Urinary Info Flashcards
what is the urinary system known as?
Excretory system
What is included in the urinary system?
- Two kidneys
- Two ureters
- Bladder
- Urethra
Whats the primary function of the urinary system?
The production of urine and its elimination from the body
What shape are the kidneys?
Bean shaped
What are the kidneys divided into?
Upper & lower poles
What is the lateral border of the kidney?
Convex
What is the medial border of the kidney?
Concave
The kidneys have a slightly _____ anterior and posterior surfaces
Convex
The left kidney is _______ than the right kidney
slightly longer and narrower
The kidney is ______ long, _____ wide, and ____ thick
- 4 1/2”
- 2-3”
- 1 1/4”
The right kidney is _____ than the left kidney
lower
why is the right kidney lower than the left?
Due to the presence of the liver
What does retro mean?
backwards
Where are retroperitoneal structures located?
Behind the peritoneum
What structures are the kidneys?
retroperitoneal
What plane do the kidneys lie in?
Oblique
How many degrees is the kidneys located?
30 degrees anteriorly toward the aorta
What views do we perform when imaging the kidneys?
30 degree oblique views
Where do the kidney lie in sthenic patients?
Level of superior border of T12 to the level of transverse processes of L3
Where do the kidneys lie in hypersthenic patients?
Higher than the Level of superior border of T12 to the level of transverse processes of L3
Where do the kidneys lie in asthenic patients?
Lower than the level of superior border of T12 to the level of transverse processes of L3
What body habitus do patients have when their kidneys lie lower?
Asthenic
What body habitus do patients have when their kidneys lie higher?
Hypersthenic
What is the renal capsule?
Semitransparent outer covering of the kidney
What is the adipose capsule?
Mass of fatty tissue that the kidney is embedded in
What is the renal fascia?
Sheath of superficial fascia that envelops the capsule and kidney
What is the renal fascia attached to?
- Diaphragm
- Lumbar vertebrae
- Other adjacent structures
What part of the kidney is attached to the diaphragm, lumbar vertebrae, and other adjacent structures?
Renal fascia
What position are the kidneys supported in?
fairly fixed
How much do the kidneys move during respiratory movement?
1”
The kidneys move 1” during what type of movement?
Respiratory
How many inches do the kidneys drop when changing from supine to upright position?
2”
Why do the kidneys drop 2”?
When changing positions from supine to upright
What part of the kidney is the semitransparent outer covering of the kidney?
Renal capsule
What part of the kidney is a mass of fatty tissue that the kidney is embedded in?
Adipose capsule
What part of the kidney is the sheath of superficial that envelops the capsule and kidney?
Renal fascia
What is the hilum of the kidney?
Longitudinal slit (fissure) in the medial border of the kidney
What is the longitudinal slit (fissure) in the medial border of the kidney called?
Hilum
What is transmitted through the kidneys hilum?
- Blood vessels
- Lymphatic vessels
- Nerves
- Ureter
What does the hilum form when it expands into the body?
The renal sinus
How is the renal sinus formed?
When the hilum expands into the body
What is the renal sinus?
Fat-filled space surrounding the renal pelvis and vessels
What is the fat-filled space surrounding the renal pelvis and vessel called?
Renal sinus
What is the renal cortex?
The outer portion of the kidney
What is the outer portion of the kidney called?
Renal cortex
What is the renal medulla composed of?
8-15 conical masses (renal pyramids)
Where does the renal medulla lie under?
The renal cortex
What part of the kidney lies under the renal cortex?
Renal medulla
What part of the kidneys does the renal pyramids compose?
Renal medulla
What do the renal columns extend to?
The renal sinus
How are the renal columns formed?
When the cortex periodically dips between the renal pyramids
What part of the kidney extends to the renal sinus?
Renal columns
What part of the kidney is formed by the cortex periodically dips between the renal pyramids?
Renal columns
What are the renal pyramids?
A collection of tubules that converge at an opening at the renal papilla and drains into the minor calyx
What part of the kidney is A collection of tubules that converge at an opening at the renal papilla and drains into the minor calyx?
Renal pyramids
What part of the kidney drains into the minor calyx?
Renal pyramid
What does the renal pyramid drain into?
Minor calyx
What are calyces?
Cup-shaped stems arising from the sides of the renal papilla
What are the Cup-shaped stems arising from the sides of the renal papilla called?
Calyces
How many minor calyces unite to form 2-3 major calyces?
4-13
4-13 minor calyces can form _____ major calyces
2-3
What part of the kidneys unites to form the renal pelvis?
Major calyces
What do major calyces unite to form?
The renal pelvis
What is the ureteropelvic junction?
The area where the renal pelvis transitions to the ureter
What is the area where the renal pelvis transitions to the ureter called?
Ureteropelvic junction
What is a nephron?
The structural and function unit of the kidney
What is the structural and function unit of the kidney called?
Nephron
How many nephrons does the kidney contain?
1 million
What is the nephron composed of?
A renal corpuscle and a renal tubule
What part of the kidney is composed of a renal corpuscle and a renal tubule?
Nephron
How long are the ureters of a kidney?
10-12” long
What is the diameter of the kidney ureters?
1 mm-1 cm
What are the ureters 3 constricted points?
- Ureteropelvic junction (UPJ)
- Near the pelvic brim
- Ureterovesical junction (UVJ)
What is the ureterovesical junction?
Where the ureter joins the bladder
What is the part of the ureter where the ureter joins the bladder called?
Ureterovesical junction (UVJ)
Where do the ureter enter the bladder?
At the level of the ischial spine
The ureters descend behind the ______ and in front of the _______
- Peritoneum
- Psoas muscles
How do the ureters convey the urine from the renal pelvis to the bladder?
Using slow, rhythmic peristaltic contractions?
What is the urinary bladder?
A musculomembranous sac that serves as a resevoir for urine
What is the musculomembranous sac that serves as a resevoir for urine called?
Urinary bladder
What is the neck of the urinary bladder?
The most fixed part of the bladder
What is the most fixed part of the bladder called?
The neck
What is the apex of the urinary bladder?
The anterosuperior aspect adjacent to the superior aspect of the pubic symphysis
What is the anterosuperior aspect adjacent to the superior aspect of the pubic symphysis of the bladder called?
The apex
Where is the urinary bladder situated in males?
Posterior and superior to the pubic symphysis and anterior to the rectum
Where is the urinary bladder situated in females?
Posterior and superior to the pubic symphysis and anterior to the vaginal canal
What does the urinary bladder vary depending on content?
- Size
- Shape
- Position
How much fluid can the adult bladder hold when full?
500 mL
How much fluid is in the adult bladder when the urge for urination occurs?
250 mL
The urinary bladder is _____ and is held in position by the _______
- Freely moveable
- Folds of the peritoneum
Where is the bladder located when its empty?
The pelvic cavity
What happens when the bladder is full?
Expands superiorly into the abdominal cavity
Ureters enter the bladder on the ______ wall at the _______ margins of the _____ part of the _____
- Posterior
- Lateral
- Superior
- Base
How far apart are the openings of the ureterovesical junction when the bladder is empty?
1” apart
How far apart are the openings of the ureterovesical junction when the bladder is distended?
2” apart
What is the internal urethral orfice?
The opening situated at the neck of the bladder which give rise to the urethra
What is the opening situated at the neck of the bladder which give rise to the urethra called?
Internal urethral orfice
What is the trigone?
The triangular area between the three orifices of the bladder
What is the triangular area between the three orifices of the bladder called?
Trigone
Muscle remains _______ over the trigone, while the remainder of the bladder contains _____, called _____, when its _____
- Smooth
- Folds
- Rugae
- Empty
What is the urethra?
Narrow, musculomembranous tube that conveys urine out of the body
What is the narrow, musculomembranous tube that conveys urine out of the body called?
Urethra
Where does the urethra arise?
At the internal urethral orifice in the bladder
How many inches do female urethras extend?
1 1/2”
How many inches do male urethras extend?
7-8”
What does the urethra pass along in females
The anterior wall of the vagina to the external urethral orifice
How many parts is the male urethra divided into?
3
What parts is the male urethra divided into?
- Prostatic portion
- Membranous portion
- Spongy portion
What does the spongy portion extend to in males?
From the pelvic floor to the external urethral orifice
How long is the membranous portion in males?
1/2” long
How long is the prostatic portion in males?
1” long
What is the prostatic portion surrounded by in males?
The prostate gland
What is a urogram?
A general term to classify the radiographic imaging of the renal drainage or collecting system
What is the general term to classify the radiographic imaging of the renal drainage or collecting system?
Urogram
What is a urogram divided into?
Antegrade filling techniques and retrograde filling techniques
What is antegrade filling of the kidneys?
When contrast media enters the kidneys in the normal direction of blood flow
How is antegrade filling administered?
Intravenously through a superficial vein in the arm
What is the technique for antegrade filling called?
Excretory or intravenous urography (IVU)
What filling technique is excretory or intravenous urography (IVU) for?
Antegrade
What is intravenous urography?
A study of all parts of the urinary system
What is the study of all parts of the urinary system called?
Intravenous urography (IVU)
What is another term for intravenous urography (IVU)?
Intravenous pyelogram (IVP)
what is intravenous pyelogram (IVP) another term for?
Intravenous urography (IVU)
What is an intravenous pyelogram (IVP)?
The study of the renal pelvis and calyces (Pyelogram)
What is the study of the renal pelvis and calyces (Pyelogram) called?
Intravenous pyelogram
What is retrograde filling?
Contrast media thats introduced against normal flow
How is retrograde filling administered?
Urethral catherization
What is the technique for retrograde filling called?
Retrograde urography
What is cystography?
examination of the bladder
What is the examination of the bladder called?
Cystography
What is cystoureterography?
Exam of the bladder and the low ureters
What is the exam of the bladder and the low ureters called?
Cystoureterography
What is cystourethrography?
Exam of the bladder and urethra
What is the exam of the bladder and urethra called?
Cystourethrography
What is a voiding cystourethrogram (VCUG)?
The act of voiding the bladder is observed
What is the act of voiding the bladder is observed called?
Voiding cystourethrogram
How is the contrast for a VCUG administered?
Retrograde flow through urethral catheter, followed by withdrawal of catheter for imaging during voiding
What is the purpose for a VCUG?
- Study of the urethra
- Evaluates patients ability to urinate
- Indicate trauma & incontinence
- Function study
What is the purpose for a retrograde cystography?
- Evaluates for trauma, calculi, tumor, and inflammatory disease of the urinary bladder
- Non-function study
What is the purpose for a IVU?
- Visualize the collecting portion of the urinary system
- Assess function ability of kidneys
- Evaluates the urinary system for pathology or anatomic anomalies
-Function study
What kind of contrast is used when doing a urinary study?
Iodinated intravenous contrast
What kind of contrast is preferred when doing a urinary study?
Non-ionic
How is the contrast introduced when doing a urinary study?
Using a bolus injection
How much contrast is injected into the venous system? Why?
- The entire dose is injected all at once
- This provides maximum enhancement
What does the rate of the bolus injection depend on?
- Gauge of needle or connecting tube
- Amount of contrast media injected
- Viscosity of contrast media
- Stability of vein
- Force applied by the individual performing the injection
What are the characteristic reactions when introducing contrast media in urinary studies?
- Feeling of warmth
- Flushing
- Hives (sometimes)
How severe are can the reactions be when introducing contrast in urinary studies?
- Mild and short duration
- Severe reaction can occur but are rare
What are the occasional reactions when introducing contrast media in urinary studies?
- Nausea
- Vomiting
- Edema or respiratory mucous membranes
What should you do before and after administering contrast during a urinary study?
- Check clinical history
- Observe patient closely after contrast administration
- Emergency equipment and medication must be readily available
What should the patient do to prep for a retrograde urography exam?
Drink 4-5 cups of water several hours before the exam
What does a clear demonstration of the urinary system require?
The intestinal tract to be free of gas and fecal material
At what age is bowel preparation not attempted?
Infants & children
What does adult preparation depend on?
Patient condition
What should adult patients do to prep for a urinary exam?
- 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 the examination
- NPO after midnight the day of the examination
What may be given to help prep the patient for a urinary exam?
Cleansing enema
What should the patient do just before the start of the exam?
Void the bladder
What could happen if the patients bladder is full for a urinary exam?
The bladder could rupture
What could happen if urine is present in the bladder during a urinary exam?
The urine could dilute the contrast that may accumulate there
Where is compression applied over for a urinary exam?
The distal ends of the ureters
What is the purpose of ureteral compression?
Slow down the flow of opacified urine into the bladder to ensure filling of the renal pelvis and calyces
Where is ureteral compression centered over?
Level of the anterior superior iliac spine (ASIS)
What is another alternative to ureteral compression?
Place patient in trendelenburg position 15 degrees
What do you do to the compressor when removing it and why?
Apply and remove slowly to reduce patient discomfort caused by changes in intrambdominal pressure
What are some contraindications for patients when doing ureteral compression?
- Urinary stones
- Abdominal mass
- Aortic aneurysm
- Colostomy
- Suprapubic catheter
- Traumatic injury
- Recent abdominal surgery
- Severe abdominal pain
What is the protocol for an IVU?
- Take clinical history
- Scout radiograph (KUB) is performed
- Injection of contrast media is performed
- Basic imaging routine is performed
What is the basic imaging routine for IVU protocol?
- 1 minute nephogram or mephrotomogram
- 5 minute AP supine
- 10-15 minute AP supine
- 10-15 minute RPO/LPO
- 20 minute AP supine (KUB or bladder shot)
- Post void (Supine, prone, or upright)
What do you need to note for an IVU protocol?
- The start time of the injection
- The type and mount of contrast injected
What is the difference between a nephrogram and nephrotomogram?
- Nephrotomogram is performed using a tomographic machine
- A nephrogram is not performed using a tomographic machine
When is the nephrogram/nephrotomogram taken?
In the nephron (nephrotic) phase
What is the purpose for doing a nephrogram/nephrotomogram?
To visualize the renal parenchyma (nephrons and collecting tubes)
Where should the centering be for anephrogram/nephrotomogram exam?
Halfway between the iliac crest and xiphoid process
What is the area of interest for a nephrogram/nephrotomogram exam?
The kidneys
What is the purpose for a retrograde urography study?
To evaluate the collecting system in a patient with renal insufficiency or who are allergic to iodinated contrast media
Why is the incidence of reactions reduced in a retrograde urography study?
Because the contrast in not introduced into the circulatory system
What is a retrograde urography study classified as?
An operative procedure
Are patients put under anesthesia for retrograde urography studies?
Yes
What is a ureterocystoscope?
A cystoscope that helps with insertion of catheters into the vesicoureteral orifices
For a retrograde urography study the urologist performs _______ of the ureters through a _______
- Catheterization
- Ureterocystoscope
What happens when the urologist passes a ureteral catheter into the ureters?
The scope is withdrawn and the catheters stay in place
What kind of contrast is injected for retrograde urography?
Iodinated contrast
How many mL of contrast does it take to fill the renal pelvis?
3-5 mL but may require more if the structures are dilated
Where is the CR for retrograde urography?
The level of the iliac crests or sometime slightly higher
What happens to the catheters when the retrograde urography exam is completed?
Catheters are fully removed
Where is the head of the table located for an AP pyelogram?
Lowered 10-15 degrees
Where is the head of the table located for an AP ureterogram?
Elevated 35-40 degrees
Why is the head of the table elevated 35-40 degrees for an AP ureterogram?
To show tortuosity of the ureters and the mobility of the kidneys
Why is the head of the table lowered 10-15 degrees for an AP pyelogram?
To prevent contrast from escaping the ureters
For a retrograde urography study, where are the catheters withdrawn to? Where is contrast injected?
- The lower ends of the ureters
- Into the canals
What is the purpose for a retrograde cystography exam?
Evaluate the urinary bladder
What kind of catheter is placed for a retrograde cystography exam?
Foley catheter
When is the preliminary image taken for a retrograde cystography?
When the foley catheter is placed
What does the physician do after the preliminary images are taken for the retrograde cystography?
Removes the bladder clamp and drains the bladder
What happens after the bladder is drained for a retrograde cystography?
Contrast is introduced into the catheter and the physician clamps the catheter to keep the contrast from escaping
Are voiding images taken for a retrograde cystography?
Yes
What is the purpose for a cystourethrography?
To examine the bladder and urethra
Why does the cystoscope do for a cystourethorgraphy?
To inspect the bladder and introduce a catheter
What happens after endoscopic inspection during a cystourethrography?
The bladder is drained and contrast is injected and then AP voiding images are taken
What degree is the patient rotated fro RPO/LPO cystourethrography voiding images?
35-45 degrees
When are the AP voiding images taken for a cystourethography?
While the contrast is injected
What is the CR for cystourethrography AP voiding images?
Perpendicular to MSP, entering at the level of the upper border of the pubic symphysis
What degree are females angled for an AP void cystourethrography image?
5 degrees caudal
