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DMST 254 ABD 1 > Urinary tract > Flashcards

Urinary tract Flashcards

1
Q

What is the embryology of the Urinary duct? (What does it originate from)

A

It originates from the mesoderm

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2
Q

Three pairs of kidneys differentiate? 3

A
  1. Pronephros
  2. Mesoneprhos
  3. Metanephros
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3
Q

When does the pronephros form? What is the pronephros in terms of function? 2

A
  1. Forms early in the 4th embryological week
  2. Rudimentary and non- functioning
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4
Q

When does the mesoneprhos form?

A

Form late in the 4th embryological week

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5
Q

What functions as a interm kidney during development?

A

mesonephros

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6
Q

What does the development of the mesonephros for males give rise to? 3

A

Gives rise to the epididymis, vas deferens and ED

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7
Q

What is the development of the mesoneprhos for females?

A

Largely supressed.
The mullerian duct»uterus»and vagina

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8
Q

What does the metanephros eventually form? When does it start to form? When does it start to be functional?

A
  1. permanent kidney
  2. Forms end of the 5th week
  3. Function begins at ~8 weeks
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9
Q

What is the growth of the kidneys like?

A

During fetal growth, kidneys appear to migrate from pelvis to the abdomen (12- 15 weeks gestation) result of rapid caudal growth0 not really migration

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10
Q

What is the embryology of the ureters in males? What is the ureters incorporated into?

A
  1. Develop from the mesonephric duct (wolffian duct) - 4 weeks gestation
  2. incorporated into the bladder trigone
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11
Q

Whatdoes the bladder develop from? What is it continuous with? What is the development like prior to puberty and after puberty?

A
  1. Develops from the urogenital sinus
  2. Continuous with the allantois
  3. Prior to puberty- abdominal organ. becomes a true pelvic structure after puberty
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12
Q

What does the allantois develop from and what does it become?

A

Develops from yolk sac and becomes urachus (becomes the median umbilical ligament (adult))

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13
Q

What is the location of the kidneys? How does it lie? 3

A
  1. Retroperitoneal
  2. Perirenal space
  3. Oblique lie
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14
Q

What muscle is the urinary tract parallel to?

A

Psoas muscles

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15
Q

How are the poles situated for the poles of the kidneys?

A

Upper poles are more medial and posterior than lower poles

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16
Q

The medial margins are orientated how in terms of the kidneys?

A

Medial Margins are more anterior than lateral margins

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17
Q

How is the IVC and Ao orientated in terms of the kidney?

A

More anterior than lateral margins

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18
Q

What is the ureters location? (What cavity is it in, how does it enter the bladder, and whereis it locatated in relation to the iliac vessels)

A
  1. Retroperitoneal
  2. Enter posterolateral aspect of bladder
  3. Anterior to iliac vessels
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19
Q

What is the size of the ureters?

A

2 to 8 mm diameters and ~30 cm in length

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20
Q

Where is the location of the bladder in relation to the symphysis pubis?

A

posterior

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21
Q

What is the location of the bladder in relation to the prostate?

A

Superior

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22
Q

What is the location of the bladder in relation to the rectum?

A

Anterior

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23
Q

What is the location of the bladder in relation to the uterus?

A

Anterior

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24
Q

Which space does the bladder lie?

A

Extraperitoneal space

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25
Q

Where is the bladder locations? 2

A
  1. Empty true pelvis
  2. Distended: extendes into false pelvis/ abdomen
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26
Q

What is the shape of the Kidney? What is the Lateral aspect like? What is the medial aspect live? 4

A
  1. Bean shaped
  2. reniform
  3. Lateral aspect is convex
  4. Medial aspect is concave
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27
Q

What is the size of the kidney? 3

A
  1. Length: 9-12 cm
  2. Width: 4-5 cm
  3. AP: 3 cm
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28
Q

The length of the kidneys should be within how much of each other in terms of size?

A

1.5 - 2 cm of each other

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29
Q

Which kidney is usually longer?

A

Left

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30
Q

What is the supportive structure of the kidney? 4

A
  1. Fibrous capsule
  2. Perirenal fat
  3. Renal fascia
  4. Pararenal fat
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31
Q

The fibrous capsule is what kind of reflector?

A

Specular

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32
Q

What is the perirenal fat continous with?

A

Renal sinus

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33
Q

What does the renal fascia do? 2

A
  1. Anchor kidney to the posterior abdominal wall
  2. Separates the perirenal space from the pararenal spaces
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34
Q

What is ptosis?

A

KIdney falls when fascia tears

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35
Q

What are the two distinct areas of the kidney? 2

A
  1. Parenchyma
  2. Sinus
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36
Q

What is the parenchyma?

A

Functional tissue of the kidneys, divided into cortex and medulla

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37
Q

What is the cortex of the kidney? What did it produce?

A

Outer portion below renal capsule, which is the site of urine production which contains the neprhons

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38
Q

The cortex arches over and extends between what?

A

The pyramids

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39
Q

What are the columns of cortex also known as?

A

Columns bertin

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40
Q

Each columns of bertin contains what?

A

interlobar artery and vein

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41
Q

What is the medulla of the kidney? What does it contain? Where does the base points towards? What does the Apices point toward?

A

Inner portion of kidney which contains
1. Pyramids
2. 8-18
3. Base towards cortex
4. Apices towards sinus - open into minor calyx

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42
Q

What is the sinus of the kidney? What is it continuous with? What does it contain?

A
  1. Fatty central portion
  2. Continuous with perirenal fat
  3. Contains the calyces, renal pelvis, vessels, and nerves
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43
Q

What is the renal hilum the entrance of ?

A

Entrance into sinus

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44
Q

From anterior to posterior what is the structure of the renal hilum?

A
  1. Renal vein
  2. Renal artery
  3. Ureter
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45
Q

What are the dimensions of the ureters?

A

Long mucosal lined tubes 30-34 cm long and 2-8 mm in diameter

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46
Q

Which ureter is shorter?

A

Right

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47
Q

What are 3 natural areas of narrowing of the ureters?

A
  1. UPJ
  2. Crossing pelvic brim anterior to iliac vessels
  3. UVJ
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48
Q

What is the size the urinary bladder? 3

A
  1. Size and shape depended on urine volume
  2. Capacity: 300-500 ml
  3. Post void <100ml not significant
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49
Q

Where is the trigone of the bladder located? What is the trigone of the bladder? 2

A
  1. Located on the posterior surface of the base of the bladder
  2. Triangular shaped area between the openings of the ureters and urethra
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50
Q

Is the shape and position of the trigone constant or variable?

A

Constant

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51
Q

What is the bladder neck? What is its shape and position, constant or variable? 2

A

1.Urethral orifice
2. Constant shape and position

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52
Q

What is the apex of the bladder? What is it the site of attachment for?

A
  1. Most anterior and superior portion of the bladder
  2. Site of median umbilical ligament attachment
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53
Q

What are the four layers of the bladder?

A
  1. Mucosa - rugae
  2. Submucosa - connective tissue
  3. Muscle - detrusor muscle
  4. Serosa - peritoneum covering superior surface
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54
Q

What is the wall thickness of the bladder? Distended and non distended.

A
  1. Distended: 3 mm
  2. Non distended: 6 mm
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55
Q

What is the urethra?

A

Membranous canal exiting the bladder at the trigone

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56
Q

In females the urethra canal pierces what?

A

Urogenital diaphragm

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57
Q

In males the urethra is how long compared to females?

A

Longer

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58
Q

What is the three areas of the male urethra?

A
  1. Prostatic
  2. Membranous
  3. Penile
59
Q

Renal arteries arise from what aspect of the arteries?

A

Lateral aspect of the aortas

60
Q

Renal arteries divide into several what?

A

Segmental branches before entering the hilum

61
Q

Segmental arteries branch into what?

A

Interlobar arteries which travels between the pyramids

62
Q

Interlobar arteries branch into what?

A

Arcuate arteries, at the base of the pyramids

63
Q

Arcuate arteries branch into what?

A

Interlobular arteries which travel into the renal cortex

64
Q

Interlobular arteries branch into what?

A

Afferent arterioles, which carry blood into the glomerulus of the nephrons

65
Q

What is the sonographic appearance of the renal capsule?

A

Echogenic line

66
Q

What is the echogenic appearance of the cortex?

A
  1. Homogeneous, even thickness
  2. Echogenicity = or slightly < than liver
67
Q

What is the sonographic appearance of the Medulla?

A
  1. Triangular, hypoechoic areas, evenly spaced (equidistant)
68
Q

What is the CM junction the location of?

A

Location of arcuate arteries

69
Q

Wha it’s the sonographic appearance of the sinus? What does over hydration do in terms of imaging? 2

A
  1. Highly echogenic central area
  2. Overhydration - small echolucent areas
70
Q

What is he sonographic appearance of the vessels?

A
  1. Linear anechoic tubes best assessed in transverse on the body
71
Q

What is the sonographic appearance of the Cortex of a neonate comapred to the liver? How is it compared to the pyramids in terms of thickness? and what is the appearnce of the capsule?

A
  1. More echogenic compared to the liver
  2. Thin compared to pyramids
  3. Lobulated
72
Q

What is the sonographic appearance of the pyramids of the neonates? 2

A
  1. Hypoechoic
  2. Large
73
Q

What is the sonographic apperance of the neonate sinus?

A
  1. Indistinct due to very little fat
74
Q

What is the sonographic appearance of the ureters? How easily is it seem? What do you need to do if you see them dilated?(3)

A
  1. Difficult to visualize unless dilated
  2. If dilated, will appear as anechoic tubular structure
  3. If you see a dilated ureter check for jets
75
Q

What is the sonographic appearance of the bladder? What is the shape of it in transverse? What is the distended appearnce of the wall?

A
  1. Appears cystic/ anechoic
  2. In transverse: appears rounded
  3. When distended, wall should appear thin and smooth (check for irregularities)
76
Q

In the transverse plane if we point Inferiorly at the bladder how would it look?

77
Q

What is the dromedary hump? What is it’s appearnce? what do we need to do to rule out a mass?

A
  1. Renal Variant on the Lateral left aspect of the kidney
  2. Thickening or bulging of cortex
  3. Visualize the CM junction to rule out mass
78
Q

What is the hypertrophied column of Bertin?

How many layers of cortex are between the pyramids here?

Which portion of the kidney is likely affected?

What does this look like for the renal sinus?

This should not measure more than what?

What is the echotexture with the cortex?

A
  1. Renal variant
  2. 2 layers of cortex between pyramids
  3. Upper/ middle portion of kidney
  4. Indents Renal sinus
  5. Should not measure >3cm
  6. Isoechoic to and continuous with cortex
79
Q

What is fetal lobulation? What does the cortex look like? How many adults are identified with this varient? 4

A
  1. Renal variant
  2. Infolding of cortex but no thinning
  3. Scalloped contour
  4. Identified 51% of adults
80
Q

What is the junctional parenchymal defect?

How does someone get this?

Which side does it typically affect?

What is it’s shape? Which section of the cortex does it affect?

What can it be confused with sometimes?

A
  1. Renal variant
  2. Incomplete embryological fusion
  3. Typically right side
  4. Wedge shaped hyperechoic defect
  5. Anterior superior cortex
  6. Can be confused with scarring
81
Q

What type of transducer do we use for renal scans?

A

2 to 6 MHz transducer

82
Q

How should the patient lie during renal scan?

A
  1. Supine
  2. Decubitus
  3. Oblique patient position
83
Q

What kind of planes should we use for renal scans?

A
  1. Sagittal
  2. Coronal
  3. Transverse views
84
Q

What is a tip for scanning the right kidney? 2

A
  1. Use liver as window
  2. Subcostal/ intercostal
85
Q

What are some tips for left kidney images?

A
  1. Decubitus/ oblique
  2. Spleen as window
86
Q

What are some techniques to optimize urinary images? 3

A
  1. Various breathing techniques
  2. Change patient position
  3. Change windows
87
Q

The kidneys lie in what plane?

A

Oblique plane

88
Q

Vessels are best seen in what plane?

A

Transverse plane of the kidney

89
Q

The echogenicity of the RK is compared to what? And the Left is compared to what?

A

Liver and the spleen

90
Q

The ureters are best imaged in what plane?

91
Q

How do we move bowel gas away during scans?

A

Use graded compression

92
Q

What planes do we image the kidney?

A
  1. Sagittal and transverse
  2. Full bladder required
93
Q

If we see dilated ureters/ hydronephrosis - what should we do?

A

Check for jets

94
Q

For some renal scans what kind of measurements do we need for the bladder?

A

Pre and post void volumes

95
Q

Cystoscope is best to evaluate what?

96
Q

What is the patient prep for kidney/ ureter exams? Why?

A
  1. NPO 6 - 12 hours
  2. Minimizes bowel gas
97
Q

What is the Patient prep for the bladder?

A
  1. Full bladder required
  2. 1 Liter of water 1 hour before test
98
Q

How many images of the kidney will we take?

A
  1. 3 sagittal
  2. 3 transverse
99
Q

For the 3 sagittal images, what additional stuff should we do?

A
  1. Measure length
  2. Hilum
  3. Lateral edge
100
Q

For the 3 transverse images of the kidney, what additional images do we need to take?

A
  1. Both poles with even cortex
  2. Hilum with vessels
101
Q

The muscle that lies directly posterior the kidney is called what?

A

Quadratics laborum

102
Q

The tissue that anchors the kidneys is called what?

A

Renal fascia

103
Q

What branch of the renal arterial system drapes over the pyramids?

104
Q

The kidneys remove ________ by producing ___________

A

Metabolic waste by producing urine

105
Q

What does the kidneys do? 3

A
  1. Balance the amount of water and electrolytes leaving and entering the body
  2. Maintains blood pressure
  3. Removes metabolic waste by producing urine
106
Q

How much fluids does the kidneys process in a day?

107
Q

What is the functional unit of the kidney?

108
Q

What does the nephron do?

A

Filters blood and produces urine

109
Q

What are the two types of nephrons?

A
  1. Juxtamedullary (deep)
  2. Cortical (superficial)
110
Q

What are the two main components of the nephron?

A
  1. Renal corpuscle
  2. Renal tubule
111
Q

What are components of the renal corpuscle? 2

A
  1. Glomerulus
  2. Bowman’s capsule
112
Q

What is the components of the renal tubules ? 4

A
  1. PCT
  2. DCT
  3. Loop of henle
  4. Collecting duct
113
Q

What is the function of the nephron? 3

A
  1. Control blood concentration and volume
  2. Help regulate blood pH
  3. Removes toxic wastes from blood (osmosis and active transports)
114
Q

How does blood reach the nephron? 6

A
  1. Renal artery
  2. Interlobar artery
  3. Arcuate artery
  4. Interlobular artery
  5. After ent arterioles
  6. Glomerulus
115
Q

What is the three steps of urine formation?

A
  1. Filtration
  2. Reasoprtion
  3. Secretion
116
Q

During tubular reabsorption nutrients are reabsorbed back into what?

A

Bloodstream. (Water, glucose, vitamins and other nutrients)

117
Q

Where does tubular reabsorption occur in? Via what?

A
  1. PCT, descending and ascending loop of henle
  2. Via pertiubular capillary
118
Q

Waste is secreted into what? What does this do?

A

DCT. This rids the body of certain substances and helps control pH

119
Q

What is ADH (Antidiuretic hormone) secreted by? What doe sit help the body do? How?

A
  1. Secreted by posterior pituitary
  2. Aids in retaining water in the body
  3. Decrease in blood volume stimulates ADH production
120
Q

What is aldosterone secreted by? What does it control? What is it stimulated by? What is it influenced by?

A
  1. Secreted by adrenal cortex, acts on PCT
  2. Controls the rate of sodium reabsorption
  3. Stimulated by low blood volume
  4. Influenced by renin angiotensin system
121
Q

What is renin? What is it secreted by? What does it respond to?

A
  1. Secreted by the juxtaglomerular apparatus
  2. Acts as a catalyst
  3. Responds to a decrease in blood pressure
122
Q

Renin stimulates the formation of what?

A

Angiotensin

123
Q

Angiotensin stimulates the release of what?

A

Aldosterone

124
Q

Where is the juxtaglomerular apparatus located?

A

At the point where the DCT, afferent and efferent arterioles come into contact

125
Q

What does granular cells (afferent arterioles) release? What’s does DCT inhibit the release of? What does the juxtaglomerular apparatus do?

A
  1. Granular cells (afferent arterioles) release renin
  2. Macular dense cells (DCT) inhibit renin release
  3. Regulates blood pressure
126
Q

Renal failure causes what to accumulate in the blood?

A

Waste products

127
Q

How much loss of renal function before the blood tests are elevated?

128
Q

What is the Serum creatinine? How does it appear?

A
  1. Breakdown product of muscle metabolism that is filtered out by the kidneys
  2. Appears in blood normally in amounts proportional to the body’s muscle mass
129
Q

What is the blood urea nitrogen (BUN)

A

End product of protein metabolism

130
Q

Where is blood urea nitrogen (BUN) formed?

A

F liver from ammonia

131
Q

Blood urea nitrogen (BUN) is readily excreted by what?

132
Q

What does the blood urea nitrogen (BUN) reflect?

A

Protein intake and renal excretory capacity

133
Q

What does increased blood urea nitrogen mean?

A

Renal dysfunction and dehydration

134
Q

What does Decreased blood urea nitrogen mean?

A

Hepatic damage, malnutrition, over hydration

135
Q

Increased levels of serum creatinine are seen with what? 3

A
  1. Renal failure
  2. Chronic nephritis
  3. Urinary tract obstruction
136
Q

What does increase/ decrease of serum electrolytes usually mean? 2

A
  1. Increase in acute renal failure and glomerulonephritis
  2. Decreased in chronic and acute renal failure
137
Q

What is included in serum electrolytes? 4

A
  1. Chloride
  2. Potassium
  3. Sodium
  4. Bicarbonate
138
Q

What are some urine test? 6

A
  1. Red blood test
  2. White blood test
  3. Pyuria
  4. Proteinuria
  5. PH
  6. Specific gravity
139
Q

What does the red blood cell test tell us? 3

A
  1. Hematuria
  2. Any amount of abnormal
  3. Inflammation, tumours, calculate
140
Q

What does the white blood cell test tell us?

A

Indicates infection, inflammation

141
Q

What does the pyuria test tell us?

A

Pus in urine, indicates infection

142
Q

What does the proteinuria test tell us? Is this normal? What did this mean?

A
  1. Protein in urine
  2. Even trace amounts abnormal
  3. Nepthritis, polycystic disease, stones, carcinoma
143
Q

What does the blood pH test tell us?

A
  1. Alkalinity or acidity
  2. Formation of stones
144
Q

What does the specific gravity test tell us? 3

A
  1. Measures ability to concentrate urine
  2. Decreased levels in renal failure
  3. Increased levels with decreased urine output (dehydration)

DMST 254 ABD 1 (26 decks)

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