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Abdominal Exam 3 > Urinary System > Flashcards

Urinary System Flashcards

1
Q

Organs of the urinary system

A

kidneys (renals), ureters, bladder

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2
Q

Renal function

A
  • produces urine & erythropoietin
  • detoxifies blood
  • regulates serum electrolytes
  • regulates acid-base balance
  • fluid regulation
    -endocrine function
  • balances calcium levels
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3
Q

What should not be in urine?

A
  • blood (signifies leak in vessel)
  • protein (sign of kidney damage)
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4
Q

What does erythropoietin do?

A
  • part of endocrine system (hormones)
  • regulates the amount of RBC’s
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5
Q

What structures in the body make RBC’s?

A

bone marrow & spleen

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6
Q

How is blood detoxified in the renals?

A
  • kidneys send blood through tubes to balance blood contents
  • BP issues if not working properly
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7
Q

What happens if calcium levels are not balanced?

A

thyroid, kidney, or gut issues (calcium is absorbed in the gut)

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8
Q

Are kindney stones similar to gallstones?

A

yes

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9
Q

Kidney size

A

9-12 cm in length (up to 14 cm)

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10
Q

Kidney shape

A

oblong & less wide, bows out

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11
Q

Kidney location

A
  • paired structures located in the flank area
  • posterior, superior retroperitoneum (within this space)
  • lateral to spine
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12
Q

Kidney borders

A

convexx lateral border & concave medial border

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13
Q

Where is the hilum?

A

concave medial border

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14
Q

What enters and exits at the hilum?

A

artery enters, vein and ureter exits

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15
Q

Renal position

A
  • superior pole is tipped posteriorly & medially
  • superior kidney is more towards spine in coronal
  • superior kidney is pointed more posterior in sagittal
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16
Q

Scanning the kidneys

A
  • tilt diagonally
  • usually intercostal
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17
Q

Appearance of the 2 regions of parenchyma

A
  • outer = hypoechoic
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18
Q

Renal cortex

A
  • outermost functioning unit
  • doesn’t completely make circle around medial border
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19
Q

Renal medulla

A

middle functioning unit

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20
Q

Renal sinus

A
  • inner = echogenic
  • urine collecting system
  • blood vessels coming in & out of liver
  • fat
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21
Q

What does fat in the renals do?

A
  • makes sinus echogenic
  • within hilum & used as a cushion so collecting system can expand under pressure w/o immediate pain
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22
Q

How should you label kidneys in sagittal?

A

long Rt or long Lt

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23
Q

Renal cortex structures

A
  • covered by fibrous capsule
  • nephrons: glomerulus, tubules
  • capillary bed: juxtaglomerular apparatus
  • group: Bowman’s capsule
  • columns of Bertin
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24
Q

Renal cortex function

A
  • nephrons under capsule filter blood & produce urine
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25
Q

Where does filtration happen?

A

glomerulus & tubules of renal cortex

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26
Q

What occurs in the tubules of the renal cortex?

A

absorption & excretion

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27
Q

Capillary bed

A

capillaries = smallest piece that blood goes through (1 cell layer thick)

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28
Q

Juxtaglomerular apparatus

A
  • w/in capillary bed
  • BP regulation
  • balances fluid
  • tumor would make BP out of control
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29
Q

Bowman’s capsule

A

clusters the nephrons

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30
Q

Columns of Bertin

A
  • bands of cortex towards the sinus
  • btwn. the pyramids
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31
Q

Renal medulla structures

A
  • inner surface of parenchyma
  • medullary pyramids
  • apex to the center of kidney (papilla)
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32
Q

Inner surface of the parenchyma

A

loops of Henle

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33
Q

Medullary pyramids

A
  • multiple inverted conical structures separated by Columns of Bertin
  • where urine is deposited, can be anechoic
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34
Q

Medullary pyramid size

A
  • sometimes one column can be bigger
  • determine if it is a mass or just a big piece of cortex
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35
Q

Apex to the center of kidney (papilla)

A
  • urine collection & transport into calyceal system
  • papilla die = echogenic (can be a problem if prolonged)
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36
Q

What could be occurring if the medullary pyramids become echogenic?

A

papillary necrosis

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37
Q

Renal sinus structures

A
  • collecting (collecting) system: minor & major calyces
  • renal pelvis: hilum, vasculature, fat
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38
Q

Renal sinus functions

A
  • renal pelvis creates funnel to ureter
  • room for expansion
    responsible for echogenic appearance
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39
Q

How does fat in the renal pelvis appear on a scan?

A
  • calyces are not seen b/c fat compresses them
  • makes them echogenic
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40
Q

Gerota’s fascia

A
  • surrounds the capsule & perinephric fat around cortex
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41
Q

Is blood in the fascia normal or abnormal?

A

abnormal

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42
Q

Supporting structures of the kidney

A
  • fibrous renal capsule
  • perirenal/perinephric fat
  • gerota’s fascia
  • pararenal/paranephric fat
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43
Q

Which kidney is easier to visualize on a scan?

A

right kidney b/c outer cortex is hypoechoic to the echogenic renal sinus

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44
Q

Sonographic appearance of kidneys

A
  • surrounds renal sinus except at the hilum
  • medulla is identified easiest by anechoic pyramids
  • evenly spaced around echogenic renal sinus
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45
Q

What is the most important measurement of the kidney?

A

long axis measurement

46
Q

Long axis (Sagittal or Coronal) scan of kidney

A
  • take measurement
  • cortical thickness
  • lateral to medial sweep
47
Q

Difference between sagittal vs. coronal scan of kidney

A
  • you will not see the hilum in sagittal
  • you will see broken hilum in coronal
48
Q

What is often not found on newborn kidneys?

A

fat

49
Q

Transverse scan of kidney

A
  • poles (lobes) of the kidney: superior, mid-hilum, inferior
  • scan both superiorly & inferiorly
50
Q

Appearance of each pole of the kidney on a scan

A
  • superior: should not see sinus
  • mid-hilum: medial border of cortex should be broken
  • inferior: cortex all the way around
51
Q

Types of cortical thickness

A
  • normal
  • thinning
52
Q

Average adult kidney length

A

9-12cm

53
Q

Kidney size differences

A
  • if one kidney is 1.5 - 2cm smaller, could be kidney disease
  • acute = sudden, chronic = develops overtime
54
Q

Ureters

A
  • renal pelvis becomes single ureter (medial to hilum)
  • one on each kidney
  • 1 way valve so urine doesn’t flow back into the body from the bladder
55
Q

Where do the ureters cross?

A

comes from either side of the spine & crosses anterior to the iliac vessels

56
Q

What happens if the ureters do not cross correctly?

A

if they do not cross anteriorly, they can get compressed

57
Q

Where do the ureters enter?

A
  • enters the posterior/inferior area of bladder
  • looks like a bump/mound of tissue
58
Q

When would we see the ureters?

A

should not see ureters unless they are abnormal (dilated)

59
Q

Bladder function

A
  • storage tank in ML of pelvis
  • smooth muscle wall permits distention (like a water balloon)
60
Q

Bladder structures

A
  • smooth muscle wall (4 layers inner to outer)
  • detrusor muscle
  • apex
  • trigone area
  • urachal ligament
61
Q

4 layers of smooth muscle in the bladder

A
  • mucosa, submucosa, muscularis, serosa
62
Q

What could be occurring if one area of the bladder is thicker than another?

A

infection or tumor development

63
Q

What scan plane can you see the full bladder in?

A

sagittal (superior to inferior)

64
Q

Which direction does the bladder expand?

A

superiorly

65
Q

Trigone area of the bladder

A
  • internal/external sphincters
  • inferior/posterior
66
Q

Urachal ligament

A
  • ligament at the top of the bladder
  • where our bladder developed in utero
67
Q

Bladder appearance on a scan

A
  • anechoic contents w/ echogenic wall
  • ureteral jets identified at the trigone area
  • urethra not seen unless voiding
68
Q

What should we look for after seeing any hydronephrosis?

A
  • we need to see ureters draining into the bladder (ureteral jets)
  • looks like volcanoes
69
Q

Why do we need to look at catheters in a scan?

A

catheters run the risk of infection & bleeding

70
Q

Renal vasculature

A
  • main renal artery (Rt & Lt)
  • segmental arteries
  • interlobar
  • arcuate
  • interlobular
  • ureteral
71
Q

Main renal artery

A
  • right & left
  • comes directly from aorta
72
Q

Segmental arteries

A

branches to the ‘poles’ of the kidney

73
Q

Interlobar vasculature

A

along the side walls of the pyramids

74
Q

Arcuate vasculature

A

along the base of the pyramids

75
Q

Interlobular vasculature

A

within the cortex

76
Q

Ureteral vasculature

A

renal/gonadal/vesical arteries

77
Q

Structures of the kidney lobes

A

small lobules created by nephrons

78
Q

What does color show us on a scan of the kidney?

A
  • shows the kidney is getting perfusion (blood is going into it)
  • blue = veins (away)
  • red = arteries (towards)
79
Q

Power doppler vs. color doppler

A
  • power doppler shows smaller vessels than color doppler
80
Q

What is micro-profusion?

A

power doppler that is more sensitive

81
Q

Adjacent anatomy of the right kidney

A
  • liver: ant/sup
  • adrenal gland: sup/med
  • duodenum: med
  • GB: ant/med
  • C loop: upper medial edge
  • colon (hep flexure): ant/lat (can get in the way ant)
  • Morison’s Pouch (btwn. kidney, liver, GB)
82
Q

Morison’s Pouch

A
  • btwn. kidney, liver, GB
  • most gravity dependent area in upper abdomen
83
Q

If fluid is the upper abdomen, where will it typically end up?

A

Morison’s Pouch

84
Q

Adjacent anatomy of the left kidney

A
  • stomach: ant/med
  • spleen: sup/ant
  • adrenal gland: sup/med
  • pancreas (tail): med
  • colon (spl flexure): ant/lat (bends at spleen, can get in the way)
85
Q

Agenesis

A
  • anatomical renal variant
  • 1 or both kidneys did not develop
  • single kidney might enlarge since it is doing all the work
86
Q

Supernumery

A
  • anatomical renal variant
  • more than 2 kidneys
87
Q

Horseshoe kidney

A
  • anatomical renal variant
  • M/C renal anomaly
  • kidneys on opposite side connected by isthmus
  • usually fusion of lower poles occurs w/ ureters passing ant
  • arterial & venous systems may be complex
88
Q

What to do if you suspect a horseshoe kidney

A
  • look to see of poles disappear medially
  • look for isthmus ML, ant to AO & post to IMA
89
Q

Pelvic (ectopic) kidney

A
  • anatomical renal variant
  • crossed/fused kidney
90
Q

Dromedary hump

A
  • not an anatomical renal variant, just unusual shape
  • always on Lt side
  • spleen compresses it
  • looks like a triangle
  • “bulge of cortical tissue on lateral surface of a kidney”
  • isoechoic to renal cortex
  • often see when liver or spleen is pressing against renal tissue
91
Q

Hypertrophied column of Bertin

A
  • prominent indentation of renal cortex w/in medulla
  • usually at upper/mid kidney
  • often difficult to distinguish from mass
  • btwn. the pyramids
  • blends w/cortical tissue
92
Q

Duplex collecting system

A
  • can cause ureter to dilate
  • complete or incomplete
93
Q

Complete duplex collecting system

A
  • 2 separate collecting systems each w/ ureter leading to bladder
  • inf pole ureter & sup pole ureter
94
Q

Inf pole ureter

A
  • empties into bladder more sup/lat than normal location
  • increases chance of pre-vesicoureteral reflux
95
Q

Sup pole ureter

A

empties into bladder more med/dist than normal location

96
Q

Imaging complete duplex collecting system

A

show complete separation, all of hilum, upper/superior, upper/superior mid, mid, lower/inferior mid, lower/inferior

97
Q

Incomplete duplex collecting system

A
  • partial duplication
  • most common congenital anomaly in neonatal
  • 2 collecting systems
  • 2 ureters that connect a single ureter that empties into bladder
  • inferior - relux
  • superior - obstruction
98
Q

Extrarenal pelvis

A
  • outside cystic bulge at renal hilum
  • may be partially or completely beyond renal sinus tissue
  • urine may drain slower, creates scum
99
Q

2 types of Agenesis

A
  • bilateral = incompatible w/ life
  • unilateral = compensatory hypertrophy
100
Q

Hypoplasia

A
  • bilateral or unilateral
  • appearance of normal small kidney = too few nephrons
  • <5 calyces
101
Q

Ectopia

A
  • absence of kidney in expected renal fossa
  • can cause complication: nephrolithiasis
102
Q

Ectopia location

A
  • located in pelvis (bilateral is rare)
  • almost always malrotated
  • kidney is contralateral to ureteral insertion
103
Q

Cross-fused ectopia

A
  • kidneys on same side & fused
  • see if tissue moves together when scanning
104
Q

Junctional parenchymal defect (Interranuncular notch)

A
  • triangular
  • echogenic area ant/sup
  • deep diagonal groove
  • incomplete fusion of upper & lower poles during embryonic development
105
Q

Fetal lobulation

A
  • infolding/indenting of cortical contour
  • slightly lobulated appearance
106
Q

When does fetal lobulation occur?

A
  • first year of life
  • may persist or return in later years
107
Q

Renal ptosis

A
  • unusual mobile kidney
  • descends from normal position towards pelvis
  • poor support structures
108
Q

Renal sinus of lipomatosis

A
  • excess of fat/fibrous tissue w/in the sinus
  • sinus may increase in size/echogenicity
  • appearance of decreased cortical thickness
109
Q

What should you do if any anechoic structures are seen within the central, echogenic sinus?

A
  • evaluate closely
  • determine if it’s vasculature or dilated calyces
110
Q

What should the renal contour look like?

A
  • should be smooth or at least uniformly lobulated
  • look for bumps
111
Q

Describe cortical thickness

A
  • slightly thicker on the inferior/medial border
  • > 1cm thickness
112
Q

What does color show?

A
  • shows organized flow
  • proves something is not a mass

Abdominal Exam 3 (3 decks)

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