal cysts and tumors
Contraindications: renal failure and contrast allergy
Nephrotomography and nephrourography
80
Requires catheterization of ureters
Contrast injected directly into pelvicaliceal system
Provides improved opacification of renal collected system
Little physiologic info provided
Indicated for evaluation of collecting system in patients with renal insufficiency or contrast sensitivity
Done in surgery/classified as an operative procedure; carried out under aseptic conditions
Retrograde urography
81
Radiologic exam of the urinary bladder
Usually performed via retrograde contrast administration
Contraindications related to catheterization of urethra
Cystography
82
7 things cystography is indicated for
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Vesicoureteral reflux
Recurrent lower UTI
Neurogenic bladder
Bladder trauma
Lower urinary tract fistulae
Urethral stricture
Posterior urethral valves
```
83
3 projections for cystography
AP or PA
AP oblique RPO or LPO
Lateral right or left
84
IR/collimation for cystography projections
10 x 12 in (24 x 30 cm) lengthwise
85
Patient and part position for AP or PA cystography
AP = supine, PA = prone
Center MSP of patient’s body to the midline of the grid
Adjust patient’s shoulders and hips so they’re equidistant from the IR
Place patient’s arms so they don’t cast shadows on the IR
Legs extended
Center IR 2 in (5 cm) above upper border of pubic symphysis (at level of symphysis for voiding studies
86
CR for AP cystography
10-15 degrees caudal to center of IR
Enters 2 in (5 cm) above the upper border of the pubic symphysis at the level of the ASIS/greater trochanter
5 degree caudal angulation when bladder neck and proximal urethra are main area of interest, projects pubic bones below them
Less angulation with greater lordosis of L-spine
87
CR for PA cystogram
Through the region of the bladder neck at an angle of 10-15 degrees cephalad
Enters about 1 in (2.5 cm) distal to the tip of the coccyx and exiting a little above the superior border of the pubic symphysis
If prostate is area of interest, CR 20-25 degrees cephalad to project it above the pubic bones
IR centered to CR
Perpendicular for voiding studies
88
What are the structures shown on AP or PA and AP oblique RPO or LPO cystogram?
Bladder filled with contrast; distal ureters also visualized if reflux is present
89
4 evaluation criteria for AP or PA cystogram
Evidence of proper collimation
Regions of the distal end of the ureters, bladder and proximal portion of the urethra
Pubic bones projected below the bladder neck and proximal urethra
Exposure technique clearly showing contrast in bladder, distal ureters and proximal urethra
90
Patient and part position for AP oblique RPO or LPO cystogram
Supine 40-60 degrees RPO or LPO depending on physician preference
Adjust patient so pubic arch closest to table is aligned over midline of grid
Extend and abduct uppermost thigh to prevent superimposition on bladder area
Center IR 2 in (5 cm) above the upper border of the pubic symphysis and about 2 in (5 cm) medial to the upper ASIS (or at pubic symphysis for voiding studies)
91
CR for AP oblique RPO or LPO cystogram
Perpendicular to center of IR
CR will fall 2 in (5 cm) above the upper border of the pubic symphysis and 1 in (5 cm) medial to upper ASIS
If bladder neck and proximal urethra are areas of interest, 10 degree caudal angle of CR will project pubic bones below them
92
Evaluation criteria for AP oblique RPO or LPO cystogram
No superimposition of bladder by uppermost thigh
Evidence of proper collimation
Regions of the distal end of the ureters, bladder and proximal portion of the urethra
Pubic bones projected below the bladder neck and proximal urethra
Exposure technique clearly showing contrast in bladder, distal ureters and proximal urethra
93
3 evaluation for AP oblique RPO or LPO voiding cystogram
Entire urethra visible and filled with contrast
Urethra overlapping the thigh on oblique projections for improved visibility
Urethra lying posterior to the superimposed pubic and ischial rami on the side down in oblique projections
94
Patient position for lateral right or left cystogram
```
Right or left lateral recumbent
Knees flexed for comfort
MCP aligned to midline of grid
Flex elbows and place hands under head
Center IR 2 in (5 cm) above upper border of pubic symphysis at MCP
```
95
CR for lateral right or left cystogram
Perpendicular to IR and 2 in (5 cm) above the upper border of the pubic symphysis at the MCP
96
3 structures shown on lateral right or left cystogram
Anterior and posterior bladder walls and the base of the bladder
Bladder filled with contrast
Distal ureters also visualized if reflux is present
97
5 evaluation criteria for lateral right or left cystogram
Superimposed hips and femur
Evidence of proper collimation
Regions of the distal end of the ureters, bladder and proximal portion of the urethra
Pubic bones projected below the bladder neck and proximal urethra
Exposure technique clearly showing contrast in bladder, distal ureters and proximal urethra
98
May be performed via endoscopic exam
Essential projection = AP oblique RPO or LPO; demonstrates bladder neck and urethra with as little bony superimposition as possible
Patient position: recumbent 35-40 degree posterior oblique
IR centered to superior border of pubic symphysis
Elevated pubis centered to midline
Image should demonstrate superimposed pubic and ischial rami of down side and body of elevated pubis anterior to bladder neck, proximal urethra and prostate
Male cystourethrography
99
AP
Fill bladder and void
Demonstrates bladders and urethra
Female cystourethrography
