Week 5 - H - Imaging in renal and urological disorders Flashcards

1
Q

What is the usual cause of renal colic?

A

This would be a ureteric calculus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What other things can stimulate renal colic?

A

Pyelonephritis or gynaelogical disease can stimulate renal colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If the patient has renal colic and a good history has been taken suggesting ureteric calculi, what is the next step and what are you looking for?

A

Carry out urinalysis looking for any haematuria which is often associated with ureteric calculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What investigations are carried out in renal colic?

A

Offer urgent (within 24 hours of presentation) low-dose non-contrast CT to adults with suspected renal colic. If a woman is pregnant, offer ultrasound instead of CT. * Offer urgent (within 24 hours of presentation) ultrasound as first-line imaging for children and young people with suspected renal colic. * If there is still uncertainty about the diagnosis of renal colic after ultrasound for children and young people, consider low-dose non-contrast CT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What investigation is carried out if thinking pyelonephritis or gynaeolocial disease?

A

Ultrasound to exclude ureteric obstruction - pyelonephritis if gynaecological disease is likely do US instead, to visualise uterine, ovarian and uterine tubal pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

If the patinet is pregnant, what should be done to avoid radiation exposure to the foetus and mother?

A

use US and/or MRI to avoid radiation exposure to foetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What stones show up on KUBxray? Which do not? Which drug is known to cause renal stones?

A

Calcium stones show as they are dense and radioopaque pure uric acid, indinavir-induced, and cystine calculi are relatively radiolucent on plain radiography. the antiviral indanivir causes renal stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is usually the first imaging test to image renal stones? What is the gold standard for renal stones?

A

Offer urgent (within 24 hours of presentation) low-dose non-contrast CT to adults with suspected renal colic. If a woman is pregnant, offer ultrasound instead of CT. * Offer urgent (within 24 hours of presentation) ultrasound as first-line imaging for children and young people with suspected renal colic. * If there is still uncertainty about the diagnosis of renal colic after ultrasound for children and young people, consider low-dose non-contrast CT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the normal ureteric course?

A

The ureters descend inferiorly over the psoas major muscles, they cross the common iliac artery bifurcation before entering the pelvis through the pelvic brim, and then pass inferomedially into the posteriolateral apsect of the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Knowledge of normal ureteric course makes it easier to spot ureteric calculi. Where are renal calculi usually located?

A

They can be located at the pelviureteric junction (PUJ) The pelvic brim (where the ureter passes over the bifurcation of the common iliac artery - there is a small change in direction to posteriomedially) and At the vesicoureteric junction (VUJ)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most calculi will pass as the calculi usually has to be 6mm or more to have difficulty passing The KUBxray lacks specificty as it is hard to differentiate from other causes of calcification small local, usually rounded, calcification within a vein. What are these?

A

Phleboliths - When located in the pelvis they are sometimes difficult to differentiate from kidney stones in the ureters on X-ray.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Non-contrast enhanced CT (‘CT stone search’) is now the definitive test to confirm a symptomatic ureteric calculus When should the CT scan be avoided?

A

CT gives a high radiation dose, so should be avoided in pregnancy and if possible, non-pregnant young females, when US and/or MRI may be used to give similar information Also avoid CT in renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most calculi pass spontaneously If you want to check the progress of a stone only seen on CT previously what would you do?

A

Use a CT again To check progress, use the simplest test that showed the calculus at presentation, as shown in the series opposite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Macroscopic haematuria may arise from the kidneys, ureters or bladder What are some causes of macroscopic haematuria?

A

Calculi, tumour, infection, glomerulonephritis, BPH the list goes on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If a patient over 50 presents with macroscopic haematuria, what investigation is carried out?

A

CT urography (CTU) examines the kidneys, collecting systems and ureters Cystoscopy examines the bladder and urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

There are two steps in CT urography (they both look for different things) What is step 1?

A

Step 1 - pre contrast scan to detect for renal calculi being the cause Administration of IV contrast which is concentrated and excreted by kidneys over 15 minutes Top up dose so the renal parenchyma can be viewed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In step 2 of CT urography, the whole of the kidneys, collecting system and ureters can be viewed What is looked for in the second stage?

A

Any renal parenchymal tuours (RCC usually) and any urothelial tumours in the collecting ducts and ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When identifying a tumour it is important to look to see if the tumour is confined to the kidney What is T1 and T2 renal cell carcinoma?

A

T1 - tumour has not spread through renal capsule T2 - tumour has not spread through renal deep fascia (gerota’s fascia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If the renal cell carcinoma is within T1 and 2, what is the treatment?

A

Carry out nephrectomy or partial nephrectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Under 50 years age, the incidence of urothelial tumours of kidney or ureter is very low, so routine CTU which imparts a double radiation dose is unjustified when there is macroscopic haematuria What is done instead?

A

US of kidneys to detect calculi and renal parenchymal tumours Cystoscopy to look for occasional bladder TCC, bladder calculi, other bladder tumours or evidence of urethritis/prostatitis Renal cancers less common in patients under 50 so CT urography is not as commonly carried out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the next line investigation in an under 50s patient only when US and cystoscopy are normal and macroscopic haematuria persists?

A

CT urography

22
Q

If CT is contra-indicated ie pregnant female, what would be used?

A

MR urography

23
Q

What is the triad in presentation of a renal cell carcinoma? How does TCC of the bladder usually present?

A

Pain, haematuria and mass Painless haematuria

24
Q

CT is typically used to assess mass size density (fat, fluid, soft tissue, calcified) uniformity (is density all the same or variable) internal morphology (presence of nodules, septa) If the tumour contains fat on CT, what is it likely to be?

A

Angiomyolipoma - they can bleed due to the vessel part of the benign tumour

25
Q

What is the difference in colour on CT between an angiomyolipoma and a malignant tumour?

A

In a tumour it is usually lgiht grey - fat on CT is dark

26
Q

What is usually done if the mass is less than 3 cm in size?

A

It is recognised that renal masses smaller than 3cm very rarely metastasize, whatever their appearance, so these are often followed up rather than operated upon

27
Q

What was the 4 things a CT is typically used to assess the mass?

A

Size Density Uniformity Internal morphology - septa or nodules

28
Q

What is often sufficient when diagnosing a simple renal cyst?

A

Ultrasound - Can see the benign cyst on CT here - best seen in nephrographic phase

29
Q

What are the lymph node metastases of a renal cell carcinoma?

A

Para aortic nodes

30
Q

What are the common renal cell carcinoma metastases?

A

Lungs and bone Also liver and brain

31
Q

What are the four stages of robson staging of renal cell carcinoma?

A

Stage 1 -tumour confined to renal capsule Stage 2 - tumour confined to gerota’s fascia Stage 3 - tumour involement of regional lymph nodes and/or renal vein and cava Stage IV - adjacent organs or distant metastases

32
Q

What can be seen here?

A

invading the inferior vena cava (robson stage 3)

33
Q

May be an acute deterioration, a steady decline or commonly an acute deterioration on a background of chronic disease If wanting to see if there is obsturction/hydroenprhosis, what can be carried out on the patinet? How would this tell apart from AKI and CKD?

A

Use ultrasound In CKD kidneys would likely be smaller than 9cm

34
Q

What are the investigations used in pre renal, post renal and renal disease? Obviously urinalyisis has been carried out

A

Pre renal - MRI - looks for RAS Renal - US guided biopsy Post-renal - Use ultrasound which shows obstruction often accompanied with hydronephrosis

35
Q

obstruction may be at bladder outlet level and US can assess completeness of bladder emptying Apart from osbtruction, what may be another cause of hydronephrosis?

A

Vesicoureteric reflux - when the bladder contracts the urine keeps going back into the urethra

36
Q

What is hydronephrosis?

A

It is the dilatation of the renal pelvis

37
Q

Once ultrasound has located obstruction leading to the renal impairment What is carried out to understand the cause of the obstruction?

A

CT scan

38
Q

Ultrasound is carried out in a painful scrotum How does testicular torsion differ from epididymitis?

A

On ultrasound in testicular torison - avascular blood flow On ultrasound in epididymitis - increased blood flow

39
Q

What age group is affected in epididymtiis and testicular torsion?

A

Epididymitis - usually in young adults - due to chlamydia is most common Testicular torsion - usually in young pubertal boys

40
Q

What are causes of painless scortal swelling? What investigation is used in the diagnosis?

A

Varicocele Hydrocele Hernia Rare - testicular tumour Carry out ultrasound

41
Q

Why can a patinet with left renal cell carcinoma develop a varicocele and a person with right sided usually does not?

A

Left testicular vein drains into left vein vein and if this is obstructed, causes the fluid to build up Right testicular vein drains directly into the inferior vena cava

42
Q

dilated scrotal venous plexus typically on left side tortuous veins usually >2mm in diameter What is this?

A

A varicocele

43
Q

What is a hydrocele caused by?

A

A patent tunica vaginalis allowing for fluid to surround the testicle - swelling does not involve inguinal canal

44
Q

If there is urinary tract trauma, what is the best investigation to assess the degree of trauma?

A

Renal injury is best assessed by CT

45
Q

Bladder rupture may be extraperitoneal (commoner and treated conservatively) intraperitoneal (due to compression of full bladder and requires surgery) How is bladder trauma diagnosed?

A

Diagnosed using contrast cystography (can use CT cystography)

46
Q

What type of injury is associated with urethral disruption?

A

Pelvic fracture/dislocation

47
Q

if you have clinical suspicion (meatal bleeding, patient can’t pass urine) don’t attempt catheterisation , how do you get the catheter in?

A

YOU CONTACT UROLOGIST

48
Q

urethral trauma may be complicated by long term stricture formation What is used to define this?

A

Urethrography

49
Q

How is the relief or ureteric obstruction carried out?

A

Nephrostomy - A nephrostomy is an artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system (renal pelvis).

50
Q

Post-biopsy haemorrhage control by ARTERIAL EMBOLISATION How is this carried out?

A

Small metal coils are used to embolize the vessel and cause bleeding to cease