URINARY PATHOLOGY Flashcards
tuberous sclerosis looks like adult polycystic kidney disease
(ADPKD) adult polycystic kidney disease
In cases of_______, calcium deposits are usually located in the medulla
nephrocalcinosis
pyelonephritis or chronic renal disease appearance
the kidneys appear diffusely enlarged with a loss of normal anatomy.
____ ___ ___may demonstrate renal vein thrombosis or tumor extension into the renal vein
Renal cell carcinoma
_____ is in urine when major damage or destruction of (RBC) erythrocytes occurs. This condition injures the kidney and can cause acute renal failure
Hemoglobin
_____ can invade the renal vein and IVC w/ tumor or thrombosis
Renal cell carcinoma
_____ occurs when pus is in obstructed renal system
Pyonephrosis
Autosomal dominant polycystic kidney characteristics:
1 latent until the fourth or fifth decade of life. 2 The severity varies, depending on the genotype. 3 may have cysts in the liver, pancreas, and spleen. 4 kidneys are small and extremely echogenic.
most common renal ectopia:
The pelvic kidney (sacral kidney), (looks like pelvic tumor)
true or false? An extrarenal pelvis appears as a central cystic region that may extend beyond the confines of the renal sinus.
true
____ ___ are one of the most common kidney problems that can occur, may cause obstruction that is very painful
kidney stones (nephrolithiasia)
stones that are large and fill the collecting system are called:
staghorn calculi
urolithiasis
calculous of urinary system
nephrolithiasis
calc of the kidney
Most ___ are formed in kidney, course down urinary tract and are made of chemicals that precipitate out of urine
kidney stones -urolithiasis
true or false? Most urolithiasis are small and can travel through the urinary system with increased hydration and without treatment, but some may obstruct the ureter in the constricted areas
true
sonographic findings urolithiasis:
- Very echogenic foci with posterior acoustic shadowing
- Scanning is done along the lines of the renal fat; stones less than 3 mm may not shadow.
- Prominent renal sinus fat, mesenteric fat, and bowel have high attenuation; they may appear as an indistinct echogenic focus with questionable posterior acoustic shadowing, making it difficult to differentiate from stones
describe what you see:
a midpole echogenic foci w/ posterior shadowing
(clean shadowing from a midpole right kidney stone (nephrolithiasis)
describe what you see:
a midpole echogenic foci w/ posterior shadowing
(clean shadowing from a midpole right kidney stone (nephrolithiasis)
Majority (95%) of bladder tumors in adults are ______.
Usually not detected until they have become advanced
Patients typically have gross hematuria, dysuria, urinary frequency, or urinary urgency.
TCC Transisitional cell carcinoma
Sonographic findings of bladder tumors (masses):
- Appearance varies
- Commonly appear as a focal bladder wall thickness
- Intravesical lesions are as small as 3 to 4 mm.
- US can NOT see a perivesical extension and pelvic wall involvement.
- Transrectal approach to detect intravesicular involvement.
_____ tumors are typically hypoechoic compared with malignant bladder tumors but may have the same echogenicity.
benign
true or false?
Any bladder mass may cause outflow obstruction; the kidneys should be evaluated for hydronephrosis.
true
____bladder tumors include squamous cell carcinoma, adenocarcinoma, and rhabdomyosarcoma in children.
This just depends on what cells turn cancerous
primary
bladder tumor
carcinoma of the urinary bladder with blood flow seen within the mass
normal renal blood flow
Low resistance
Flow to vital organs
Low resistance
Flow to vital organs
All _____bladder tumors have the same sonographic appearance: an irregular echogenic mass that projects into the lumen of the bladder.
primary
normal intrarenal vessels with vascular flow throughout the renal cortex
normal arcuate arteries
a rapid systolic rise w/ RI of 0.56. gradual decrease into dystole.
diagram of normal renal artery spectral waveform with early systolic peak (ESP) and rapd systolic upstroke followed by peak systole (PS) and gradual decrease into diastole
abnormal renal artery spectral waveform w/ absence of early systolic peak and a long systolic upstroke
The most common correctable cause of hypertension.
(RAS) renal artey stenosis
Most common causes of the renal artery stenosis:
atherosclerosis and fibromuscular dysplasia
sonographic characteristics RAS (renal artery stenosis)
Overall waveform shape: “tardus” and “parvus” waveform
Resistive index: RI = (S-D) ≥ 0.70 S
what occurs when part of the tissue undergoes necrosis after the cessation of the blood supply (usually arterial occlusion), and renal function is usually normal
renal infarction
renal infarction may result from:
- thrombus
- tumor infiltration
- obstruction
- or be iatrogenic
renal infarction sonographic findings:
- irregular areas, somewhat triangular in shape, and along the periphery of the renal border.
- Irregular area may be more echogenic than renal parenchyma.
- Renal contour “lumpy-bumpy.”
renal failure:
- failure of the kidneys to remove metabolites from blood.
- can be acute or chronic
- chronic- long term disease, shrunken kidney w/ increased echogenicity
end stage renal disease
may not even be able to id kidneys because they blend in w/ sinus fat and are so shrunken
Arteriovenous Fistula
and Pseudoaneurysm
bladder imaging:
- U.S. not modality of choice, masses of approx. 5 mm. can be seen
- Bladder should always be examined with upper urinary system
- Bladder must be distended to examine walls for tumors, diverticulum, thickening
- Cystoscopy diagnoses early neoplasms
bladder imaging:
Cystoscopy is usually used to examine the bladder because it can diagnose early neoplasms.
Transabdominal sonography will allow visualization of most lesions greater than 5 mm.
Transurethral intravesicular sonographic approach has been used to evaluate bladder tumors.
bladder US technique:
- Bladder is distended.
- Right or left lateral decubitus position is recommended.
- TGC is adjusted to reduce anterior wall artifacts.
- Bladder wall should be smooth and measure 3 to 6 mm.
- Look for asymmetry in the walls.
- Evaluate residual volume.
- Ureteral jets
Ureters: Congenital Anomalies: stricture
- Ureteral narrowing a result of fibrosis is a common form of ureteral stricture.
- Ureteral narrowing a result of fibrosis is a common form of ureteral stricture.
- Ureteral strictures may also result from inflammatory disease, tuberculosis, localized periureteral fibrosis, impacted ureteral stone, schistostomiasis, iatrogenic ureteral injury, or radiation therapy.
- Other causes include amyloidosis, adjacent malignancies, metastases, extrinsic compression caused by primary retroperitoneal tumors, enlarged lymph nodes, and medial lower pole renal masses.
sonographic evaluation of transplant (allograft)
Sonographic evaluation:
- Renal size
- hydronephrosis
- perirenal fluid collections
- Hematomas
- Urinomas
- Lymphoceles
- Adequate perfusion: Doppler RI > .7 may indicate rejection
double ureter jet
single ureteral jet
what pathology is shown?
where is this bladder calc located?
nephrolithiasis
calc at base of bladder - ureterovesicle junction
ureter dialates all the way up to the bladder
Ureters: Congenital Anomalies: ureterocele
- Cystlike enlargement of the lower end of the ureter
- Caused by congenital or acquired stenosis of the distal end of the ureter
- Cystlike enlargement of the lower end of the ureter
- Caused by congenital or acquired stenosis of the distal end of the ureter
- Ectopic ureteroceles are rare; are usually associated with complete ureteral duplication.
***ureterocele***
true or false?
the most sensitive and specific way to evaluate the presence of stones is the intravenous urogram and the helical CT scan
true
bladder diverticula
2 bladder diverticula; one on each side of the bladder
T or F? flank pain caused by urolithiasis is a common prob. in pt. coming to ER
true
what do you see?
2 stones causing hydronephrosis
2 echogenic foci wth posterior shadowing
