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ABDOMINAL I21 > URINARY WORKBOOK EX 4-11 > Flashcards

URINARY WORKBOOK EX 4-11 Flashcards

1
Q

The urinary system has two principal functions: excreting _____ and regulating the composition of _____.

A

wastes, blood

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2
Q

the right kidney lies slightly _____ than the left kidney because the large right lobe of the _____ pushes it ______.

A

Lower, liver, inferiorly

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3
Q

the kidneys move with respiration; on deep inspiration, both kidneys move ______ approximately 1 inch.

A

downward

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4
Q

Within the hilus of the kidney are other _____ structures, a ureter, and the _______

A

vascular, lymphatics

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5
Q

A fibrous capsule called the ______ surrounds the kidney.

A

true capsule

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6
Q

Outside of this fibrous capsule is a covering of _______

A

perinephric fat

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7
Q

The _____ fascia surrounds the perinephric fat and encloses the kidneys and adrenal glands.

A

perinephric

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8
Q

The renal fascia, known as ______fascia, surrounds the true capsule and perinephric fat.

A

Gerota’s

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9
Q

The medullary substance consists of a series of striated conical masses, called the renal _____

A

pyramids

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10
Q

A nephron consists of two main structures, a renal _____ and a renal _____

A

corpuscle, tubule

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11
Q

Nephrons ____ the blood and produce _____

A

blood, urine

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12
Q

The renal corpusle consists of a network of capillaries, called the _____, which is surrounded by a cuplike structure known as ________

A

glomerulus, Bowman’s capsule

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13
Q

Blood flow into the glomerulus through a small ______ arteriole and leaves the golmerulus through a(n) _______ arteriole.

A

afferent, efferent

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14
Q

There are three constrictions along the ureter’s course (1) _______,(2) ______,and (3) ________

A
  1. Where the ureter leaves the renal pelvis,2. Where it is kinked as it crosses the pelvic brim3. where it pierces the bladder wall
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15
Q

The main renal artery is a lateral branch of the aorta and arises just inferior to the ________ artery.

A

superior mesenteric

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16
Q

The renal vein drains into the ______ of the inferior vena cava.

A

lateral wall

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17
Q

The urinary system is located posterior to the peritoneum lining and the abdominal cavity in an area called the ______

A

retroperitoneum

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18
Q

The kidneys adjust the amounts of _____ and ______ leaving the body so that these equal the amounts of substances entering the body.

A

water. electrolytes

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19
Q

The principle metabolic waste products are ____, _____ and nitrogenous wastes.

A

water, carbon dioxide

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20
Q

Both urea and uric acid are carried away from the liver into the kidneys by the ______ system.

A

vascular

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21
Q

The presence of an acute infection causes _____, which is ____ in the urine; pyuria means there is _____ in the urine.

A

hematuria, RBC, pus

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22
Q

The pH refers to the strength of the urine as a partly ____ or _____ solution.

A

acidic, alkaline

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23
Q

The ________ is the measurement of the kidney’s ability to concentrate urine.

A

specific gravity

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24
Q

The specific gravity is especially ______ in cases of renal failure, glomerular nephritis, and pyelonephritis

A

low

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25
Q

A decreased ______ occurs with acute hemorrhagic processes secondary to disease or blunt trauma.

A

hematocrit

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26
Q

Impairment of renal function and increased protein catabolism results in BUN _____ that is relative to the degree of renal impairment and rate of urea nitrogen excreted by the kidneys.

A

elevation

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27
Q

The renal parenchyma surrounds the fatty central renal sinus, which contains these five structures:

A

calyces infundibula pelvis vesselslymphatics

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28
Q

Dilation of the collecting system has also been noted in ____ patients, especially the right kidney.

A

pregnant

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29
Q

The ________ and _______ arteries are best demonstrated as intense specular echos in cross section or oblique section at the corticomedullary junction.

A

arcuate arteries, interlobar

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30
Q

The ______is the area from the renal sinus to the outer renal surface.

A

parenchyma

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31
Q

The _____ generally is echo producing, whereas the meduallary pyramids are ______

A

cortex, hypoechoic

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32
Q

The cortex and medullary pyramids are separated from each other by bands of cortical tissue, called ________, that extend inward to the renal sinus.

A

column’s of Bertin

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33
Q

The ____ lie posterior to the renal arteries and should be identified by their lack of pulsations and absence of Doppler flow.

A

Crura

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34
Q

The ____ of the pyramids points towards the sinus, and the _____ lies adjacent to the renal cortex.

A

Apex, base

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35
Q

The ________ is a cortical bulge that occurs on the lateral border of the kidney, typically more on the left side

A

dromedary hump

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36
Q

A(n) _______ is a triangular, echogenic area in the upper pole of the renal parenchyma that can be seen during normal scanning.

A

junctional parenchymal defect

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37
Q

In a patient with a(n) _______, there is fusion of the kidneys during fetal development that almost invariably involves the _____ poles.

A

horseshoe kidney, lower

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38
Q

A cystlike enlargment of the lower end of the ureter is called _______

A

ureterocele

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39
Q

a cystic mass presents sonographically w/ several characteristic features:

A

-Smooth, thin, well-defined border -round or oval shape -sharp interface btwn cyst and renal parenchyma -anechoic w/ ↑ posterior acoustic enhancement

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40
Q

Renal stones have very ____ foci with posterior acoustic sha

A

Echogenic

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41
Q

If the stone causes obstruction, there will be ____ and, depending on the location of the stone, the ureter may be dilated____ to the level of obstruction.

A

Hydronephrosis, superior

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42
Q

____ entails herniation of all layers of the bladder wall and is located in the posterior angle of the trigone.

A

Congenital Diverticulum

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43
Q

___ diverticula are herniations of only the two inner layers through the muscle layer.

A

Acquired

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44
Q

____ is usually secondary to another condition that causes stasis of the urine in the bladder.

A

Cystitis

45
Q

The majority of bladder tumors in adults are ____ carcinoma.

A

Transitional Cell

46
Q

Sonographically, it is difficult to differentiate between a(n) _____ cyst and a small adjacent cortical cyst.

A

Septated

47
Q

The parapelvic cyst is found in the ____ but does not communicate with the renal collecting system.

A

Renal hilum

48
Q

Name the four forms of autosomal recessive polycystic kidney disease. (ARPKD)

A

Perinatal, neonatal, infantile, and juvenile

49
Q

Usually a(n) ____ renal contour is the first finding that a mass may be present and requires further treatment.

A

Abnormal

50
Q

One of the most common benign renal tumors is called ____.

A

Adenoma

51
Q

An uncommon benign renal tumor composed mainly of fat cells and commonly found in the renal cortex is _____.

A

Angiomyolipoma

52
Q

A(n) ____ appears as a well-defined echogenic mass, found more often in females.

A

Lipoma

53
Q

Sonographic findings include one or more fluid spaces at the ____ junction that corresponds to the distribution of the renal pyramids.

A

Corticomedullary

54
Q

Although the kidneys appear enlarged with a highly echogenic renal sinus, the intrarenal anatomy is preserved with uniform loss of renal tissue in patients with _____.

A

Renal atrophy

55
Q

The most common medical renal disease that produces acute renal failure is _____.

A

Acute Tubular Necrosis

56
Q

Chronic renal disease is loss of renal ____ as a result of disease, most commonly parenchymal disease.

A

Function

57
Q

There are 3 primary types of chronic renal failure: _____, _____ and _____.

A

Nephron, vascular, and interstitial abnormalities

58
Q

____ is when the dilated pyelocalyceal system appears as separation of the renal sinus echoes by fluid-filled areas that conform anatomically to the infundibula, calcyes, and renal pelvis.

A

Hydronephrosis

59
Q

A localized hydronephrosis occurs as a result of ____, calculi, _____, or the ____.

A

Strictures, focal masses, duplex collecting system

60
Q

Hydronephrosis with a dilated ureter and bladder indicates obstruction of the ____ junction or of the ____.

A

Ureterovesical, urethra

61
Q

If hydronephrosis is suspected, the sonographer should evaluate the ____.

A

Bladder

62
Q

Name two conditions that might mimic hydronephrosis.

A

peripelvic cyst- (the septations may be numerous) extrarenal pelvis - would protrude outside of the renal area,-(renal vessels in the peripelvic area also mimic hydronephrosis. (Color flow Doppler is extremely useful.)

63
Q

Describe the sonographic findings in acute obstruction.

A

* Resistive index of intrarenal vessels may be > 0.70 for 48 to 72 hours after obstruction. * The RI returns to normal. * No ureteral jet will be present on the affected side, or flow will be decreased if the obstruction is partial.

64
Q

Ureteral jets are best visualized by ____ imaging.

A

Color doppler

65
Q

When pus is found within the obstructed renal system, the condition is called _____.

A

Pyonephrosis

66
Q

_____ is a diffuse foci of calcium deposits, which is usually located in the medulla and infrequently can also be seen in the renal cortex.

A

Nephrocalcinosis

67
Q

A renal ____ occurs when part of the tissue undergoes necros

A

Infarction

68
Q

The major problem encountered with renal transplantation is ____.

A

Graft Rejection

69
Q

Early after surgery, a baseline sonographic examination is performed to determine ____, _____, and _____.

A

Renal size, calycealpattern, extrarenal fluid collections

70
Q

Perirenal fluid collections, such as ____, ____, ____, or ____ can be diagnosed reliably and differentiated from acute rejection.

A

Hematoma, abscess, lymphocele, urinoma

71
Q

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

A

Hyperacute

72
Q

____ rejection occurs within days to months after transplant.

A

Acute

73
Q

_____ rejection causes include performed antibiodies, immune complexes, and cell-mediated responses.

A

Immunologic

74
Q

____ rejection can occur months after transplantation with gradual onset.

A

Chronic

75
Q

The incidence of acute tubular necrosis is usually higher in ____ transplants than in ____ transplants.

A

Cadaveric, donor-relative

76
Q

Early signs of obstruction are ___ or severe ___ in a patient with satisfactory renal volumes.

A

Anuria, oliguria

77
Q

Renal artery stenosis exhibits a(n) ____ jet with distal turbulence.

A

High-velocity

78
Q

____ Doppler is not angle dependent and has a greater sensitivity to detect blood flow.

A

Power

79
Q

The initial clinical sign of a kidney stone is extreme ____,

A

Pain

80
Q

Discuss the characteristics of autosomal dominant polycystic kidney disease (ADPKD)

A
  • -common genetic disease men & women.
  • -progressive (start age 40-50) -50% age 60 has end-stage renal disease
  • -severity varies w/ genotype.
  • -most common is PKD1 (16th chromosome), severely affects kidneys (more than PKD2 (4th chromosome).
  • -spontaneous mutations (no genetic marker to ADPKD)
  • -Clinical S/: pain**, ↑BP, palpable mass, hematuria, headache, UTI, & renal insufficiency.
  • -bilateral w/ multiple cysts in cortex & medulla
  • varied size and shape.
81
Q

Define the characteristics of renal cell carcinoma.

A
  • -most common renal tumors (85%).
  • -2x more common in males - 60-70 years old
  • -classic presentation: nonspecific; may experience hematuria, flank pain, and palpable mass.
  • -bilateral is rare
    • ↑ incidence w/ von Hippel–Lindau disease long-term dialysis.
82
Q

When using ultrasound to help diagnose rejections, care must be taken to visualize these 5 things:

A
  • -The size and shape of the kidneys
  • -appearance of pyramids, cortex, and parenchyma
  • -presence of any surrounding fluid collections
83
Q

**WB IMAGE** list the anatomic structures shown to arise from the IVC in this coronal image

A

The renal veins arise from the IVC in this image.

84
Q

**WB IMAGE** What structure are the arrows pointing to?

A

crura of the diaphragm

crura lie posterior to the renal arteries and can be identified by their lack of pulsatility, and Doppler flow

85
Q

**WB IMAGE** what anatomic variation of the kidney are the arrows pointing to?

A

column of Bertin.

86
Q

**WB IMAGE**what anatomic variant is shown in this image?

A

A dromedary hump

a coritcal bulge that occurs on the lateral border of the kidney (usually left)

87
Q

**WB IMAGE** Name the structure the arrow is pointing to

A

junctional parenchymal defect.

88
Q

** WB IMAGE** describe the sonographic finding in this transverse and longitudinal image of the kidney

A

renal sinus lipomatosis.

appears as enlarged kidneys with an echogenic, enlarged sinus and thin cortical rim.

89
Q

**WB IMAGE** what pathology is shown on these longitudinal scans of both kidneys of a young adult male

A

extrarenal pelvis.

appears as a cystic area that extends beyond the confines of the renal borders (color Doppler confirms the extrarenal pelvis)

90
Q

**WB IMAGE** 66 year old male presents w/ an incidental finding on his abdominal ultrasound. what pathology do the images demonstrate?

A

Renal cyst with good transmission

91
Q

**WB IMAGE** a 14 month old child presents w/ a palpable right sided mass, decreased appetite, and lethargy. What is the sonographic finding?

A

Wilms’ tumor (nephroblastoma)

  • a large Wilms tumor (M) extending from the right kidney (KID) into the IVC.*
  • on coronal scan D, tumor mass is seen w/in IVC*
  • (Pt is slight decubitus for better imaging of the IVC and Aorta (Ao).*
92
Q

**WB IMAGE** a 6 year old male presents with chronic urinary tract infections. what is the ultrasound finding?

A

Medullary sponge kidney

Medullary sponge kidney show nephrocalcinosis and stone formation

93
Q

**WB IMAGE** does this patient have hydronephrosis? explain why or why not

A

No, this patient does not have hydronephrosis. The hyperechoic pyramids are consistent with nephrocalcinosis. There is a large stone with shadowing.

94
Q

**WB IMAGE** a yound adult male presents with flank pain after renal transplant surgery. what are the sonographic findings?

A

These images show normal ureteral jets in the fluid-filled bladder.

95
Q

**know this diagram**

A

**know this diagram**

96
Q

anatomic structures related to the anterior surface of the kidneys

A
97
Q

Kidneys (relational anatomy)

Anterior to the right kidney

  • Right adrenal gland and liver
  • Morison’s pouch
  • Second part of the duodenum
  • Right colic flexure

Anterior to the left kidney

  • Left adrenal gland
  • Spleen, stomach, and pancreas
  • Left colic flexure
  • Coils of jejunum
A
98
Q

vascular relationship of great vessels and their tributaries to the kidneys

A
99
Q

Dilation of the kidney or ureter or both occurs superior to the obstruction, true or false?

A

true

100
Q

*What is the most common correctable cause of hypertension?

A

Renal artery stenosis (RAR)

101
Q

*True or false? a basline US can be done as early as 48 hours after transplant to evaluate renal size, calyceal pattern, and extraranal fluid collections

A

True

102
Q

*complete obstruction demonstrates an _____ of ureteral jet

partial obstruction shows a __ ___ jet on the side of teh obstruction or an asymmetry of the ureteral jets or both

A

obstruction

low-level

103
Q

*what may cause dilation of the renal pelvis?

A
  • polyuria
  • distended bladdder
  • reflux
  • pregnancy
  • atrophy after obstruction
104
Q

*grade 4 hydronephrosis is characterized by:

A
  • prominent dilation of the collecting system
  • thinning of the renal parenchyma
  • lack of differentiation btwn collecting system and renal parenchyma
105
Q

*herniation of the bladder wall?

A

diverticulum

106
Q

*after voiding the bladder, __ cc of urine is considered normal in the adult

A

20

107
Q

true or false? a complication of (nephroblastoma) Wilm’s tumor is spreading into the IVC

A

true

108
Q

*what are the 4 perinephric fluid collections?

A

hematoma, abscess, urinoma, lymphocele

ABDOMINAL I21 (11 decks)

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