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urinary pathology > Urinary Pathology Week 10 > Flashcards

Urinary Pathology Week 10 Flashcards

1
Q

Obstructive Nephropathy

A 
Ureteral necrosis
Abscess
Lymphocele
Fungus ball
Retroperitoneal fibrosis
Stricture at the ureterovesical junction
Ureteral calculus
Hemorrhage into the collecting system with obstruction from clots
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2
Q

Renovascular impedance specificity

A

If high renovascular impedance develops immediately after surgery, patency of the renal vein must be tested.
With the use of color and pulsed Doppler imaging, renal thrombosis displays distinctive spectral pattern with a plateaulike reversal of diastolic flow (accentuated at end diastole).
Renal artery stenosis (RAS) exhibits a high-velocity jet with distal turbulence.

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3
Q

Hydronephroisis

A

Grading system

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4
Q

Grade 1 hydronephrosis

A

Small, fluid-filled separation of the renal pelvis

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5
Q

Grade 2 hydronephrosis

A

Dilation of some but not all calyces; renal sinus orientation still concave

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6
Q

Grade 3 hydronephrosis

A

Complete pelvocaliectasis; calyx presentation is changed in convex.

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7
Q

Grade 4 hydronephrosis

A

: Prominent dilation of collecting system; thinning of renal parenchyma; no differentiation between the collecting system and renal parenchyma

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8
Q

With severe hydronephrosis

A

Parenchyma differentiaon is not seen

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9
Q

While scanning hdronephrosis

A

Post void residual and recheck the kidneys

May have effect on collecting system

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10
Q

Acquired causes of hydronephrosis

A 
Bladder tumors
Carcinoma of the cervix
Calculi
Neurogenic bladder
Normal pregnancy
Pelvic mass
Prostatic enlargement
Retroperitoneal fibrosis
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11
Q

Obstruction is not

A

Synonymous with dilation

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12
Q

Intrinsic causes

A 
Calculus
Stricture (Ureter)
Inflammation
Pyelonephritis
Congenital
Bladder neck obstruction
Posterior urethral valves
Ureterocele
Ureteropelvic junction (UPJ) obstruction
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13
Q

Obstructive findings

A

Renal insufficiency
Decreased urine output
Hypertension

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14
Q

Obstructive hydronephrosis sono findings

A

Fluid filled renal collecting system
thin parenchyma
hydroureter
decreased or absent ureteral jets

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15
Q

twinkle can help to

A

Locate stones

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16
Q

Milly distended collecting system

A

Overhydration

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17
Q

nonobstructive hydronephrosis

A 
Reflux
Infection 
Large extra renal pelvis 
High floww tstate 
distended bladder
Atrophy after obstruction 
Pregnancy dilation
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18
Q

Pregnancy

A

Uterus can compress urters, third trimester, more common on right side

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19
Q

False positive Hydronephrosis

A 
Arteriovenous malformation
Congenital megacalyces
Extrarenal pelvis
Papillary necrosis
Parapelvic cysts
Persistent diuresis
Reflux
Renal artery aneurysm
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20
Q

Localized hydronephrosis

A

Duplex
strictures
In females, may insert lower which can cause dribbling

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21
Q

False negative hydronephrosis

A 
Retroperitoneal fibrosis or necrosis
Distal calculi “newly” lodged
Staghorn calculus
PCKD and multicystic KD
Parapelvic cysts
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22
Q

Staghorn

A

Fills the collecting system

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23
Q

Pyonephrosis

A

Pus within the collecting system

Severe urosepsis

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24
Q

Pyonephrosis is

A

A true urologic emergency that requires IV antibiotics

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25
Q

When does pyonephrosis occur

A

Long-standing ureteral obstruction from calculus disease, stircture or congenital anomaly

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26
Q

Most renal infections

A

Stay in the kidneys

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27
Q

Perirenal abscess

A

Direct extension

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28
Q

Sono findings of pyonephritis

A

Low level echoes with a fluid debris level

May find an anechoic dilated

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29
Q

Pyonephrosis Clinical

A

Renal insufficiency

Hematuria

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30
Q

Emphysemtous pyelonephritis

A

Occurs when air is in the parenchyma
May be caused by E-Coli
Dirty shadowing

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31
Q

Emphysematous is unilateral/bilateral

A

Unilateral

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32
Q

Sono findindings of emphysematous pyeloniptitus

A

Enlarged kidneys are hypoechoic and inflamed
Avascular
Area in the kidney that does not perfuse like the rest

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33
Q

Xanthogranulomatous Pyelonephritis

A

Uncommon renal disease associated with chronic obstruction and infection
Involves the destruction of renal parenchyma and the infiltration of lipid-laden histiocytes
Presenting symptoms include a large, nonfunctioning kidney, staghorn calculus, and multiple infections.
More common in females

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34
Q

Xanthogranulomatous Pyelonephritis clincial findings

A

Multiple infections
Nonfunctioning kidneys
`

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35
Q

Xanthogranulomatous Pyelonephritis sono appearance

A

“Staghorn appearance” which can cause echogenicity
Destruction of renal parenchyma ↑ (Cystic spaces)
Echogenicity ↑
Renal size is increased
Dilated calyces
Disease may be diffuse or segmental

36
Q

Renal calcifications Localized parenchymal

A

scar tissue by bacterial infection, abscess, infected hematoma, urinoma, lymphocele, TB, infarction, post-percutaneous procedures
Seen in cystic and solid masses
Seen in vascular components

37
Q

Renal calcifications intraluminal calcifcations

A

Renal calculi

Milk of calcium Diveticulum

38
Q

Benign renal masses

A

May calcify

39
Q

Nephrocalcinosis

A

Parenchymal calcification occurs
Affects both kidneys
Diffuse foci calcium deposits are usually located in the medulla; may be seen in the renal cortex.

40
Q

Cortical nephrocalcinosis

A

most commonly seen with chronic glomerulonephritis, chronic hypercalemic states, sickle cell disease, and rejected renal transplants.

41
Q

MSK

A

Anatomic, causes stasis and stone formation, shadowing within them
Anatomic, not metabolic (Therefore may be unilateral or segmental)

42
Q

Nephrocalinosis calcification may be

A

dystrophic from devitalized tissues, ischemia and/or necrosis, or from hypercalemic states, hyperparathyroidism, renal tubular acidosis, and renal failure.

43
Q

sonographic findings nephrocalcinosis

A

Cortical nephrocalcinosis appears as increased cortical echogenicity with spared pyramids.
Medullary nephrocalcinosis pyramids become more echogenic than the adjacent cortex.

44
Q

Cortical nephrocalcinosis appearance

A

appears as increased cortical echogenicity with spared pyramids.

45
Q

Medullary nephrocalcinosis appearance

A

pyramids become more echogenic than the adjacent cortex.

46
Q

Urolithiasis

A

stone in urinary system

Majority of stones formed in the kidney and course down the urinary tract

47
Q

Stones

A

Made up of a comnination f chemical from urine

48
Q

Chemicals in kidney stones

A

Uric acid, calcium, systene, zanthene

49
Q

Kidney stone size

A

Most are small and can travel through the urinary system with increased hydration and without treatment.
Large stones that fill the renal collecting system, called staghorn calculi
Some kidney stones may obstruct the ureter in the constricted areas.

50
Q

Where do urolithasis

A

Can develop anywhere in urinary tract

51
Q

Kidney stones are more common in

A

Men

Ppl who have a hx of kidney stones

52
Q

When do kidney stones form

A

Excessive amounts of solutes in filtrate
Insufficient fluid intake – major factor for calculi formation
Urinary tract infection

53
Q

Stones are associated with

A

Acidosis

54
Q

Stones clinically

A

Extreme pain, cramping on side (flank pain), may be lower in the plevis

55
Q

Manifestations only occur with obstruction of urine flow

A

May lead to infection
Hydronephrosis with dilation of calyces
If located in kidney or ureter and atrophy

56
Q

Tx of stones

A

Lithotripsy (breaks apart stone)
Pertucutanous nephrlithotomy
Scope removal of stone (Mid or lower urinary tract stones)

57
Q

Early treatment of stones

A

Can reverse the damage done by stones

58
Q

Sono findings of kidney stone

A

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.

59
Q

Blockage for long time

A

Thinning of parenchyma

60
Q

When looking for urolithasis

A

Turn off compound imaging to optimize posterior acoustic shadowing

61
Q

Colour and power doppler

A

Can cause twinkling artifact

Rapidly changing mix of colours behind the stone

62
Q

Urinary bladder

A

US is not the imaging modality of choice

Cystoscopy

63
Q

TA sonography

A

Bladder lesions greater than 5mm

64
Q

Bladder normal

A

should be smooth and uniform
3-6mm
evaluate residual volume

65
Q

Normal post void residual bladder

A

<20ml

66
Q

Bladder diverticulum

A

Hernination/outpouching of the bladder wall
My be single or multiple
Can be acquired or congenital

67
Q

Acquired

A

No muscle
Neck
From increased pressure
Diverticulum lacks a muscular layer and is narrow
Associated with calculi, chronic bladder outlet or neurogenic bladder

68
Q

Congenital bladder diveriulum

A

Rare
Posterior angle of bladder trigone
All components of bladder wall

69
Q

When patients empty bladder

A

Diverticulum may or may not empty post void

70
Q

Sono finding

A

Fluid filled sac with neck, can still be filled after void, may lead to stone formation due to stasis of the bladder

71
Q

Uterocele

A

Cyst like enlargemet of distal end of ureter
Usually small and aysmptomatic but may cause obstruction or bladder outlet
More often in adults
May be bilateral or unilateral

72
Q

Uterocele

A

Cobra head appearance

May change in size with urine

73
Q

Candle stick

A

Continuous ureteral jet

74
Q

Uterocele may mimic

A

diverticula

75
Q

Ectopic uterocele

A

More common in females
Extravesical (ectopic)
May be associated with hydronephrosis
Round, thin walled cystic strcuture, may cause debris protuding into bladder

76
Q

Inflammation of the bladder

A

Cystitis is usually secondary other to satistis

Cause by a number of different causes

Sonon: early: wall may appear to be normal, as duration increases, smooth bladder wall becomes diffuse or nonfiffuse with hypoechoic thickening
As progresses: fibrosis, will get more echogenic bladder

77
Q

Bladder tumors

A

Mostly transitional cell carcinomas

Usually not dteetced until large

78
Q

Bladder tumors clinical findings

A

Patients typically have gross hematuria, dysuria, urinary frequency, or urinary urgency.

79
Q

bladder mass may be

A

Secondary

Prostate, ovarian, rectum,

80
Q

Bladder tumors sonographic findings

A

Appearance of bladder masses vary.
Commonly appear as a focal bladder wall thickness
Intravesical lesions are as small as 3 to 4 mm.
Sonography unable to detect a perivesical extension and pelvic wall involvement.
Transrectal approach can be used to detect intravesicular involvement.

81
Q

Most bladder tumors

A

Most bladder tumors are malignant and commonly arise from transitional epithelium of the bladder.
Often develops as multiple tumors
Diagnosed by urine cytology and biopsy

82
Q

Bladder tumor is

A

invasive through wall to adjacent structures.

Metastasizes to pelvic lymph nodes, liver, and bone

83
Q

Benign bladder tumors

A

Hypoechoic comapred to malignant bladder tumors but may have echogenciity as maliganancy

84
Q

All primary bladder tumors

A

tumors have the same sonographic appearance: an irregular echogenic mass that projects into the lumen of the bladder.
Any bladder mass may cause outflow obstruction; the kidneys should be evaluated for hydronephrosis.

85
Q

Primary bladder tumors

A

squamous cell carcinoma, adenocarcinoma, and rhabdomyosarcoma in children.

86
Q

If something is found in bladder

A

Scan the kidneys

urinary pathology (2 decks)

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