Witwer - GUT Anatomy and Radiology Flashcards
1
Q
retroperitoneal structures
A
Suprarenal (adrenal)
Aorta/IVC
Duodenum (2nd/3rd parts)
Pancreas (excluding tail)
Ureters
Colon (ascending/descending)
Kidneys
Esophagus
Rectum
2
Q
shape of adrenal glands
A
inverted Y/lambda
3
Q
location of the bladder
A
pelvic cavity
posterior to pubis symphysis
below parietal peritoneum
intraperitoneal
4
Q
location of ureters
A
begin at ureteropelvic junction (UPJ) of kidney
posterior to renal vein and artery in the hilum
retroperitoneal
5
Q
location of the kidneys
A
either side of spine
supine - T12-L3 vertebrae
ribs 11/12 - L¾
retroperitoneal
abdominal cavity
6
Q
the __ kidney is lower
when erect, the kidneys are slightly __
A
right
lower
7
Q
structures related to the right side of the kidney
A
descending duodenum
posterior liver
hepatic flexure of colon
8
Q
structures related to the left kidney
A
stomach
spleen
pancreas
splenic flexure
9
Q
structure medial to the kidneys
A
psoas m
10
Q
course of the ureter
A
along medial aspect of psoas → anterior/medial to L2/L5 transverse process → enters pelvis at sacroiliac joint at bifurcation of common iliac vessels → runs anteriorly to internal iliac to lateral pelvic sidewall
11
Q
3 constrictions of the ureter
A
pelviureteric junction (PUJ)
common iliac artery bifurcation
vesicoureteric junction (VUJ)
12
Q
constrictions of the ureter are the mc sites of
A
renal calculus
13
Q
fxn of the psoas
A
flexion of hip
14
Q
fxn of iliopsoas
A
flexion and external rotation of hip
15
Q
innervation of psoas major
A
L1-L3
16
Q
note the renal fascia, perinephric (perirenal) fat, psoas m, IVC/aorta
A
17
Q
not the cortex and medulla
A
18
Q
location of renal arteries
A
L1-L2
19
Q
significance of aortic aneurysms on kidneys
A
can involve renal arteries
20
Q
consequence of blockage of renal arteries
A
htn
21
Q
renal pain is referred to cutaneous areas supplied by __,
including __ (5)
A
T12 - L2
posterior/lateral abdominal wall below ribs
above iliac crest
scrotum
labia majora
proximal anterior thigh
22
Q
the gonadal arteries arise from the
A
aorta
23
Q
a short urethra predisposes pt to
A
cystitis
24
Q
the filling of the bladder is under __ control
A
sympathetic
25
during filling of the bladder, the detrusor m is
relaxed
26
the emptying of the bladder is under __ control
parasympathetic
27
during filling of the bladder, the __ are contracted (2)
internal sphincter
external sphincter
28
contraction of the internal sphincter is under __ control
sympathetic
29
contraction of the external sphincter is under __ control
voluntary
30
during emptying of the bladder, the detrusor m is
contracted
31
during emptying of the bladder, relaxation of the internal sphincter is under __ control
and relaxation of the external sphincter is under __ control
parasympathetic
voluntary
32
what n roots innervate sympathetic control of the bladder
L1-L3
33
what n roots control parasympathetic control of the bladder
S2-S4
34
what binds the trigone of the bladder (2)
ureteral orifices
internal urethral sphincter
35
2 populations affected by adrenal hemorrhage
adults
newborn
36
in newborns, adrenal hemorrhage is 2/2 to (2)
and results in \_\_
anoxia (no O2), sepsis
adrenal insufficiency
37
benign adrenal adenomas are a type of
incidentaloma → benign, no clinical significance
38
pheochromocytomas arise from the \_\_,
secrete \_\_,
and cause \_\_
adrenal medulla
catecholamines
htn
39
pheochromocytomas arising outside of adrenal medulla are called
paragangliomas
40
ex of a paraganglioma
glomus tumor of the jugular foramen
41
primary hyperaldosteronism is same same
conn syndrome
42
conn syndrome can be 2/2 to (2)
cortical hyperplasia
tumor
43
sx of conn syndrome (3)
fatigue
high bp
hypokalemia
44
2 treatable causes of htn
pheochromocytoma
conn syndrome
45
metastases to adrenal gland are common from common tumors, including (4)
melanoma
lung
colon
breast
46
is primary adrenal carcinoma common
no!
47
2 consequences of VUR
renal scarring
renal infxn (pyelonephritis)
48
how does VUR cause pyelonephritis
infected urine is refluxed
49
causes of VUR in peds (4)
immature short ureteral tunnel
congenital anomaly at UVJ
posterior urethral valves
neurogenic bladder
50
what cause of VUR resolves w. age
immature short ureteral tunnel
51
what cause of VUR is only in males
posterior urethral valves
52
imaging for hydronephrosis
US
53
hydronephrosis requires \_\_
full work up
54
40% of peds \< 5 yo w. UTI have
VUR
55
VUR and UTI both require what kind of care
aggressive individual evaluation/tx
close long term f.u
*risk for significant renal damage*
56
work up for VUR
VCUG or isotope cystogram
radionuclide DMSA renogram
57
2 components of bladder fxn, filling, emptying/voiding/micturition
neurologic
muscular
58
what controls conscious interpretation of full or empty bladder
cerebral cortex
59
what monitors filling and coordinates voiding of bladder
pontine micturition center
60
spinal cord pathways for bladder (2)
ANS
somatic
61
what nerve inhibits detrusor contraction and contracts the internal urethral sphincter in the urethra and bladder neck **during filling**
hypogastric n
62
hypogastric n arises from
T10-T12
63
what n controls detrusor contraction and relaxation of the internal urethral sphincter and bladder neck **during bladder emptying**
pelvic n
64
pelvic n arises from
S2-S4
65
what n controls contraction of the external sphincter in the urogenital diaphragm during bladder filling/relaxation during voiding
pudendal n
66
pudendal n innervation of the bladder is under __ control
voluntary
67
what nerve pathways does the sacral micturition center include
PSNS
somatic
68
PSNS component of sacral micturition center (2)
detrusor contraction
internal sphincter relaxation
69
somatic component of sacral micturition center
pudendal n relaxation → coordination of micturition
70
interference/damage to any of the centers and/or pathways controlling storage of urine and micturition
neurogenic/neuropathic bladder
71
neurogenic bladder can be \_\_
or \_\_
complete
incomplete
72
what do these symptoms make you think: involuntary bladder contractions (detrussor hyperreflexia) with coordinated sphincter relaxation, sudden strong urge to urinate
neurogenic bladder lesion above the brain stem
73
what is coordinated bladder sphincter relaxation
urge incontinence
74
what do these symptoms make you think of: detrusor hyperreflexia, uncoordinated spastic external sphincter (detrusor-sphincter dyssenergy), residual urine w. reduced bladder capacity
complete lesion of the spinal cord above T12 vertebral body
75
what do these symptoms make you think of: detrusor areflexia, loss of sense of fullness, weak unsustained contractions, incomplete bladder emptying w. large amounts of residual volume
lesion to the spinal micturition reflex
76
lesion to the spinal micturition reflex is a __ motor lesion
with loss of \_\_
and \_\_
lower
motor and sensory
77
pt education for neurogenic bladder
shock phase may last weeks-months → may have no sensation/areflexia
78
summary of neurogenic bladder
what to know: concept of UMN and LMN and their relation to the reflex arc
79
where can kidney stones be located
in kidney → mc r**enal medulla**
**renal collecting system** → calyces, infundibula, renal pelvis, ureter
80
what is this showing
stone in left renal pelvis
81
what is this showing
stone in the renal pelvis
82
when do patients commonly pass stones
when they are dehydrated
83
where is renal stone pain felt (5)
back
flank
groin
labia
scrotum
84
mc differential dx for painful hematuria
kidney stone
85
mc cause of painless hematuria
bladder ca
86
best imaging to evaluate for stone/stone ddx
non contrast spiral CT
87
how does hydronephrosis appear on imaging
enlarged collecting system → can be confused for cysts
88
what causes renal papillary necrosis (5)
analgesic abuse (acetaminophen)
pyelonephritis
renal ichemia
DM (sorry tess, but not you bc you are so good at managing yours)
sickle cell dz
89
in renal papillary necvrosis, the __ sloughs off and causes
\_\_
medulla
filling defects
90
2 forms of nephrocalcinosis
cortical
medullary
91
causes of cortical nephrocalcinosis (5)
acute cortical necrosis
chronic glomerulonephritis
prolonged hypercalcemia
hypercalciuria
poisoning/toxicities
92
causes of medullary nephrocalcinosis (6)
hyperparathyroidism
medullary sponge kidney
renal tubular acidosis
renal papillary necrosis
milk-alkali syndrome
hyperoxaluria
93
all causes of nephrocalcinosis are related to (4)
hypercalcemia
renal damage from ischemia
inflammation
toxins
94
what is this showing
nephrocalcinosis
95
congenital condition involving dilated renal tubules; generally asymptomatic
medullary sponge kidney
96
medullary sponge kidney predisposes infant to (2)
infxn
stone formation
97
relatively common autosomal dominant condition involving multiple cysts → massive non-functioning kidneys → renal failure later in 40s and 50s
adult polycystic kidney dz
98
what is this showing
polycystic kidney dz w. cysts in liver and pancreas
99
are renal cysts always pathologic
no! they can be common/normal incidental findings with age
usually single or several
100
rare (usually) incidental finding where lower poles of kidney are fused across abd midline
horseshoe kidney
101
horseshoe kidney predisposes pt to (2)
obstructions
stones
102
renal condition that is a potentially treatable cause of HTN
renal artery stenosis
103
renal stenosis activates the \_\_
RAAS
104
2 forms of renal artery stenosis
atherosclerotic
fibromuscular dysplasia (hyperplasia)
105
tx for atherosclerotic renal artery stenosis
1. meds
2. balloon angioplasty or surgical correction
106
tx for fibromuscular renal artery stenosis
balloon angioplasty
107
what happens to kidney size in renal artery stenosis
it shrinks → loss of fxn
108
renal artery stenosis is really only curable if it is diagnosed
early
109
how do you evaluate bruit in renal artery stenosis
put stethoscope to the right and left of transpyloric plane
110
condition that mc affects women in 40 and 50s that involves fibrous thickening of all layers of renal artery wall
fibromuscular dysplasia
111
tx for htn caused by fibromuscular dysplasia
balloon angioplasty
112
4 potentially treatable forms of HTN
pheochromocytoma
conn tumor/hyperplasia
renal artery stenosis 2/2 arteriosclerosis
renal artery stenosis 2/2 fibromuscular dysplasia
113
condition mc found in dehydrated pt's or infants w. clotting abnormalities that can cause nephrotic syndrome and pulmonary blood clots
renal vein thrombosis
114
what is this showing
atherosclerotic renal artery stenosis
115
mc cause of cystitis (UTI)
e.coli
116
predisposing factors for UTI/cystitis (2)
sex :(
catheterization
117
what do you think when you see a kid w. recurrent cystitis
underlying abnormality →
neurogenic bladder
ureteral issues
VUR
developmental abnormalities of ureter
renal damage
118
painless hematuria
bladder ca til proven otherwise
also
renal cell carcinoma
*there better be a gd test question on this!*
119
imaging for renal cell carcinoma (3)
CT
IVP
US
120
symptom of renal cell carcinoma
painless hematuria
*all painless hematuria must be evaluated for urinary tract malignancy*
121
sx of transitional cell carcinoma
painless hematuria!
122
where are transitional cell carcinoma tumors found (4)
ureters
bladder
urethra
kidney
123
what do you think when you see US or MRI showing asymetry in prostate gland
carcinoma of the prostate
124
where does prostate carcinoma metastasize
bones
125
possible sx of prostate carcinoma
bone pain
elevated alk phos
126
where do the testicles form embryologically
beneath kidneys → descend thru inguinal canal → into scrotum
127
"hidden testicles"
cryptochordism
128
potential complications of cryptochoridism
infertility
malignancy
129
majority of cryptochordism resolves w.in
first year of life
130
imaging for epidydymitis
US
131
common US findings of eididymitis
enlarged heterogenous, hyper-vascular w. reactive hydrocele
132
can hydroceles in the absence of epididymitis be a benign finding
yes! common in kids and adults
133
painful condition involving spermatic cord twisting
testicular torsion
134
what is a bell clapper deformity and why do we care about it
testicle not attached to scrotum → tunica vaginalis surrounds much of the testicle
predisposes to testicular torsion
135
in terms of tx, what is testicular torsion
medical emergency → twisted (torted) testicle is avascular
136
imaging for testicular torsion
US doppler flow
137
ddx for painful testicle/scrotum (6)
epididymitis
orchitis
epididymitis/orchitis combo
testicular torsion
varicocele
hernia w.in scrotum
138
symptoms of epididymitis/orchitis combo
increased blood flow →
rubor, calor, tumor, dolor → redness, heat, swelling, pain
139
imaging if pt complains of testicular/scrotal pain
US
140
testicular malignancies are associated w. __ cells
germ → sperm progenitors
141
imaging to visualize mass in scrotum
US
142
venous drainage of testes is via the \_\_,
which runs with the \_\_
pampiniform plexus
spermatic cord
143
a varicocele is a varicosity of the
pampiniform plexus
144
US findings of varicocele
multiple veins w. slow blood supply
145
enlarged ovaries w. thick sclerotic capsules and an abnormally high number of follicles
poly cystic ovary dz
146
stein-leventhal syndrome
obesity
ammenorrhea
infertility
hirsutism
PCOD
147
when you see stein-leventhal syndrome, think
PCOD
148
what is this showing
blue ovary → ovarian torsion
149
imaging to evaluate ovarian torsion
doppler US → shows blood flow to ovary
150
what do you think when you see a pt w. extensive abscesses in tubes and ovaries (tuboovarian abscess)
long standing, untreated pelvic inflammatory dz
151
CT/US findings of PID
fluid collections
152
PID involves inflammation of the __ (3)
uterus
tubes
ovaries
153
benign ovarian tumor
serous cystadenoma
154
malignant ovarian tumor
carcinoma of the ovary → large, solid
155
condition in which the uterine tissue is outside of the uterus in the adnexa or bowel
endometriosis
156
benign tumor of the uterus
leomyomata/fibroids
157
leomyomata is mc in \_\_
and can lead to \_\_
older pt
infertility
158
condition similar to endometriosis involving endometrial tissue w.in myometrium
uterine adenomyosis
159
symptoms of uterine adenomyosis
same as endometriosis:
painful menstrual cramps
uterine bleeding
dyspareunia
infertility
160
what is dyspareunia
painful intercourse
161
painful post menopausal bleeding is __ until proven otherwise
endometrial carcinoma
162
rf for endometrial carcinoma
obesity
DM
breast ca
tamoxifen
nulliparity
increasing age
high estrogen levels
genetics
PCOS
163
70% of cervical carcinoma can be prevented by
HPV vaccine
164
what is parametrial invasion
invasion of tumor behind the uterus, which obstructs ureters
165
cervical carcinoma that leads to masses that involve the bladder anteriorly and the rectum posteriorly → creates a **shelf of tumor**
frozen pelvis
166
PE exam for frozen pelvis
DRE → can feel large pelvic masses
