Urinary System Flashcards
Where the renal pelvis and ureter meet
Ureteropelvic Junction (UPJ)
The ureter empties into the bladder at the
ureterovesical junction (UVJ)
A condition in which urine flows retrograde (backwards) from the bladder into one or both ureters and sometimes to the kidneys
chronic vesicoureteral reflux (VUR)
Polyuria is
•Excessive urination
•Output >3 L/day
Oliguria is
•Low urine output
•Output <500 mL/day in an adult
Dysuria is
Painful urination
presence of pus (white cells) created by the body’s reaction to the infection is known as
Pyuria
Blood in the urine is known as
Hematuria
Uremia is
•characteristic of renal (kidney) failure
•consists of retention of urea (high levels of waste) in blood
Dilated(swollen) renal pelvis and calyces caused by an obstructive process is known as
hydronephrosis
Abnormal dilation(swelling) of the ureter is known as
hydroureter
Micturition is
voiding (emptying urine from the bladder and out of the body)
Hard deposits of stone(calculi) in the urinary tract is known as
urolithiasis
Components of the Nephron
What is the main function of the urinary system?
remove waste from the bloodstream for excretion by forming urine
Approximately, how much urine is produced in a day?
1 L to 1.5 L
What is the function of the bladder?
Store urine
How much urine can the bladder store?
350 to 600 mL
When is the urge to void (empty the bladder) usually triggered?
at a volume of 250 mL
Describe the location and orientation of the kidneys
-Retroperitoneal, normally located between T12-L3
-The right kidney lies slightly lower because of the presence of the liver
-The kidneys are posteriorly rotated approximately 30 degrees from the coronal plane
The kidneys are posteriorly rotated approximately ___ degrees from the coronal plane
30
What is the functional part of the kidney that filters blood, removes waste, and regulates the body’s balance called
Parenchyma
What are the three lab tests used to diagnose renal failure?
• GFR, BUN, Creatine
What risk factors should be considered before IV contrast administration?
•Persons with a BUN greater than 50 mg/dL or a serum creatinine greater than 3 mg/dL an eGFR ≤ 30 mL/min/1.73 m2.
•Older than 60 years
•History of renal disease (dialysis, kidney transplant, single kidney, renal cancer, and renal surgery)
•Hypertension requiring medical therapy
•Diabetes mellitus
•The use of a medication containing metformin
Normal kidney function values:
•eGFR: 90 mL per minute per 1.73 m2
•BUN: between 8 and 25 mg
•Creatine: 0.6 and 1.2 mg
What contrast media is used for IVU (IVP) exams? How is it administered?
•Nonionic, low-osmolar contrast agents (type of iodinated contrast)
•Intravenously
What contrast media is used for Cystography/Retrograde cystography exams? How is it administered?
•iodinated water-soluble contrast material
•insertion of a urinary catheter through the urethra into the bladder
What contrast media is used for Urethrography exams? How is it administered?
•Contrast used: iodinated water-soluble contrast
•Administered: catheter is inserted into the urethral opening and contrast is slowly injected
What contrast media is used for Retrograde pyelogram exams? How is it administered?
•
•injected through the ureter into the affected kidney
•How is the IVU exam carried out?
•Indications for performing IVU?
•CM used:
•What is the nephrogram phase?
•How is the IVU exam carried out?
• Scout KUB and possible scout tomogram
• Contrast Injection (30 to 100 ml)
• Immediate AP KUB or kidney film (nephrogram/blush stage)
• 3 to 4 tomo cuts through the kidneys
• 5 minute KUB
• 10 minute KUB (possibly prone)
• RPO/LPO obliques at 10 to 15 minutes (greatest concentration of contrast in the kidneys occurs at 15– 20 min after injection)
• pre-voiding KUB at 20 to 30 minutes
• AP upright post-voiding
•Indications for performing IVU? flank pain, calculus disease, suspected urinary tract obstruction, abnormal urinary sediment (especially hematuria), systemic hypertension, urinary tract infections, screening for congenital GU anomalies, or history of transitional cell or renal cell carcinoma (RCC), concern of injury to the GU tract related to trauma or abdominopelvic surgery
•CM used: Nonionic, low-osmolar contrast agents (type of iodinated contrast)
•What is the nephrogram phase? An image to taken within 30 seconds to 1 minute after IV contrast injection to demonstrate the contrast agent in the nephrons before it reaches the renal calyces
Cystography/ Retrograde Cystography
● How is a cystogram procedure carried out?
● What projections are traditionally included in radiographs?
● How does kidney function impact contrast administration for this exam?
● Identify a frequent indication for this exam:
● What is a VCUG, and how might it relate to this exam?
● What is (RUG), which gender is it performed on, and why:
● How is a cystogram procedure carried out? thin, flexible catheter is inserted into the bladder through the urethra
● What projections are traditionally included in radiographs? AP, LPO, RPO, and Lateral
● How does kidney function impact contrast administration for this exam? Has no impact
● Identify a frequent indication for this exam: vesicoureteral reflux (VUR), congenital bladder anomalies, tumors, diverticula, calculi, bladder injury, fistula, urinary retention, or neurogenic bladder
● What is a VCUG, and how might it relate to this exam? a VCUG allows visualization of the urethra during voiding (micturition) and also is frequently used to assess for VUR
● What is (RUG), which gender is it performed on, and why: a retrograde exam that examines the distal urethra in men. Looking for urethral trauma or to assess for urethral injury following a pancreas transplant
Retrograde Pyelography
•Describe this this exam:
•Why it is termed retrograde?
•Describe this this exam: Placement of a catheter into the ureteric orifice in a retrograde fashion. This is usually performed by a urologist during intraoperative cystoscopy so that contrast medium is directly injected into the ureter to opacify the renal collecting system
•Why it is termed retrograde? the contrast agent is injected through the ureter into the affected kidney, opposite of the normal direction of urine flow
Identify which picture is what
o Ureteral Stent
o Nephrostomy Tube
o Foley Catheter
o Cystography
o Suprapubic Catheter
Supernumerary kidney
•Involves the presence of a third small, rudimentary kidney. The third kidney is more frequently located below the normal kidney on the left side
Hypoplasia
•Anomaly of size involving a kidney that has developed less than normal in size but contains normal nephron structure
•Usually associated with hyperplasia of the other kidney
Horseshoe Kidney
•Most common fusion anomaly
•The lower poles of the kidneys are joined across the midline by a band of soft tissue, called the isthmus, causing a rotation anomaly on one side or both sides
•Incidence is higher in individuals with Down syndrome and Turner syndrome
Cross Fused Ectopic Kidney
•One kidney lies across the midline and is fused with the other kidney
•Second most common fusion anomaly
•Both kidneys demonstrate various anomalies(not normal) of position, shape, fusion, and rotation
•Sonography, Retrograde Pyelogram
Ectopic Kidney
•An ectopic kidney is one that is out of its normal position, generally involving overascent or underascent (underascent is more common)
•Usually asymptomatic
•However, renal ectopia is associated with UPJ obstruction, VUR, and decreased function. Stone formation can also occur more frequently if urinary drainage is impaired
Ureterocele
•Cyst-like dilation of a ureter near its opening into the bladder
•May result from congenital stenosis of the ureteral orifice.
•Radiographically, a ureterocele appears as a filling defect in the bladder with a characteristic “cobra head” appearance
•Orthotopic or simple ureteroceles are mostly asymptomatic and often incidentally found in adults
•Ureteroceles larger than 2 cm are more likely to contribute to ureteral obstruction or stone formation within a ureterocele
•Ultrasound, Intravenously urography (IVU)
Ureteral diverticula
•Congenital anomaly and may represent a dilated, branched ureteric remnant (out-pouching on the ureter)
•Retrograde urography
Bladder diverticula
•May occur as a congenital anomaly or be caused by chronic bladder outlet obstruction and resultant infection (out-pouching on bladder)
•They usually occur in middle-aged men, often associated with benign prostatic hyperplasia (BPH)
•Cystography or cystoscopy
Chronic pyelonephritis
•Recurrent or persistent infection of the kidneys, such as that caused by chronic reflux of infected urine from the bladder into the renal pelvis
•It generally has no relation to acute pyelonephritis and is seen sometimes in those individuals with a major anatomic abnormality or more commonly in children with VUR
•Chronic pyelonephritis is often bilateral and leads to destruction and scarring of the renal tissue, with cortical atrophy and marked dilation of the calyces. The eventual result is an overall reduction in kidney size
•Intravenous Urography (IVU), Sonography
Acute Glomerulonephritis/Bright disease
•An antigen–antibody reaction in the glomeruli causes an inflammatory reaction of the renal parenchyma
•This condition occurs mainly in children after streptococcal infection
•CT or sonographic guidance helps the physician obtain samples of renal tissue and send them to the laboratory for inspection
•Radiographically, both kidneys appear enlarged, particularly during the nephrogram phase of IVU
Cystitis
● Define cystitis
● Which population is more susceptible to cystitis and why?
● What symptoms are present with this condition?
● What might lead to VUR?
● Which radiographic exam may demonstrate VUR?
● What is the etiology of bladder stones?
● Identify the modality/ modalities that may be used to diagnose bladder stones:
● Define cystitis: an acute or chronic inflammation of the bladder, is a fairly common infection that is generally caused by bacteria such as E. coli and Staphylococcus saprophyticus.
● Which population is more susceptible to cystitis and why? females, because the short urethra in females provides bacteria easier access into the bladder
● What symptoms are present with this condition? burning pain during urination or the urge to urinate frequently.
● What might lead to VUR? in the normal urinary tract, VUR is prevented by compression of the bladder musculature on the ureters during micturition. Failure of this valve mechanism usually results from a shortening of the intravesical portion of the ureter caused by abnormal embryologic development, leading to ureteric orifices that are displaced laterally
● Which radiographic exam may demonstrate VUR? Cystography
● What is the etiology of bladder stones? Chronic infection or bladder outlet obstruction
● Identify the modality/ modalities that may be used to diagnose bladder stones: Conventional radiographs, US, or CT
Define staghorn calculus
a large calculus(stone) that assumes the shape of the pelvicalyceal junction
Renal Cysts
● What are the usual symptoms of renal cysts?
● How are these commonly discovered?
● Where are renal cysts most commonly found?
● How might tumors be differentiated from cysts during an IVU?
● What are the usual symptoms of renal cysts? usually asymptomatic, in some instances, they may cause symptoms from rupture, hemorrhage, infection, or obstruction
● How are these commonly discovered? incidentally on imaging studies ordered for other reasons
● Where are renal cysts most commonly found? a lower pole of the kidney
● How might tumors be differentiated from cysts during an IVU? by tomography, in which a cyst shows an absence of early parenchymal enhancement after contrast medium injection. In contrast, tumors, the majority of which have vascularity, may show irregular opacification during the nephrogram phase.
Bladder Carcinoma
● Identify 4 risk factors associated with bladder carcinoma.
● What is the main symptom associated with bladder cancer?
● Which modality/ exam is of choice to investigate bladder carcinoma?
● How is a definitive diagnosis made?
● Define loopogram and describe its association with bladder cancer treatment.
● Identify 4 risk factors associated with bladder carcinoma: cigarette smoking, certain industrial chemicals, abuse of analgesics, and pelvic radiation therapy
● What is the main symptom associated with bladder cancer? hematuria(blood in urine)
● Which modality/ exam is of choice to investigate bladder carcinoma? Cystoscopy
● How is a definitive diagnosis made? concurrent biopsy, resection, or small lesions
● Define loopogram and describe its association with bladder cancer treatment: The loop of bowel may be connected to the native urethra, a fluoroscopic injection study of this type of anatomy is called a loopogram and it is a retrograde contrast study requiring catheterization of the urostomy and bowel segment. A loopogram may be requested to evaluate for patency of the anastomoses between the ureters and the bowel segment, rule out obstruction, evaluate for postoperative urine leaks, or assess for tumor recurrence..
