Urinary tract Flashcards
Each ureter usually measures _____ long; diameter of _____ but is narrower at three sites ____, ___, ___.
25-30 cm long
3mm
> The junction of the pelvis and ureter.
The pelvic brim
The intravesical ureter where it runs through the muscular bladder
wall.
a pyramidal muscular organ when empty. It has a triangular-shaped base
posteriorly.
Urinary bladder
ncomplete fusion of upper and lower pole
moieties resulting in complete or incomplete duplication of the
collecting system
Dulex collecting system
duplex collecting system - a duplex kidney draining into:
___ ureter - i.e. duplex kidney’s duplication pelvicalcyeal systems
uniting at the pelvi-ureteric junction (PUJ)
___ ureter (ureter fissus) - two ureters that unite before emptying into
the bladder
___ ureter (complete duplication) two ureters that drain separately
into the bladder or genital tract
single
bifid
double
Orthotopic ureter
ectopic urter
Orthotopic ureter: drains lower pole and
enters bladder near trigone
Ectopic ureter: drains upper pole and enters
bladder inferiorly and medially (WeigertMeyer rule); the ectopic ureter may be
stenotic and obstructed
Drooping lily sign
a urographic sign of duplicated renal collecting system. It refers to the inferolateral displacement of the opacified lower pole moiety due to an obstructed (and relatively unopacified) upper pole moiety.
Weigert-Meyer
law.
n duplicated collecting system it is classically the upper pole ureter that is obstructed due to a ureterocoele and the lower pole ureter that refluxes
Most common congenital anomaly of th GUT in neonates.
Intrinsic, 80%: defect in circular muscle bundle
of renal pelvis
• Extrinsic, 20%: renal vessels (lower pole artery
or vein)
Congenital ureteropelvic junction
(UPJ) obstruction
s an incidental finding which mimics hydronephrosis. It is a result of
underdevelopment of the renal medullary pyramids with resultant
enlargement of the calyces.
Congenital megacalyces
Congenital megacalyces is more frequently seen in _____ (M/F).
Males
The renal pelvis is of normal size helping to distinguish _____
from hydronephrosis.
In addition to enlargement of the calyces there is often also polycalycosis (increased number of calyces); they are crowded and multifaceted with a mosaic-like appearance.
Congenital ,egacalyces
Outpouching of calyx into corticomedullary region.
(PYELO)Calyceal diverticulum
(PYELO)Calyceal diverticulum
Type I: originates from
• Type II: originates from
• Type III: originates from
minor calyx
infundibulum
renal pelvis
Imahing features of (PYELO) Calyceal diverticulum
Cystic lesion connects through channel with collecting
system.
• If the neck is not obstructed, diverticula opacify retrograde from the
collecting system on delayed IVP films.
• May contain calculi or milk of calcium, 50%
This imaging feature on sonography is pathognomic of a
pyelocalyceal diverticulum.
presence of mobile, echogenic and
dependent layering due to milk of
calcium
Renal papillary necrosis (RPN)
represents an ischemic coagulative necrosis involving variable
amounts of pyramids and medullary papillae.
Classical imaging features of RPN includes:
ball on tee forniceal excavation lobster claw signet ring sloughed papilla with clubbed caly
Pyonephrosis
infection of the renal pelvic system
which can then subsequently get filled with pus and is then
complicated by obstruction.
he diagnosis of pyonephrosis is suspected when the clinical
symptoms of fever and flank pain are combined with the radiologic
evidence of obstruction to the urinary tracts 1
.
Most reliable sign in diagnosing pyonegrosis in ultrsaound
echogenic collecting system debris
other features:
fluid-fluid levels within the collecting system
incomplete (dirty) echoes of collecting system gas can be
occasionally seen.
A sensitive indicator of pyonephrosis in CT
infection with hydronephrosis
ther features:
thickening of the renal pelvic wall (>2 mm)
parenchymal or perinephric inflammatory changes, dilatation and
obstruction of the collecting system, higher than usual attenuation
values of the fluid within the renal collecting system, and layering of
contrast material above and anterior to the purulent fluid on
excretory studies.
Ectopic ureter
Ureter does not insert in the normal location in the trigone of the
bladder
Can detect and grade ectopic ureter
VCUG
herniation of the distal ureter into the bladder
ureterocele
Enlarged ureter
Megaureter
Types of megaureter
obstructed primary megaureter
refluxing primary megaureter (although vesico-ureteric reflux (VUR) is
a cause of primary congenital megaureter it is usually considered
separately)
non-refluxing unobstructed primary megaureter
Define / describe obstructive primary megaureter
Obstructive primary megaureter is related to a distal adynamic
segment with proximal dilatation, and is a common cause of
obstructive uropathy in children It is analogous to oesophageal
achalasia or colonic Hirschsprung disease although lack of ganglion
cells within the wall of the ureter has not been proven to be the
cause .
Define / describe refluxing megaureter
Refluxing primary megaureter is a result of an
abnormal vesico-ureteric junction, which
impedes the normal anti-reflux mechanisms. This
can be due to a short vertical intramural
segment, congenital paraureteric diverticulum,
ureterocoele with or without associated
duplicated collecting system etc..
Define / describe non-refluxing unobstructed primary megaureter
most common cause of primary megaureter
in neonates, and even though the vesicoureteric junction is normal,
with no evidence of reflux or obstruction the ureter is enlarged. The
cause for this is unknown.
the term for abnormal flow of urine
from the bladder into the upper urinary tract and is typically a
problem encountered in young children
VUR Vesicoureteral reflux
Primary diagnostic procedure for evaluation of VUR.
Imaging of presence and grade VUR
VCUG voiding cystourethrogram (
VUR grading
Grade I: • Grade II: • Grade III: • Grade IV: • Grade V:
Grade I: reflux to ureter but not to kidney
• Grade II: reflux into ureter, pelvis, and
calyces without dilatations
• Grade III: reflux to calyces with mild
dilatation,blunted fornices
• Grade IV: to calyces with moderate
dilatation,obliteration of fornices
• Grade V: gross dilatation, tortuous ureters
Describe / define urolithiasis
presence of calculi anywhere along the course of
the urinary tracts.
most common stone is calcium oxalate
