URINARY WORKBOOK EX 4-11 Flashcards
The urinary system has two principal functions: excreting _____ and regulating the composition of _____.
wastes, blood
the right kidney lies slightly _____ than the left kidney because the large right lobe of the _____ pushes it ______.
Lower, liver, inferiorly
the kidneys move with respiration; on deep inspiration, both kidneys move ______ approximately 1 inch.
downward
Within the hilus of the kidney are other _____ structures, a ureter, and the _______
vascular, lymphatics
A fibrous capsule called the ______ surrounds the kidney.
true capsule
Outside of this fibrous capsule is a covering of _______
perinephric fat
The _____ fascia surrounds the perinephric fat and encloses the kidneys and adrenal glands.
perinephric
The renal fascia, known as ______fascia, surrounds the true capsule and perinephric fat.
Gerota’s
The medullary substance consists of a series of striated conical masses, called the renal _____
pyramids
A nephron consists of two main structures, a renal _____ and a renal _____
corpuscle, tubule
Nephrons ____ the blood and produce _____
blood, urine
The renal corpusle consists of a network of capillaries, called the _____, which is surrounded by a cuplike structure known as ________
glomerulus, Bowman’s capsule
Blood flow into the glomerulus through a small ______ arteriole and leaves the golmerulus through a(n) _______ arteriole.
afferent, efferent
There are three constrictions along the ureter’s course (1) _______,(2) ______,and (3) ________
- Where the ureter leaves the renal pelvis,2. Where it is kinked as it crosses the pelvic brim3. where it pierces the bladder wall
The main renal artery is a lateral branch of the aorta and arises just inferior to the ________ artery.
superior mesenteric
The renal vein drains into the ______ of the inferior vena cava.
lateral wall
The urinary system is located posterior to the peritoneum lining and the abdominal cavity in an area called the ______
retroperitoneum
The kidneys adjust the amounts of _____ and ______ leaving the body so that these equal the amounts of substances entering the body.
water. electrolytes
The principle metabolic waste products are ____, _____ and nitrogenous wastes.
water, carbon dioxide
Both urea and uric acid are carried away from the liver into the kidneys by the ______ system.
vascular
The presence of an acute infection causes _____, which is ____ in the urine; pyuria means there is _____ in the urine.
hematuria, RBC, pus
The pH refers to the strength of the urine as a partly ____ or _____ solution.
acidic, alkaline
The ________ is the measurement of the kidney’s ability to concentrate urine.
specific gravity
The specific gravity is especially ______ in cases of renal failure, glomerular nephritis, and pyelonephritis
low
A decreased ______ occurs with acute hemorrhagic processes secondary to disease or blunt trauma.
hematocrit
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.
elevation
The renal parenchyma surrounds the fatty central renal sinus, which contains these five structures:
calyces infundibula pelvis vesselslymphatics
Dilation of the collecting system has also been noted in ____ patients, especially the right kidney.
pregnant
The ________ and _______ arteries are best demonstrated as intense specular echos in cross section or oblique section at the corticomedullary junction.
arcuate arteries, interlobar
The ______is the area from the renal sinus to the outer renal surface.
parenchyma
The _____ generally is echo producing, whereas the meduallary pyramids are ______
cortex, hypoechoic
The cortex and medullary pyramids are separated from each other by bands of cortical tissue, called ________, that extend inward to the renal sinus.
column’s of Bertin
The ____ lie posterior to the renal arteries and should be identified by their lack of pulsations and absence of Doppler flow.
Crura
The ____ of the pyramids points towards the sinus, and the _____ lies adjacent to the renal cortex.
Apex, base
The ________ is a cortical bulge that occurs on the lateral border of the kidney, typically more on the left side
dromedary hump
A(n) _______ is a triangular, echogenic area in the upper pole of the renal parenchyma that can be seen during normal scanning.
junctional parenchymal defect
In a patient with a(n) _______, there is fusion of the kidneys during fetal development that almost invariably involves the _____ poles.
horseshoe kidney, lower
A cystlike enlargment of the lower end of the ureter is called _______
ureterocele
a cystic mass presents sonographically w/ several characteristic features:
-Smooth, thin, well-defined border -round or oval shape -sharp interface btwn cyst and renal parenchyma -anechoic w/ ↑ posterior acoustic enhancement
Renal stones have very ____ foci with posterior acoustic sha
Echogenic
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.
Hydronephrosis, superior
____ entails herniation of all layers of the bladder wall and is located in the posterior angle of the trigone.
Congenital Diverticulum
___ diverticula are herniations of only the two inner layers through the muscle layer.
Acquired
____ is usually secondary to another condition that causes stasis of the urine in the bladder.
Cystitis
The majority of bladder tumors in adults are ____ carcinoma.
Transitional Cell
Sonographically, it is difficult to differentiate between a(n) _____ cyst and a small adjacent cortical cyst.
Septated
The parapelvic cyst is found in the ____ but does not communicate with the renal collecting system.
Renal hilum
Name the four forms of autosomal recessive polycystic kidney disease. (ARPKD)
Perinatal, neonatal, infantile, and juvenile
Usually a(n) ____ renal contour is the first finding that a mass may be present and requires further treatment.
Abnormal
One of the most common benign renal tumors is called ____.
Adenoma
An uncommon benign renal tumor composed mainly of fat cells and commonly found in the renal cortex is _____.
Angiomyolipoma
A(n) ____ appears as a well-defined echogenic mass, found more often in females.
Lipoma
Sonographic findings include one or more fluid spaces at the ____ junction that corresponds to the distribution of the renal pyramids.
Corticomedullary
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 _____.
Renal atrophy
The most common medical renal disease that produces acute renal failure is _____.
Acute Tubular Necrosis
Chronic renal disease is loss of renal ____ as a result of disease, most commonly parenchymal disease.
Function
There are 3 primary types of chronic renal failure: _____, _____ and _____.
Nephron, vascular, and interstitial abnormalities
____ 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.
Hydronephrosis
A localized hydronephrosis occurs as a result of ____, calculi, _____, or the ____.
Strictures, focal masses, duplex collecting system
Hydronephrosis with a dilated ureter and bladder indicates obstruction of the ____ junction or of the ____.
Ureterovesical, urethra
If hydronephrosis is suspected, the sonographer should evaluate the ____.
Bladder
Name two conditions that might mimic hydronephrosis.
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.)
Describe the sonographic findings in acute obstruction.
* 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.
Ureteral jets are best visualized by ____ imaging.
Color doppler
When pus is found within the obstructed renal system, the condition is called _____.
Pyonephrosis
_____ is a diffuse foci of calcium deposits, which is usually located in the medulla and infrequently can also be seen in the renal cortex.
Nephrocalcinosis
A renal ____ occurs when part of the tissue undergoes necros
Infarction
The major problem encountered with renal transplantation is ____.
Graft Rejection
Early after surgery, a baseline sonographic examination is performed to determine ____, _____, and _____.
Renal size, calycealpattern, extrarenal fluid collections
Perirenal fluid collections, such as ____, ____, ____, or ____ can be diagnosed reliably and differentiated from acute rejection.
Hematoma, abscess, lymphocele, urinoma
____ rejection occurs within hours of transplantation and is caused by vasculitis leading to thrombosis and usually the loss of the graft.
Hyperacute
____ rejection occurs within days to months after transplant.
Acute
_____ rejection causes include performed antibiodies, immune complexes, and cell-mediated responses.
Immunologic
____ rejection can occur months after transplantation with gradual onset.
Chronic
The incidence of acute tubular necrosis is usually higher in ____ transplants than in ____ transplants.
Cadaveric, donor-relative
Early signs of obstruction are ___ or severe ___ in a patient with satisfactory renal volumes.
Anuria, oliguria
Renal artery stenosis exhibits a(n) ____ jet with distal turbulence.
High-velocity
____ Doppler is not angle dependent and has a greater sensitivity to detect blood flow.
Power
The initial clinical sign of a kidney stone is extreme ____,
Pain
Discuss the characteristics of autosomal dominant polycystic kidney disease (ADPKD)
- -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.
Define the characteristics of renal cell carcinoma.
- -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.
When using ultrasound to help diagnose rejections, care must be taken to visualize these 5 things:
- -The size and shape of the kidneys
- -appearance of pyramids, cortex, and parenchyma
- -presence of any surrounding fluid collections
**WB IMAGE** list the anatomic structures shown to arise from the IVC in this coronal image
The renal veins arise from the IVC in this image.
**WB IMAGE** What structure are the arrows pointing to?
crura of the diaphragm
crura lie posterior to the renal arteries and can be identified by their lack of pulsatility, and Doppler flow
**WB IMAGE** what anatomic variation of the kidney are the arrows pointing to?
column of Bertin.
**WB IMAGE**what anatomic variant is shown in this image?
A dromedary hump
a coritcal bulge that occurs on the lateral border of the kidney (usually left)
**WB IMAGE** Name the structure the arrow is pointing to
junctional parenchymal defect.
** WB IMAGE** describe the sonographic finding in this transverse and longitudinal image of the kidney
renal sinus lipomatosis.
appears as enlarged kidneys with an echogenic, enlarged sinus and thin cortical rim.
**WB IMAGE** what pathology is shown on these longitudinal scans of both kidneys of a young adult male
extrarenal pelvis.
appears as a cystic area that extends beyond the confines of the renal borders (color Doppler confirms the extrarenal pelvis)
**WB IMAGE** 66 year old male presents w/ an incidental finding on his abdominal ultrasound. what pathology do the images demonstrate?
Renal cyst with good transmission
**WB IMAGE** a 14 month old child presents w/ a palpable right sided mass, decreased appetite, and lethargy. What is the sonographic finding?
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).*
**WB IMAGE** a 6 year old male presents with chronic urinary tract infections. what is the ultrasound finding?
Medullary sponge kidney
Medullary sponge kidney show nephrocalcinosis and stone formation
**WB IMAGE** does this patient have hydronephrosis? explain why or why not
No, this patient does not have hydronephrosis. The hyperechoic pyramids are consistent with nephrocalcinosis. There is a large stone with shadowing.
**WB IMAGE** a yound adult male presents with flank pain after renal transplant surgery. what are the sonographic findings?
These images show normal ureteral jets in the fluid-filled bladder.
**know this diagram**
**know this diagram**
anatomic structures related to the anterior surface of the kidneys
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
vascular relationship of great vessels and their tributaries to the kidneys
Dilation of the kidney or ureter or both occurs superior to the obstruction, true or false?
true
*What is the most common correctable cause of hypertension?
Renal artery stenosis (RAR)
*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
True
*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
obstruction
low-level
*what may cause dilation of the renal pelvis?
- polyuria
- distended bladdder
- reflux
- pregnancy
- atrophy after obstruction
*grade 4 hydronephrosis is characterized by:
- prominent dilation of the collecting system
- thinning of the renal parenchyma
- lack of differentiation btwn collecting system and renal parenchyma
*herniation of the bladder wall?
diverticulum
*after voiding the bladder, __ cc of urine is considered normal in the adult
20
true or false? a complication of (nephroblastoma) Wilm’s tumor is spreading into the IVC
true
*what are the 4 perinephric fluid collections?
hematoma, abscess, urinoma, lymphocele
