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ARRT > Urinary system > Flashcards

Urinary system Flashcards

1
Q

normal kidneys measure _____ long, _____ wide, and _____ thick

A

9 to 12 cm, 5 cm, and 2.5 cm

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2
Q

the outer cortex is _____ than the inner medulla because of increased perfusion of blood

A

darker

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3
Q

the inner surface of the medulla is folded into projections called _____, which empty into the renal pelvis

A

renal pyramids

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4
Q

the _____ are located at the base of the pyramids and separate the medulla from the cortex

A

arcuate arteries

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5
Q

numerous collecting tubes bring the urine from its sites of formation in the cortex to the pyramids, the renal tubules, or _____, are the functional units of the kidneys

A

nephrons

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6
Q

a fibrous capsule called the _____ capsule surrounds the kidney

A

true

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7
Q

outside of the fibrous capsule is a covering of perinephric fat, which is surrounded by the perinephric fascia known as _____

A

Gerota’s fascia

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8
Q

within the kidney, the upper expanded end of the ureter, known as the renal pelvis of the ureter, divides into two or three _____, each divides further into 2 or 3 _____

A

major calyces; minor calyces

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9
Q

the apex of the medullary pyramid, called the renal _____, indents each minor calyx

A

papilla

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10
Q

a nephron consists of 2 main structures, a renal ____ and a renal ____; nephrons filter the blood and produce urine

A

corpuscle (filers blood); tubule (where substance needed by the body is returned to the blood)

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11
Q

the renal corpuscle consists of a network of capillaries called the _____, which is surrounded by a cuplike structure known as Bowman’s capsule

A

glomerulus

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12
Q

blood flows into the glomerulus through small _____ arteries and leave the glomerulus through an _____ arteries

A

afferent; efferent

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13
Q

the ureter is a _____ long tubular structure whose proximal end is expanded and continuous with the funnel shape of the renal pelvis; travels behind the parietal peritoneum long the psoas muscle; enters the pelvis by crossing the bifurcation of the common iliac artery

A

25 cm

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14
Q

what are the 3 constrictions seen along the ureter’s course?

A

where the ureter leaves the renal pelvis, where it is kinked as it crosses the pelvic brim, and where it pieces the bladder wall

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15
Q

the _____ has a posterior and lateral opening for the ureters and an anterior opening for the urethra

A

urinary bladder; interior is lined with elastic transitional epithelium; the middle contracts to expel urine

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16
Q

the ______ includes 2 sphincters; the internal sphincter and the external

A

urethra

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17
Q

to prevent threatening homeostasis, metabolic waste must be quickly _____

A

excreted; these include water, carbon dioxide, and nitrogenous waste (urea, uric acid, and creatinine)

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18
Q

a patient with a renal _____ or disease process may present with flank pain, hematuria, polyuria, oliguria, fever, urgency, weight loss, or general edema

A

infection

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19
Q

_____ is essential to detect urinary tract disorders in patients whose renal function is impaired or absent

A

urinalysis; the presences of an acute infection causes hematuria, or red blood cells in the urine; pyuria is pus in the urine

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20
Q

______ is very important in managing disease such as bacteriuria and renal calculi

A

Urine pH; the pH refers to the strength of the urine as a partly acidic or alkaline solution

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21
Q

the _____ is the measurement of the kidney’s ability to concentrate urine

A

specific gravity; depends of the quantity of dissolved waste products; this is especially low in cases of renal failure, glomerular nephritis, and pyelonephritis

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22
Q

_____ is the appearance of blood cells in the urine; it can be associated with early renal disease

A

hematuria; abundance may suggest renal trauma, neoplasm, calculi, pyelonephritis, or glomerular or vascular inflammatory processes, such as acute glomerulonephritis and renal infarction

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23
Q

the _____ is the relative ratio of plasma to packed cell volume in the blood

A

hematocrit; decreased occurs with acute hemorrhagic process secondary to disease or blunt trauma

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24
Q

_____ is present in urine whenever extensive damage or destruction of the functioning erythrocytes occur

A

hemoglobin; can cause acute renal failure

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25
Q

when glomerular damage is evident, _____ and other plasma proteins may be filtered in excess, allowing the overflow to enter the urine, which lowers the blood serum albumin concentration

A

albumin; albuminuria is commonly found with benign and malignant neoplasms, calculi, chronic infection, and phylonephritis

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26
Q

specific measurement of _____ concentration in urine and blood serum are considered an accurate index for determining the glomerular filtration rate

A

creatinine; decreased urinary creatinine clearance indicates renal dysfunction because creatinine blood levels are constant, and only decreased renal function prevents the normal excretion of creatinine

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27
Q

the ______ is the concentration of urea nitrogen in blood and is the end product of cellular metabolism

A

blood urea nitrogen (BUN); impairment of renal function and increased protein catabolism results in BUN elevation that is relative to the degree of renal impairment

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28
Q

renal dysfunction also results in serum creatinine _____

A

elevation; they are said to be more specific and more sensitive in determining real impairment than BUN

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29
Q

a state of _____ causes the infundibula and renal pelvis to be collapsed and thus indistinguishable from the echo-dense renal sinus fat

A

dehydrated

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30
Q

the _____ of the pyramid points toward the sinus, and the _____ lies adjacent to the renal cortex

A

apex; base

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31
Q

_____ is a result of a partial fusion of two embryonic parenchymal masses called renunculi during normal development

A

junctional parenchymal defect; rectangular echogenic area

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32
Q

_____ is development variation that usually presents in children up to 5 years old, may be present in adults

A

fetal lobulation

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33
Q

______ is a condition characterized by deposition of a moderate amount of fat in the renal sinus with parenchymal atrophy

A

sinus lipomatosis

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34
Q

a _____ is a long pelvis that extends outside the renal border

A

extrarenal pelvis; central cystic region that extends beyond the medial renal border

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35
Q

______ is a fusion of the polar region of the kidneys, usually the lower poles

A

horseshoe kidney; kidneys are seen more medial and anterior to the spine; most common renal anomaly

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36
Q

_____ shows two echogenic regions separated by moderately echogenic parenchymal tissue

A

duplex collecting system; located in the central renal sinus

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37
Q

renal _____ is incomplete development of the kidney, usually with fewer than five calyces

A

hypoplasia

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38
Q

_____ duplication consists of two collecting systems and two ureters, with a single ureter entering into the urinary bladder

A

incomplete

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39
Q

with ______ it is almost always malrotated; the renal pelvis faces anteriorly and is predisposed to reflex, infection, ureteropelvic junction obstruction, and stone formation

A

renal ectopia

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40
Q

a _____ lesion is described as 1) smooth, thin, well-defined border 2) round or oval shape 3) sharp interface between the cyst and the renal parenchyma 4) no internal echoes and 5) increased posterior acoustic enhancement

A

cystic

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41
Q

a _____ lesion projects as a nongeometric shape with irregular borders, a poorly defined interface between the mass and the kidney, low-level internal echoes, a weak posterior border caused by increased attenuation of the mass, and poor through-transmission

A

solid

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42
Q

areas of necrosis, hemorrhage, abscess, or calcification within the mass may alter the classification and cause the lesion to fall into the _____ category

A

complex; characteristics of both cystic and solid lesion

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43
Q

ureteral narrowing due to fibrosis is a common form of ureteral _____

A

stricture

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44
Q

a _____ is a cystlike enlargement of the lower end of the ureter caused by congenital or acquired stenosis or the distal end of the ureter

A

ureterocele; may cause obstruction and infection of the upper urinary system; a cobra head appearance is seen in sagittal view

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45
Q

with ectopic ureterocele, the ureter which empties the _____ pole inserts low in the bladder by the bladder neck, urethra, or lower genital tract

A

upper; the ectopic ureter may become stenotic and cause ureteral obstruction, associated with hydroureter and hydronephrosis; round thin-walled cystic structure that may contain debris

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46
Q

the bladder wall should be smooth and thin measuring _____

A

3-6 mm

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47
Q

a residue of less than _____ of urine is considered normal in an adult

A

20 ml

48
Q

_____ cysts may contain septations, thick walls, calcifications, internal echoes, and mural nodularity

A

complex; must be considered malignant until otherwise proven; walls any thicker than 1mm is abnormal

49
Q

sonographically it is hard to differentiate between a septated cyst and small, adjacent cortical cysts known as ______ cysts

A

kissing

50
Q

the _____ cyst originate from the renal sinus and is most likely lymphatic in origin

A

parapelvic; could present with hypertension or obstruction (hilum cyst); well-defined sonolucent mass with regular or irregular border; not connected to the renal collecting system

51
Q

with _____ predominant abnormalities include retinal angiomas, cerebellar hemangioblastomas, and variety of abdominal cysts and tumors, including renal and pancreatic cysts

A

von Hippel-Lindau; high incidence of renal cysts

52
Q

______ may be difficult to separate from adult polycystic kidney disease

A

tuberous sclerosis

53
Q

_____ is found in native kidneys of patients with renal failure who need to undergo renal dialysis or peritoneal dialysis for greater than 3 years

A

acquired cystic kidney disease; found in cortex; simple cyst; atypical because of hemorrhage; normal or small echogenic kidneys with decrease in corticomedullary distinction with simple or atypical cysts

54
Q

_____ disease may present in one of two forms: the infantile autosomal recessive form and the adult autosomal dominant form

A

polycystic kidney disease

55
Q

_____ polycystic kidney disease is a fairly rare genetic disorder, the gene that causes this disorder has been located on chromosome 6; no distinction between the corticomedullary region; cysts to small to be seen

A

autosomal recessive (infantile); may be seen in utero; renal insufficiency; long hypoplasia; in juvenile form portal hypertension, hepatic fibrosis, and GI hemorrhage; bilateral enlargment of echogenic kidneys

56
Q

the most common type of autosomal dominant polycystic kidney disease is _____

A

type 1; located on the short arm of the forth chromosome and affects the kidney more severely than type 2

57
Q

with _____ kidneys lose their reniform shape; in late stage, no normal renal parenchyma may be identified; bilateral enlarged kidneys with multiple cysts of varied size; cysts may be atypical because of infection and hemorrhage; cysts may be found in liver, spleen, testes, and pancreas

A

adult polycystic kidney disease; hypertension; renal failure; abdominal, flank pain; fever chills; uremia; palpable mass; polycythemia; hematuria; does not usually manifest until the 4th or 5th decade of life

58
Q

_____ disease is a common nonhereditary renal dysplasia that usually occurs unilaterally, with the kidney functioning poorly if at all; no renal parenchyma surrounding the cysts; enlarged kidneys in children, but small in adults

A

multicystic dysplastic kidney; most common palpable mass in neonates; restricted growth in children; polyuria; hypertension; infection; absence of renal vascularity

59
Q

_____ is a development anomaly that occurs in the medullary pyramids and consists of cystic or fusiform dilatation of the distal collection ducts (duct of Bellini), causing stasis of urine and stone formation

A

medullary sponge kidney; pain; hydronephrosis; infection; normal or small kidneys with echogenic parenchyma (cysts too small to be resolved on sonogram) or small cysts in medulla and corticomedullary region with increased echogenicity

60
Q

medullary cystic disease is very similar to the childhood disease familial juvenile _____; anima; salt loss; progressive azotemia; polyuria

A

nephronophthisis; normal small echogenic kidneys with widening of the renal sinus after 2 cm in the medulla or corticomedullary junction

61
Q

the presence of _____ in a renal mass is always a sign of malignancy

A

calcifications; if malignancy is suspected look for thrombus/tumor in surrounding veins; evaluate the contralateral kidney, liver, and retroperitoneum for metastases

62
Q

_____ also called hypernephroma, or Grawitz’s tumor, is the most common of all renal neoplasms and represents 85% of all kidney tumors; weight loss; fatigue; fever; pain; palpable mass; twice as common in males as females (6th or 7th decade of life)

A

renal cell carcinoma; cystic or complex mass that may have areas of calcifications; may displace renal pyramids and invade renal architecture; irregular margins; hypervascular; renal vein and IVC thrombosis

63
Q

_____ carcinoma accounts for 90% of malignancies that involve the renal pelvis, ureter, and bladder; twice as often in man than women; often occurs in 7th decade; most common in renal pelvis

A

transitional cell; solid hypoechoic mass; not well defined within the renal sinus; may be multiple; papillary are more common (low-grade malignancies); small tend to be flat and generally high-grade malignancies

64
Q

_____ carcinoma is a rare, highly invasive tumor with a poor prognosis

A

squamous cell; gross hematuria; history of chronic irritation; large bulky mass; invasion of the renal vein and IVC

65
Q

_____ form of renal lymphoma is more common; hypoechoic mass may be bilateral; enlarged kidneys

A

secondary; usually caused by lymph involvement; more common in patients with non-hodgkin lymphoma; usually no renal symptoms

66
Q

______ or Wilms tumor is the most common abdominal malignancy in children; peak incidence is seen at 2.5 to 3 years of age (normally always younger than 5)

A

Nephroblastoma; palpable abdominal mass; abdominal pain; nausea and vomiting; usually unilateral; heterogeneous; look for extension into renal vein and IVC

67
Q

renal _____ is the most common benign renal tumor; hyperechoic; intratumoral hemorrhage

A

angiomyolipoma; composed of varying proportions of fat, muscle, and blood vessels; associated with tubular sclerosis

68
Q

_____ is a well-defined mass with spoke-wheel patterns of enhancement and central scar

A

oncocytoma; asymptomatic

69
Q

a _____ consists of fat cells and is the most common of the mesenchymal type of tumors

A

lipomas; well-defined echogenic masses within the kidney

70
Q

there are 2 classifications of intrinsic renal disease 1) produces an increase in ______ echoes, believed to result from deposition of collagen and fibrous tissue 2) causes loss of normal _____ detail, resulting in inability to distinguish the cortex and medullary regions of the kidney

A

cortical; anatomic

71
Q

in _____, necrosis or proliferation of cellular elements occurs in the glomeruli

A

acute glomerulonephritis; increase cortical echoes; nephrotic syndrome; hypertension; anemia; peripheral edema

72
Q

______ has been associated with the infectious processes of scarlet fever and diphtheria; enlarged kidneys with increased cortical echoes

A

acure interstitial nephritis; may manifest from an allergic reaction to certain drugs; uremia; hematuria; rash; fever; eosinophilia;

73
Q

systemic _____ is a connective tissue disorder believed to result from an abnormal immune system

A

lupus erythematosus (nephritis); increased cortical echoes and renal atrophy; hematuria; proteinuria; renal vein thrombosis; renal insufficiency

74
Q

_____ is a highly contagious disease, spread mainly by unprotected sex or infected needle; the virus destroys T cells and then replicates rapidly within the body

A

acquired immunodeficiency syndrome (AIDS); renal dysfunction; kidneys are normal or enlarged; echogenic parenchyma; increased cortical echoes

75
Q

_____ causes hematuria and renal vein thrombosis; patents with acute renal vein thrombosis has enlarged kidneys with decreased echogenicity; subacute, enlarged kidneys with increased cortical echogenicity

A

sickle cell Nephropathy

76
Q

with _____ uncontrolled hypertension can lead to progressive renal damage and azotemia

A

hypertensive nephropathy; small kidneys with smooth borders may have distortion of intrarenal anatomy

77
Q

_____ occurs when the cells at the apex of the renal pyramids are destroyed; may develop within weeks or months after transplantation; patients with cadaveric kidney are at greatest risk

A

papillary necrosis; fluid-filled spaces at the corticomedullary junction; round or triangular; mimics calculi; dysuria; acute renal failure

78
Q

with renal _____ intrarenal anatomy is preserved with uniform loss of renal tissue; renal sinus lipomatosis occurs secondary

A

atrophy; renal failure; small echogenic kidneys

79
Q

decrease profusion of the kidneys can cause _____ failure and can be diagnosed by clinical and laboratory data and also by color doppler

A

prerenal; acute renal failure findings; decreased renal output; hydronephrosis; enlarged hyperechoic kidneys; renal artery stenosis

80
Q

______ is usually the result of outflow obstruction and is potentially reversible

A

postrenal failure; increased in patients with malignancy of the bladder, prostate, uterus, ovaries, or rectum \

81
Q

______ is the most common medical renal disease to produce acute renal failure

A

acute tubular necrosis; renal insufficiency; hematuria; bilateral enlarged kidneys with hyperechic pyramids

82
Q

______ disease is the loss of renal function as a result of disease, most commonly parenchymal disease

A

chronic renal; hypertension; bilateral small echogenic kidneys

83
Q

_____ is the separation of renal sinus echoes by interconnected fluid-filled calyces (dilation of the pelvocalyceal system)

A

hydronephosis; has 3 grades 1) small fluid-filling 2) dilatation of some but not all calyces (still concave) 3) complete pelvocaliectasis (change to convex); echogenic line separating collecting system 4) prominent dilatation of the collecting system, thinning of renal parenchyma; no differentiation between collecting system and renal parenchyma

84
Q

with a congenital obstruction of the ______ junction the collecting system will be dilated without dilation of the ureter

A

ureteropelvic; localized hydro occurs as a result of strictures, calculi, focal masses, or a duplex collecting system

85
Q

hydronephrosis with a dilated ureter indicates obstruction of the ______ junction

A

ureterovesical; with dilated bladder indicates obstruction of the posterior urethra

86
Q

______ occurs when pus is found within the collecting renal system; associated with severe urosepsis

A

pyonephrosis; dilated collecting system with low-level echoes or decrease through transmission; renal insufficiency; hematuria

87
Q

______ pyelonephritis occurs when air is present in the parenchyma

A

emphysematous; diffuse gas-forming parenchymal infection; enlarged kidneys appear hypoechoic and inflamed

88
Q

______ pyelonephritis is an uncommon renal disease associated with chronic obstruction and infection; involves destruction of renal parenchyma and infiltration of lipid-laden histiocytes

A

xanthgranulmatous; multiple infections; nonfunctioning kidneys; “stagehorn appearance”; increased echogenicity; increased renal size; dilated calyces

89
Q

linear vascular calcifications commonly are associated with renal artery atherosclerosis and/or ______ malformation

A

vascular

90
Q

______, or parenchymal calcification, involve diffuse foci of calcium deposits, which usually are located in the medulla but infrequently can be seen in the renal cortex

A

Nephrocalcinosis; both kidneys are affected; increased cortical echogenicity with spared pyramids; and increased medulla

91
Q

the most common type of _____ are atherosclerosis and fibromuscluar dysplasia

A

renal artery stenosis; increased velocity through the stenotic area greater than 150 to 190 cm/sec; turbulance distal to the narrowing;

92
Q

_____ is associated with hypertension, which is more common in older patients, and account for one third of cases of RAS

A

atherosclerosis; occurs within the first 2cm of the renal artery

93
Q

_____ dysplasia accounts for approximately two thirds of RAS cases and is seen in younger patients

A

fibromuscular; may involve any layer of the renal walls; usually in middle portion; string of beads appearance

94
Q

renal _____ occurs when part of the tissue undergoes necrosis after cessation of the blood supply, usually as a result of artery occlusion

A

infarction; appear as irregular areas; triangular in shape; contour may be lumpy-bumpy;

95
Q

complications that can arise after _____ include rejection; acute tubular necrosis, obstructive nephropathy, extraperitoneal fluid collections, hemorrhage or infarction, recurrent glomerulonephritis, graft rupture, and renal emphysema

A

transplant; patients risk are age, primary diagnosis, secondary medical complications, and transplant source

96
Q

the success of the transplant is directly related to the _____ of the donated kidney

A

source; the surgical procedure begins with removal of the donor’s left kidney; which is then rotated and placed in the recipient’s right iliac fossa or groin region; the ureter is inserted into the bladder above the normal ureteral orifice

97
Q

as early as _____ hours after surgery, a baseline sonographic examination is performed to identify renal size, calyceal pattern, and extrarenal fluid collections

A

48

98
Q

the _____ appears as parallel linear echoes posterior to the kidney transplant

A

psoas

99
Q

what are the 4 types of renal transplant rejections?

A

hyperacute, acute, immunologic, chronic

100
Q

_____ rejection occurs within hours and is caused by vasculitis leading to thrombosis and usually loss of the graft

A

hyperacute

101
Q

_____ rejection occurs within days to months after transplant

A

acute

102
Q

causes of _____ rejection include pre-formed antibodies, immune complexes, and cell-mediated responses

A

immunologic

103
Q

_____ rejection can occur months after transplantation with gradual onset; secondary to mononuclear infiltration and fibrosis

A

chronic; signs of rejection: enlargement and decreased echogenicity of the pyramids; hyperechogenic cortex; a localized area of renal parenchyma presenting an anaechoic appearance; distortion of the renal outline caused by localized areas of swelling involving both cortex and medulla

104
Q

irregular parenchymal echo patterns may result from parenchymal atrophy with fibrosis and shrinkage resulting from long-standing renal _____

A

rejection

105
Q

_____ is the most common cause of acute posttransplant failure; associated with prolonged severe ischemia

A

acure tubular necrosis; higher in cadaveric transplants; elevated serum creatinine level

106
Q

_____ is an immunosuppressant drug used to prevent rejection of kidney allogenic transplants

A

cyclosporine; toxic to the kidney in high doses

107
Q

_____ is a newly discovered delayed complication that is now becoming prevalent as the life of transplants have improved

A

malignancy; 2 major types are non-Hodkins lymphoma and skin cancer; there is a correlation with the immunosuppressant drugs used cyclosporine (increases non-Hodkins) and Azathioprine (increases skin cancer)

108
Q

a _____ may develop shortly after surgery, one of the major indications for a sonogram may be a drop in hematocrit

A

hematoma

109
Q

graft rupture can occur in the first _____ after surgery, presenting with an abrupt onset of pain and swelling over the graft, oliguria, and shock

A

2 weeks; gross distortion of the graft contour and perinephric or paranephric hematoma

110
Q

the use of contrast agents for visualization of renal arteries is not ____ approved

A

FDA

111
Q

a stone located in the urinary system is called _____; consists of a combination of chemicals that precipitate out of urine

A

urolithiasis (kidney stones); doppler causes a twinkling artifact posterior to the stone

112
Q

stones that are large and fill the renal collecting system are called _____

A

stagehorn calculi; stones are associated with renal acidosis

113
Q

a bladder _____ is a herniation of the bladder wall

A

diverticula; congenital lacks a muscular layer and has a neck; acquired are associated with calculi; neck of varying size connecting the adjacent fluid-filled structure to the bladder

114
Q

______ is usually secondary to another condition that causes stasis of the urine in the bladder; as inflammation increases, the smooth bladder wall will become diffuse or nondiffuse with hypoechogenic thickening, the bladder will become fibrotic and scarred

A

cystitis

115
Q

most bladder tumors in adults are _____ carcinoma

A

transitional cell; present with hematuria, dysuria, urinary frequency, or urinary urgency; focal bladder wall thickness

ARRT (9 decks)

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