UrinarySystem Flashcards
URINARY SYSTEM
- Kidneys
- Ureters
- Urinary Bladder
- Urethra
SUPRARENAL GLANDS
AKA Adrenal glands, part of the endocrine system
- Located superior and medial of each kidney
Divided into two=
Cortex - secretes cortical hormones
Medulla- secretes epinephrine ( adrenaline)
Commonly images with a CT scan
KIDNEYS
Bean shaped structures that produce urine =
- Located in the retro peritoneum
- Extends from T2 - L3
- Right slightly lower than the left
-
HILUM
Concave medial border of the kidney
- Site of transmission of nerves, vessels and ureters
- Expands into the kidney to form the renal sinus
RENAL SINUS
A central fat filled cavity that surrounds the renal pelvis and vessels
Has two portions
- Renal cortex - outer portion
- Renal medulla- inner-portion
NEPRON
Microscopic functional unit of the kidney
CALYXES
Cup shaped stems at the sides of the renal papilla
URETEROPELVIC JUNCTION UPJ
Where the renal pelvis transitions into the ureter
URETERS
Tubes that convey urine from the kidneys to the bladder by was of slow rhythmic peristalsis
- 25-30 cm long
- Enther the bladder at the level of the ischia spine
- UVJ is the entry point of each ureter into the urinary bladder
URINARY BLADDER
Musculomembranous sac that serves as a temporary reservoir for urine
- In males =
- It is directly anterior to the rectum with the neck on the prostate
In females
- Anterior to the vaginal canal with neck on the pelvic diaphragm
TRIGONE
Triangular muscle on the posterior wall where openings of the ureters and urethra join the bladder
URETHRA
Muscular tube with a sphincter type of muscle at the neck of the bladder that transports urine from the bladder to the exterior
- Originates at the internal urethral orifice in the urinary bladder and extends about 3,6 cm in the female and 17,8 cm in males
Male urethra is divided into three=
- Prostatic urethra
- Membranous urethra
- Spongy urethra
PROSTATE
A small glandular body in the male reproductive system that surrounds that surrounds the male urethra
- Located posterior to the inferior Pubic symphysis
- Has two portions- Base and Apex
- it’s about 3,8 x 1,9 cm at its base and approximately 2;5 cm long
AP KUB PROJECTION
- Patient supine with legs flexed ( Places kidneys closer to the IR ) NB
- CR perpendicular to the iliac crest
- Exposure at the end of exhalation
AP KUB PROJECTION
STRUCTURES DEMONSTRATED
- Out line of kidneys
- Lower border of Kidneys
- Psoas muscles
- Include from top of kidneys to symph
AP PROJECTION BLADDER SHOT
- Patient supine with legs extended
- CR 15-20 deg caudad just below the ASIS
AP PROJECTION BLADDER SHOT
STRUCTURES DEMONSTRATED
Symphysis pubis off the bladder and the urethra
VCU
Functional test of the urinary bladder and urethra.
Indications=
- Tumours , abscess, diverticulum, dilations and strictures
- UTI in children
VCU AP OR AP AXIAL PROJECTION
- Patient supine , legs extended
- 5-15 deg Caudad to free the bladder neck off the the symphysis pubis
- CR superior bored of symph
- if reflux is present centre higher at the iliac crest
VCU AP OR AP AXIAL PROJECTION
STRUCTURES DEMONSTRATED
- Bladder and urethra
- Distal ureters if reflux is spotted
- Best-image for female patients
AP OBLIUE PROJECTION RPO
- Patient supine, legs extended
- patient turns 30-40 deg RPO
- CR superior border of the symphysis pubis
AP OBLIUE PROJECTION RPO
STRUCTURES DEMONSTRATED
- Bladder neck and entire urethra as free of boney superimposition
- Best for male urethra
- Distal ureters visualised if reflux is present
LATERAL POSITION VCU
- Patient in right or left lateral
- Cr 5 cm above the symphysis border in the MCP
- If reflux is present Centre at the iliac crest
LATERAL POSITION VCU
STRUCTURES DEMONSTRATED
- Anterior and posterior bladder walls
- If reflux is visualised, the distal ureters are also visualised
RETROGRADE UROGRAPHY
Non functional examination of the urinary system during which contrast medium is introduced directly into the pelvicalyceal system via catheterisation by a urologist during a minor surgical procedure
Indication=
- patients with renal insufficiency or allergic to iodine contrast
- contra indicated to patients with UTI
RETROGRADE UROGRAPHY
IMAGING
- CR perpendicular to L3
- scout image demonstrates the ureteral catheters in position
-
RETROGRADE CYSTOGRAPHY
Non functional test of the urinary bladder following installation of a water soluble iodinated contrast medium
Indications=
Vesicoureteral reflux, recurrent UTI or fistulas, neurogenic bladder, bladder trauma, ureteral stricture, posterior urethral valves
Contraindications=
- Related to catheterisation of the urethra
MALROTATION
When kidney one or both fail to rotate towards mid sagittal plane as they ascent towards the upper abdomen
- abnormal appearance if the renal pelvis and calyces is seen
- kidney functions normally
- Anomally demonstrated with CT and US
ECTOPIC KIDNEY
Abnormal placement of the kidney
Intra thoracic =
- Kidney fails to ascent into the upper abdomen resting in the pelvis
Intrathoracic Kidney=
- Kidney ascents high into the upper abdomen
US and CT can demonstrate the anomaly
HORSESHOE KIDNEY
Fusion of the kidneys with each other
- Most common fusion anomaly
- Band of fused tissue is called the isthmus
- Kidneys appear lower in the abdomen
Can be demonstrated with US and CT
DUPLICATION
Duplication of renal pelvis and or ureter
- This anomaly may also refer to a kidney that has a bifid renal pelvis with two ureters that join together having one ureterovesical orifice
URETEROCELE
A cyclic dilation of the distal ureter at the ureterovesical orifice
- Prolapsed ureter May cause obstruction to urine flow and or vesicoureteral reflux
- Children are often associated
Clinical signs
- Flank pain
- Hematuria
- Dysuria
- Incontinence
- Frequent UTI
Imaging =
- IVP
- VCU
- US
- CT
URETEROCELE
RADIOGRAPHIC APPEARANCE
IVU
- If filled with iodinated contrast media the prolapsed ureter will appear as an oval structure surrounded by a radiolucent ring outlining the wall of the uretercele, cobra head sign
- When not filled the uretocele will appear as a filling defect in the urinary bladder
- If the ureterocele causes obstruction to urine, hydronephrosis May be present
POSTERIOR URETHRAL VALVES
A thin membrane in the urethra obstructing the flow of urine from the urinary bladder
- Found in male patients
- Causes bilateral hydronephrosis
Clinical signs =
- Enlarged bladder, May be palpable
- Dysuria
- UTI
- Poor urine stream
Imaging
- VCU
POSTERIOR URETHRAL VALVES
RADIOGRAPHIC APPEARANCE
VCU
- Tapered appearance of the urethra at the level of the PUV
- Proximal dilation of the urethra above the PUV
- Enlarged bladder
- Vesicoureteral reflux
POLYCYSTIC KIDNEY DISEASE
Numerous fluid filled cysts develop on the kidneys
- Genetic disorder
- Kidneys enlarge
- Cysts will replace the normal kidney tissue
Clinical signs=
- Hematuria
- Polyuria
- Flank pain
- Recurrent kidney infection
Imaging =
- CT
- IVP
POLYCYSTIC KIDNEY DISEASE
RADIOGRAPHIC APPEARANCE
- Enlarged kidney
- Multiple radiolucent cysts
PYELONEPHRITIS
Kidney infection commonly caused by bacteria that has travelled from the bladder to the kidney
- May also be due to enlarged prostate, urinary catheterisation and kidney stones which reduce the flow of urine
Clinical signs=
- Fever and chills
- Back and flankpain
- Urgent, frequent urination
- Dysuria
- Hematuria
Imaging=
- CT
- IVU
- Usually diagnosed with urinalysis
PYELONEPHRITIS
RADIOGRAPHIC APPEARANCE
- IVP is typically normal
- INTHE chronic condition the calyces may have a clubbing appearance
CYSTITIS
Inflammation of the urinary bladder ( UTI)
- More common in females due to short urethra
- Commonly caused by bacteria spreading from fecal material ( E. coli bacteria) and urinary catheterisation
- Any interference with bladder emptying can predispose the bladder to infection
- Cystitis is the most common hospital infection
Clinical signs =
- Polyuria
- Dysuria, burning sensation
- Pyuria
- Hematuria
- Low back pain
Imaging =
- IVU
- Voiding CYSTOGRAPHY
CYSTITIS
RADIOGRAPHIC APPEARANCE
- Usually normal appearance
- Chronic cystitis May cause changes in bladder wall decreasing the bladder size
UROLITHIASIS/ URINARY CALCULI
AKA kidney stones, caused by excessive excretion of calcium in the urine
- Urinary stasis and infection may also enhance stone formation
- Symptoms May show when an obstruction occurs
- 3mm or less stones will pass in the urine without symptoms
Clinical signs =
- Flank pain radiating down groin
- Nausea and vomiting
- Dysuria,pain while urinating
- Oliguria, reduced volume of urine
Imaging =
- KUB
- Unenhanced CT abdomen
-
UROLITHIASIS/ URINARY CALCULI
RADIOGRAPHIC APPEARANCE
CT
- A calcified density will be demonstrated in the kidney, ureter or bladder
- Hydronephrosis or hydroureter if present
KUB
- 80% of symptomatic renal stones contain enough calcium to be radiopaque and detectable on plain abdominal images
STAGHORN CALCULUS
Upper urinary tract stones that involve the renal pelvis and extend into at least 2 calyces
- Most are composed of struvite
- Caused by recurrent UTI
- Stones fill the renal pelvis and block the flow of urine from the kidney
- Must-be treated or could destroy the kidney
- Percutaneous Nephrolithotomy- treatment option
HYDRONEPHROSIS
Dilation of the renal pelvis and calyces
Occurs with a renal condition , not a disease it’s self
- Unilateral: caused by obstruction superior to the bladder ,
Eg, kidney stones, ureteropelvic stricture, ureterovesical reflux - Bilateral: caused by obstruction inferior the bladder
Eg, bladder tumours neurogenic bladder, prostatic hypertrophy, posterior urerthral valve
Clinical signs
- Flank pain
- Nausea and vomiting
- UTI, fever , Dysuria
- Increased frequency of urination
Imaging
- IVU
- CT
HYDRONEPHROSIS
RADIOGRAPHIC APPEARANCE
IVU
- Dilated pelvicalyceal system
- Clubbing of calyces
- Delayed drainage of collecting system
CT
- Hypodense dilation of the pelvicalyceal system
VESICOURETERAL REFLUX
Abnormal flow of urine from the urinary bladder to the ureters
- Diagnosed in children
- Caused by abnormal ureter entering the bladder, UTI, cystitis, urinary tract obstruction, ureteroceles, duplicated ureters
- If left untreated May cause pyelonephritis and kidney failure
Clinical signs =
- Presence of infection , most common
- Bedwetting
- High blood pressure
- Proteinuria
Imaging =
- Ultrasound
- Voiding Cystogram
VESICOURETERAL REFLUX
RADIOGRAPHIC APPEARANCE
Voiding Cystogram
- Costrast reflux into ureter and kidneys
- Possible hydronephrosis and hydroureter depending on severity
- Post mic pic NB
- Typically upon voiding reflux of urine from bladder to ureter is more pronounced
ACUTE RENAL FAILURE
Loss of kidney function with nitrogenous waste products such as BUN, creatinine build up in the blood
- Caused by prerenal, renal or post renal condition
- Pre renal- Decreased blood supply to the kidneys, or damage to the kidneys
- Post renal- due to obstruction of urinary outflow from bladder or ureters
Urine out put drops lower than 400ml in 24 hr period
Clinical signs =
- Swelling
- Oliguria or anuria
- Hyperkalemia, inability to remove potassium causing arrhythmia,s
- Anemia, decrease production of erythropoietin reducing red blood cell count
Imaging
- US
- IVU
ACUTE RENAL FAILURE
RADIOGRAPHIC APPEARANCE
IVU
- Prolonged Nephrogram with little or no calyceal filling
CHRONIC RENAL FAILURE
- Nephrons are replaced with scar tissue
- A common cause is uncontrolled Diabetes
- Other causes are uncontrolled or poorly managed hypertension, chronic glomerulonephritis, pyelonephritis, urinary obstructions, poly cystic kidney disease
Clinical signs
- Fatigue
- Oliguria
- Congestive heart failure due to increase blood volume
- Hypertension
Imaging
- KUB
- Ultrasound
CHRONIC RENAL FAILURE
RADIOGRAPHIC APPEARANCE
Demonstrates any renal calculus
RENAL HYPERTENSION
High blood pressure caused by renal artery stenosis
- Rennin is released by kidney to raise blood pressure
- Renin secretion causes the angiotensin conversation that causes aldosterone release, from he adrenal cortex to retain water. How ever the patient does not have low blood pressure
- Common treatment is angioplasty and stenting of the renal arteries
Clinical signs
- High blood pressure that responds poorly to medication
Imaging
- CTA
- Angiography
- MRI
RENAL HYPERTENSION
RADIOGRAPHIC APPEARANCE
CTA
- Demonstration of a stenoses artery
Angiography
- Identify the stenosis, severity and provide treatment
NEPHROBLASTOMA ( Wilms Tumor )
- Most Common abdominal pediatric Tumor
- Average age 3 and 4 years old
- Unilateral or bilateral involvement
- Highly malignant, large palpable mass
Clinical signs
- Abdo palpable mass
- Hematuria
- Fever
- High blood pressure
- Reduced appetite/ weight loss
Imaging
- IVU
- Abdo CT
- US
NEPHROBLASTOMA ( Wilms Tumor )
RADIOGRAPHIC APPEARANCE
IVU
- Intrarenal mass- displaced pelvic Alyce all system
- Often associated with hydro nephrosis
- Extrarenal mass- displaces the kidney inferior and lateral
CT
- Invasion of IVC
- Mass of mixed densities
- Tumour will enhance when contrast is administered
- Demonstrates the exact location of mass
- Involvement of other organs or structures
HYPERNEPHROMA. ( Renal Cell Carcinoma )
- Most common renal neoplasm
- Patients over 40
- Developes in lining of renal tubules of one or both kidneys
Clinical signs
- Flank pain
- Painless Hematuria
- Palpable abdominal mass
Imaging
- IVU
- Abdo CT
HYPERNEPHROMA. ( Renal Cell Carcinoma )
RADIOGRAPHIC APPEARANCE
IVU
- Kidney enlargement
- Distortion of calyces and renal pelvis
- Large tumour May cause obstruction of drainage system resulting in dilation of calyces and renal pelvis
CT
- Demonstrates the exact location of the mass
- Round appearance, solid lesion
- Demonstrates any invasion of renal veins or IVC
- Will enhance after contrast media administration
BLADDER CARCINOMA
- Originates in the bladder epithelium called urothelial carcinoma
- Mostly males over 50
- Chemical exposure including cigarette increases the risk of developing bladder cancer
Clinical signs
- Classic Painless gross Hematuria
Imaging
- IVU
- CT
BLADDER CARCINOMA
RADIOGRAPHIC APPEARANCE
IVU
- Irregular filling defects after contrast media administration
-
CT
- Mass projecting into bladder lumen, thickening of bladder wall
SIMPLE RENAL CYSTS
- Benign lesion of the renal cortex
- Fluid filled
- Single or multiple sites in one or both kidneys
- Range in size
- Predominately seen patients over 50
Clinical signs
- Asymptomatic
Imaging
- CT
- US
SIMPLE RENAL CYSTS
RADIOGRAPHIC appearance
CT
- Round smooth borders, no irregularities in the lining of the cyst wall
- Homogenous attenuation
