Urinary tract Flashcards
1
Q
What is the embryology of the Urinary duct? (What does it originate from)
A
It originates from the mesoderm
2
Q
Three pairs of kidneys differentiate? 3
A
- Pronephros
- Mesoneprhos
- Metanephros
3
Q
When does the pronephros form? What is the pronephros in terms of function? 2
A
- Forms early in the 4th embryological week
- Rudimentary and non- functioning
4
Q
When does the mesoneprhos form?
A
Form late in the 4th embryological week
5
Q
What functions as a interm kidney during development?
A
mesonephros
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
7
Q
What is the development of the mesoneprhos for females?
A
Largely supressed.
The mullerian duct»uterus»and vagina
8
Q
What does the metanephros eventually form? When does it start to form? When does it start to be functional?
A
- permanent kidney
- Forms end of the 5th week
- Function begins at ~8 weeks
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
10
Q
What is the embryology of the ureters in males? What is the ureters incorporated into?
A
- Develop from the mesonephric duct (wolffian duct) - 4 weeks gestation
- incorporated into the bladder trigone
11
Q
Whatdoes the bladder develop from? What is it continuous with? What is the development like prior to puberty and after puberty?
A
- Develops from the urogenital sinus
- Continuous with the allantois
- Prior to puberty- abdominal organ. becomes a true pelvic structure after puberty
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))
13
Q
What is the location of the kidneys? How does it lie? 3
A
- Retroperitoneal
- Perirenal space
- Oblique lie
14
Q
What muscle is the urinary tract parallel to?
A
Psoas muscles
15
Q
How are the poles situated for the poles of the kidneys?
A
Upper poles are more medial and posterior than lower poles
16
Q
The medial margins are orientated how in terms of the kidneys?
A
Medial Margins are more anterior than lateral margins
17
Q
How is the IVC and Ao orientated in terms of the kidney?
A
More anterior than lateral margins
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
- Retroperitoneal
- Enter posterolateral aspect of bladder
- Anterior to iliac vessels
19
Q
What is the size of the ureters?
A
2 to 8 mm diameters and ~30 cm in length
20
Q
Where is the location of the bladder in relation to the symphysis pubis?
A
posterior
21
Q
What is the location of the bladder in relation to the prostate?
A
Superior
22
Q
What is the location of the bladder in relation to the rectum?
A
Anterior
23
Q
What is the location of the bladder in relation to the uterus?
A
Anterior
24
Q
Which space does the bladder lie?
A
Extraperitoneal space
25
Where is the bladder locations? 2
1. Empty true pelvis
2. Distended: extendes into false pelvis/ abdomen
26
What is the shape of the Kidney? What is the Lateral aspect like? What is the medial aspect live? 4
1. Bean shaped
2. reniform
3. Lateral aspect is convex
4. Medial aspect is concave
27
What is the size of the kidney? 3
1. Length: 9-12 cm
2. Width: 4-5 cm
3. AP: 3 cm
28
The length of the kidneys should be within how much of each other in terms of size?
1.5 - 2 cm of each other
29
Which kidney is usually longer?
Left
30
What is the supportive structure of the kidney? 4
1. Fibrous capsule
2. Perirenal fat
3. Renal fascia
4. Pararenal fat
31
The fibrous capsule is what kind of reflector?
Specular
32
What is the perirenal fat continous with?
Renal sinus
33
What does the renal fascia do? 2
1. Anchor kidney to the posterior abdominal wall
2. Separates the perirenal space from the pararenal spaces
34
What is ptosis?
KIdney falls when fascia tears
35
What are the two distinct areas of the kidney? 2
1. Parenchyma
2. Sinus
36
What is the parenchyma?
Functional tissue of the kidneys, divided into cortex and medulla
37
What is the cortex of the kidney? What did it produce?
Outer portion below renal capsule, which is the site of urine production which contains the neprhons
38
The cortex arches over and extends between what?
The pyramids
39
What are the columns of cortex also known as?
Columns bertin
40
Each columns of bertin contains what?
interlobar artery and vein
41
What is the medulla of the kidney? What does it contain? Where does the base points towards? What does the Apices point toward?
Inner portion of kidney which contains
1. Pyramids
2. 8-18
3. Base towards cortex
4. Apices towards sinus - open into minor calyx
42
What is the sinus of the kidney? What is it continuous with? What does it contain?
1. Fatty central portion
2. Continuous with perirenal fat
3. Contains the calyces, renal pelvis, vessels, and nerves
43
What is the renal hilum the entrance of ?
Entrance into sinus
44
From anterior to posterior what is the structure of the renal hilum?
1. Renal vein
2. Renal artery
3. Ureter
45
What are the dimensions of the ureters?
Long mucosal lined tubes 30-34 cm long and 2-8 mm in diameter
46
Which ureter is shorter?
Right
47
What are 3 natural areas of narrowing of the ureters?
1. UPJ
2. Crossing pelvic brim anterior to iliac vessels
3. UVJ
48
What is the size the urinary bladder? 3
1. Size and shape depended on urine volume
2. Capacity: 300-500 ml
3. Post void <100ml not significant
49
Where is the trigone of the bladder located? What is the trigone of the bladder? 2
1. Located on the posterior surface of the base of the bladder
2. Triangular shaped area between the openings of the ureters and urethra
50
Is the shape and position of the trigone constant or variable?
Constant
51
What is the bladder neck? What is its shape and position, constant or variable? 2
1.Urethral orifice
2. Constant shape and position
52
What is the apex of the bladder? What is it the site of attachment for?
1. Most anterior and superior portion of the bladder
2. Site of median umbilical ligament attachment
53
What are the four layers of the bladder?
1. Mucosa - rugae
2. Submucosa - connective tissue
3. Muscle - detrusor muscle
4. Serosa - peritoneum covering superior surface
54
What is the wall thickness of the bladder? Distended and non distended.
1. Distended: 3 mm
2. Non distended: 6 mm
55
What is the urethra?
Membranous canal exiting the bladder at the trigone
56
In females the urethra canal pierces what?
Urogenital diaphragm
57
In males the urethra is how long compared to females?
Longer
58
What is the three areas of the male urethra?
1. Prostatic
2. Membranous
3. Penile
59
Renal arteries arise from what aspect of the arteries?
Lateral aspect of the aortas
60
Renal arteries divide into several what?
Segmental branches before entering the hilum
61
Segmental arteries branch into what?
Interlobar arteries which travels between the pyramids
62
Interlobar arteries branch into what?
Arcuate arteries, at the base of the pyramids
63
Arcuate arteries branch into what?
Interlobular arteries which travel into the renal cortex
64
Interlobular arteries branch into what?
Afferent arterioles, which carry blood into the glomerulus of the nephrons
65
What is the sonographic appearance of the renal capsule?
Echogenic line
66
What is the echogenic appearance of the cortex?
1. Homogeneous, even thickness
2. Echogenicity = or slightly < than liver
67
What is the sonographic appearance of the Medulla?
1. Triangular, hypoechoic areas, evenly spaced (equidistant)
68
What is the CM junction the location of?
Location of arcuate arteries
69
Wha it’s the sonographic appearance of the sinus? What does over hydration do in terms of imaging? 2
1. Highly echogenic central area
2. Overhydration - small echolucent areas
70
What is he sonographic appearance of the vessels?
1. Linear anechoic tubes best assessed in transverse on the body
71
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?
1. More echogenic compared to the liver
2. Thin compared to pyramids
3. Lobulated
72
What is the sonographic appearance of the pyramids of the neonates? 2
1. Hypoechoic
2. Large
73
What is the sonographic apperance of the neonate sinus?
1. Indistinct due to very little fat
74
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)
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
What is the sonographic appearance of the bladder? What is the shape of it in transverse? What is the distended appearnce of the wall?
1. Appears cystic/ anechoic
2. In transverse: appears rounded
3. When distended, wall should appear thin and smooth (check for irregularities)
76
In the transverse plane if we point Inferiorly at the bladder how would it look?
squared
77
What is the dromedary hump? What is it's appearnce? what do we need to do to rule out a mass?
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
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?
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
What is fetal lobulation? What does the cortex look like? How many adults are identified with this varient? 4
1. Renal variant
2. Infolding of cortex but no thinning
3. Scalloped contour
4. Identified 51% of adults
80
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?
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
What type of transducer do we use for renal scans?
2 to 6 MHz transducer
82
How should the patient lie during renal scan?
1. Supine
2. Decubitus
3. Oblique patient position
83
What kind of planes should we use for renal scans?
1. Sagittal
2. Coronal
3. Transverse views
84
What is a tip for scanning the right kidney? 2
1. Use liver as window
2. Subcostal/ intercostal
85
What are some tips for left kidney images?
1. Decubitus/ oblique
2. Spleen as window
86
What are some techniques to optimize urinary images? 3
1. Various breathing techniques
2. Change patient position
3. Change windows
87
The kidneys lie in what plane?
Oblique plane
88
Vessels are best seen in what plane?
Transverse plane of the kidney
89
The echogenicity of the RK is compared to what? And the Left is compared to what?
Liver and the spleen
90
The ureters are best imaged in what plane?
Long axis
91
How do we move bowel gas away during scans?
Use graded compression
92
What planes do we image the kidney?
1. Sagittal and transverse
2. Full bladder required
93
If we see dilated ureters/ hydronephrosis - what should we do?
Check for jets
94
For some renal scans what kind of measurements do we need for the bladder?
Pre and post void volumes
95
Cystoscope is best to evaluate what?
Bladder
96
What is the patient prep for kidney/ ureter exams? Why?
1. NPO 6 - 12 hours
2. Minimizes bowel gas
97
What is the Patient prep for the bladder?
1. Full bladder required
2. 1 Liter of water 1 hour before test
98
How many images of the kidney will we take?
1. 3 sagittal
2. 3 transverse
99
For the 3 sagittal images, what additional stuff should we do?
1. Measure length
2. Hilum
3. Lateral edge
100
For the 3 transverse images of the kidney, what additional images do we need to take?
1. Both poles with even cortex
2. Hilum with vessels
101
The muscle that lies directly posterior the kidney is called what?
Quadratics laborum
102
The tissue that anchors the kidneys is called what?
Renal fascia
103
What branch of the renal arterial system drapes over the pyramids?
Arcuate
104
The kidneys remove ________ by producing ___________
Metabolic waste by producing urine
105
What does the kidneys do? 3
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
How much fluids does the kidneys process in a day?
~ 180 L
107
What is the functional unit of the kidney?
Nephron
108
What does the nephron do?
Filters blood and produces urine
109
What are the two types of nephrons?
1. Juxtamedullary (deep)
2. Cortical (superficial)
110
What are the two main components of the nephron?
1. Renal corpuscle
2. Renal tubule
111
What are components of the renal corpuscle? 2
1. Glomerulus
2. Bowman’s capsule
112
What is the components of the renal tubules ? 4
1. PCT
2. DCT
3. Loop of henle
4. Collecting duct
113
What is the function of the nephron? 3
1. Control blood concentration and volume
2. Help regulate blood pH
3. Removes toxic wastes from blood (osmosis and active transports)
114
How does blood reach the nephron? 6
1. Renal artery
2. Interlobar artery
3. Arcuate artery
4. Interlobular artery
5. After ent arterioles
6. Glomerulus
115
What is the three steps of urine formation?
1. Filtration
2. Reasoprtion
3. Secretion
116
During tubular reabsorption nutrients are reabsorbed back into what?
Bloodstream. (Water, glucose, vitamins and other nutrients)
117
Where does tubular reabsorption occur in? Via what?
1. PCT, descending and ascending loop of henle
2. Via pertiubular capillary
118
Waste is secreted into what? What does this do?
DCT. This rids the body of certain substances and helps control pH
119
What is ADH (Antidiuretic hormone) secreted by? What doe sit help the body do? How?
1. Secreted by posterior pituitary
2. Aids in retaining water in the body
3. Decrease in blood volume stimulates ADH production
120
What is aldosterone secreted by? What does it control? What is it stimulated by? What is it influenced by?
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
What is renin? What is it secreted by? What does it respond to?
1. Secreted by the juxtaglomerular apparatus
2. Acts as a catalyst
3. Responds to a decrease in blood pressure
122
Renin stimulates the formation of what?
Angiotensin
123
Angiotensin stimulates the release of what?
Aldosterone
124
Where is the juxtaglomerular apparatus located?
At the point where the DCT, afferent and efferent arterioles come into contact
125
What does granular cells (afferent arterioles) release? What’s does DCT inhibit the release of? What does the juxtaglomerular apparatus do?
1. Granular cells (afferent arterioles) release renin
2. Macular dense cells (DCT) inhibit renin release
3. Regulates blood pressure
126
Renal failure causes what to accumulate in the blood?
Waste products
127
How much loss of renal function before the blood tests are elevated?
60%
128
What is the Serum creatinine? How does it appear?
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
What is the blood urea nitrogen (BUN)
End product of protein metabolism
130
Where is blood urea nitrogen (BUN) formed?
F liver from ammonia
131
Blood urea nitrogen (BUN) is readily excreted by what?
Kidneys
132
What does the blood urea nitrogen (BUN) reflect?
Protein intake and renal excretory capacity
133
What does increased blood urea nitrogen mean?
Renal dysfunction and dehydration
134
What does Decreased blood urea nitrogen mean?
Hepatic damage, malnutrition, over hydration
135
Increased levels of serum creatinine are seen with what? 3
1. Renal failure
2. Chronic nephritis
3. Urinary tract obstruction
136
What does increase/ decrease of serum electrolytes usually mean? 2
1. Increase in acute renal failure and glomerulonephritis
2. Decreased in chronic and acute renal failure
137
What is included in serum electrolytes? 4
1. Chloride
2. Potassium
3. Sodium
4. Bicarbonate
138
What are some urine test? 6
1. Red blood test
2. White blood test
3. Pyuria
4. Proteinuria
5. PH
6. Specific gravity
139
What does the red blood cell test tell us? 3
1. Hematuria
2. Any amount of abnormal
3. Inflammation, tumours, calculate
140
What does the white blood cell test tell us?
Indicates infection, inflammation
141
What does the pyuria test tell us?
Pus in urine, indicates infection
142
What does the proteinuria test tell us? Is this normal? What did this mean?
1. Protein in urine
2. Even trace amounts abnormal
3. Nepthritis, polycystic disease, stones, carcinoma
143
What does the blood pH test tell us?
1. Alkalinity or acidity
2. Formation of stones
144
What does the specific gravity test tell us? 3
1. Measures ability to concentrate urine
2. Decreased levels in renal failure
3. Increased levels with decreased urine output (dehydration)
