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Clin Med II - Exam 4 > Witwer - GUT Anatomy and Radiology > Flashcards

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

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2
Q

shape of adrenal glands

A

inverted Y/lambda

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3
Q

location of the bladder

A

pelvic cavity

posterior to pubis symphysis

below parietal peritoneum

intraperitoneal

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4
Q

location of ureters

A

begin at ureteropelvic junction (UPJ) of kidney

posterior to renal vein and artery in the hilum

retroperitoneal

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5
Q

location of the kidneys

A

either side of spine

supine - T12-L3 vertebrae

ribs 11/12 - L¾

retroperitoneal

abdominal cavity

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6
Q

the __ kidney is lower

when erect, the kidneys are slightly __

A

right

lower

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7
Q

structures related to the right side of the kidney

A

descending duodenum

posterior liver

hepatic flexure of colon

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8
Q

structures related to the left kidney

A

stomach

spleen

pancreas

splenic flexure

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9
Q

structure medial to the kidneys

A

psoas m

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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

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11
Q

3 constrictions of the ureter

A

pelviureteric junction (PUJ)

common iliac artery bifurcation

vesicoureteric junction (VUJ)

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12
Q

constrictions of the ureter are the mc sites of

A

renal calculus

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13
Q

fxn of the psoas

A

flexion of hip

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14
Q

fxn of iliopsoas

A

flexion and external rotation of hip

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15
Q

innervation of psoas major

A

L1-L3

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16
Q

note the renal fascia, perinephric (perirenal) fat, psoas m, IVC/aorta

A
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17
Q

not the cortex and medulla

A
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18
Q

location of renal arteries

A

L1-L2

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19
Q

significance of aortic aneurysms on kidneys

A

can involve renal arteries

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20
Q

consequence of blockage of renal arteries

A

htn

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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

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22
Q

the gonadal arteries arise from the

A

aorta

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23
Q

a short urethra predisposes pt to

A

cystitis

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24
Q

the filling of the bladder is under __ control

A

sympathetic

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25
Q

during filling of the bladder, the detrusor m is

A

relaxed

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26
Q

the emptying of the bladder is under __ control

A

parasympathetic

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27
Q

during filling of the bladder, the __ are contracted (2)

A

internal sphincter

external sphincter

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28
Q

contraction of the internal sphincter is under __ control

A

sympathetic

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29
Q

contraction of the external sphincter is under __ control

A

voluntary

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30
Q

during emptying of the bladder, the detrusor m is

A

contracted

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31
Q

during emptying of the bladder, relaxation of the internal sphincter is under __ control

and relaxation of the external sphincter is under __ control

A

parasympathetic

voluntary

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32
Q

what n roots innervate sympathetic control of the bladder

A

L1-L3

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33
Q

what n roots control parasympathetic control of the bladder

A

S2-S4

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34
Q

what binds the trigone of the bladder (2)

A

ureteral orifices

internal urethral sphincter

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35
Q

2 populations affected by adrenal hemorrhage

A

adults

newborn

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36
Q

in newborns, adrenal hemorrhage is 2/2 to (2)

and results in __

A

anoxia (no O2), sepsis

adrenal insufficiency

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37
Q

benign adrenal adenomas are a type of

A

incidentaloma → benign, no clinical significance

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38
Q

pheochromocytomas arise from the __,

secrete __,

and cause __

A

adrenal medulla

catecholamines

htn

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39
Q

pheochromocytomas arising outside of adrenal medulla are called

A

paragangliomas

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40
Q

ex of a paraganglioma

A

glomus tumor of the jugular foramen

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41
Q

primary hyperaldosteronism is same same

A

conn syndrome

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42
Q

conn syndrome can be 2/2 to (2)

A

cortical hyperplasia

tumor

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43
Q

sx of conn syndrome (3)

A

fatigue

high bp

hypokalemia

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44
Q

2 treatable causes of htn

A

pheochromocytoma

conn syndrome

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45
Q

metastases to adrenal gland are common from common tumors, including (4)

A

melanoma

lung

colon

breast

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46
Q

is primary adrenal carcinoma common

A

no!

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47
Q

2 consequences of VUR

A

renal scarring

renal infxn (pyelonephritis)

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48
Q

how does VUR cause pyelonephritis

A

infected urine is refluxed

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49
Q

causes of VUR in peds (4)

A

immature short ureteral tunnel

congenital anomaly at UVJ

posterior urethral valves

neurogenic bladder

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50
Q

what cause of VUR resolves w. age

A

immature short ureteral tunnel

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51
Q

what cause of VUR is only in males

A

posterior urethral valves

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52
Q

imaging for hydronephrosis

A

US

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53
Q

hydronephrosis requires __

A

full work up

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54
Q

40% of peds < 5 yo w. UTI have

A

VUR

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55
Q

VUR and UTI both require what kind of care

A

aggressive individual evaluation/tx

close long term f.u

risk for significant renal damage

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56
Q

work up for VUR

A

VCUG or isotope cystogram

radionuclide DMSA renogram

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57
Q

2 components of bladder fxn, filling, emptying/voiding/micturition

A

neurologic

muscular

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58
Q

what controls conscious interpretation of full or empty bladder

A

cerebral cortex

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59
Q

what monitors filling and coordinates voiding of bladder

A

pontine micturition center

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60
Q

spinal cord pathways for bladder (2)

A

ANS

somatic

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61
Q

what nerve inhibits detrusor contraction and contracts the internal urethral sphincter in the urethra and bladder neck during filling

A

hypogastric n

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62
Q

hypogastric n arises from

A

T10-T12

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63
Q

what n controls detrusor contraction and relaxation of the internal urethral sphincter and bladder neck during bladder emptying

A

pelvic n

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64
Q

pelvic n arises from

A

S2-S4

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65
Q

what n controls contraction of the external sphincter in the urogenital diaphragm during bladder filling/relaxation during voiding

A

pudendal n

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66
Q

pudendal n innervation of the bladder is under __ control

A

voluntary

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67
Q

what nerve pathways does the sacral micturition center include

A

PSNS

somatic

68
Q

PSNS component of sacral micturition center (2)

A

detrusor contraction

internal sphincter relaxation

69
Q

somatic component of sacral micturition center

A

pudendal n relaxation → coordination of micturition

70
Q

interference/damage to any of the centers and/or pathways controlling storage of urine and micturition

A

neurogenic/neuropathic bladder

71
Q

neurogenic bladder can be __

or __

A

complete

incomplete

72
Q

what do these symptoms make you think: involuntary bladder contractions (detrussor hyperreflexia) with coordinated sphincter relaxation, sudden strong urge to urinate

A

neurogenic bladder lesion above the brain stem

73
Q

what is coordinated bladder sphincter relaxation

A

urge incontinence

74
Q

what do these symptoms make you think of: detrusor hyperreflexia, uncoordinated spastic external sphincter (detrusor-sphincter dyssenergy), residual urine w. reduced bladder capacity

A

complete lesion of the spinal cord above T12 vertebral body

75
Q

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

A

lesion to the spinal micturition reflex

76
Q

lesion to the spinal micturition reflex is a __ motor lesion

with loss of __

and __

A

lower

motor and sensory

77
Q

pt education for neurogenic bladder

A

shock phase may last weeks-months → may have no sensation/areflexia

78
Q

summary of neurogenic bladder

A

what to know: concept of UMN and LMN and their relation to the reflex arc

79
Q

where can kidney stones be located

A

in kidney → mc renal medulla

renal collecting system → calyces, infundibula, renal pelvis, ureter

80
Q

what is this showing

A

stone in left renal pelvis

81
Q

what is this showing

A

stone in the renal pelvis

82
Q

when do patients commonly pass stones

A

when they are dehydrated

83
Q

where is renal stone pain felt (5)

A

back

flank

groin

labia

scrotum

84
Q

mc differential dx for painful hematuria

A

kidney stone

85
Q

mc cause of painless hematuria

A

bladder ca

86
Q

best imaging to evaluate for stone/stone ddx

A

non contrast spiral CT

87
Q

how does hydronephrosis appear on imaging

A

enlarged collecting system → can be confused for cysts

88
Q

what causes renal papillary necrosis (5)

A

analgesic abuse (acetaminophen)

pyelonephritis

renal ichemia

DM (sorry tess, but not you bc you are so good at managing yours)

sickle cell dz

89
Q

in renal papillary necvrosis, the __ sloughs off and causes

__

A

medulla

filling defects

90
Q

2 forms of nephrocalcinosis

A

cortical

medullary

91
Q

causes of cortical nephrocalcinosis (5)

A

acute cortical necrosis

chronic glomerulonephritis

prolonged hypercalcemia

hypercalciuria

poisoning/toxicities

92
Q

causes of medullary nephrocalcinosis (6)

A

hyperparathyroidism

medullary sponge kidney

renal tubular acidosis

renal papillary necrosis

milk-alkali syndrome

hyperoxaluria

93
Q

all causes of nephrocalcinosis are related to (4)

A

hypercalcemia

renal damage from ischemia

inflammation

toxins

94
Q

what is this showing

A

nephrocalcinosis

95
Q

congenital condition involving dilated renal tubules; generally asymptomatic

A

medullary sponge kidney

96
Q

medullary sponge kidney predisposes infant to (2)

A

infxn

stone formation

97
Q

relatively common autosomal dominant condition involving multiple cysts → massive non-functioning kidneys → renal failure later in 40s and 50s

A

adult polycystic kidney dz

98
Q

what is this showing

A

polycystic kidney dz w. cysts in liver and pancreas

99
Q

are renal cysts always pathologic

A

no! they can be common/normal incidental findings with age

usually single or several

100
Q

rare (usually) incidental finding where lower poles of kidney are fused across abd midline

A

horseshoe kidney

101
Q

horseshoe kidney predisposes pt to (2)

A

obstructions

stones

102
Q

renal condition that is a potentially treatable cause of HTN

A

renal artery stenosis

103
Q

renal stenosis activates the __

A

RAAS

104
Q

2 forms of renal artery stenosis

A

atherosclerotic

fibromuscular dysplasia (hyperplasia)

105
Q

tx for atherosclerotic renal artery stenosis

A
  1. meds
  2. balloon angioplasty or surgical correction
106
Q

tx for fibromuscular renal artery stenosis

A

balloon angioplasty

107
Q

what happens to kidney size in renal artery stenosis

A

it shrinks → loss of fxn

108
Q

renal artery stenosis is really only curable if it is diagnosed

A

early

109
Q

how do you evaluate bruit in renal artery stenosis

A

put stethoscope to the right and left of transpyloric plane

110
Q

condition that mc affects women in 40 and 50s that involves fibrous thickening of all layers of renal artery wall

A

fibromuscular dysplasia

111
Q

tx for htn caused by fibromuscular dysplasia

A

balloon angioplasty

112
Q

4 potentially treatable forms of HTN

A

pheochromocytoma

conn tumor/hyperplasia

renal artery stenosis 2/2 arteriosclerosis

renal artery stenosis 2/2 fibromuscular dysplasia

113
Q

condition mc found in dehydrated pt’s or infants w. clotting abnormalities that can cause nephrotic syndrome and pulmonary blood clots

A

renal vein thrombosis

114
Q

what is this showing

A

atherosclerotic renal artery stenosis

115
Q

mc cause of cystitis (UTI)

A

e.coli

116
Q

predisposing factors for UTI/cystitis (2)

A

sex :(

catheterization

117
Q

what do you think when you see a kid w. recurrent cystitis

A

underlying abnormality →

neurogenic bladder

ureteral issues

VUR

developmental abnormalities of ureter

renal damage

118
Q

painless hematuria

A

bladder ca til proven otherwise

also

renal cell carcinoma

there better be a gd test question on this!

119
Q

imaging for renal cell carcinoma (3)

A

CT

IVP

US

120
Q

symptom of renal cell carcinoma

A

painless hematuria

all painless hematuria must be evaluated for urinary tract malignancy

121
Q

sx of transitional cell carcinoma

A

painless hematuria!

122
Q

where are transitional cell carcinoma tumors found (4)

A

ureters

bladder

urethra

kidney

123
Q

what do you think when you see US or MRI showing asymetry in prostate gland

A

carcinoma of the prostate

124
Q

where does prostate carcinoma metastasize

A

bones

125
Q

possible sx of prostate carcinoma

A

bone pain

elevated alk phos

126
Q

where do the testicles form embryologically

A

beneath kidneys → descend thru inguinal canal → into scrotum

127
Q

“hidden testicles”

A

cryptochordism

128
Q

potential complications of cryptochoridism

A

infertility

malignancy

129
Q

majority of cryptochordism resolves w.in

A

first year of life

130
Q

imaging for epidydymitis

A

US

131
Q

common US findings of eididymitis

A

enlarged heterogenous, hyper-vascular w. reactive hydrocele

132
Q

can hydroceles in the absence of epididymitis be a benign finding

A

yes! common in kids and adults

133
Q

painful condition involving spermatic cord twisting

A

testicular torsion

134
Q

what is a bell clapper deformity and why do we care about it

A

testicle not attached to scrotum → tunica vaginalis surrounds much of the testicle

predisposes to testicular torsion

135
Q

in terms of tx, what is testicular torsion

A

medical emergency → twisted (torted) testicle is avascular

136
Q

imaging for testicular torsion

A

US doppler flow

137
Q

ddx for painful testicle/scrotum (6)

A

epididymitis

orchitis

epididymitis/orchitis combo

testicular torsion

varicocele

hernia w.in scrotum

138
Q

symptoms of epididymitis/orchitis combo

A

increased blood flow →

rubor, calor, tumor, dolor → redness, heat, swelling, pain

139
Q

imaging if pt complains of testicular/scrotal pain

A

US

140
Q

testicular malignancies are associated w. __ cells

A

germ → sperm progenitors

141
Q

imaging to visualize mass in scrotum

A

US

142
Q

venous drainage of testes is via the __,

which runs with the __

A

pampiniform plexus

spermatic cord

143
Q

a varicocele is a varicosity of the

A

pampiniform plexus

144
Q

US findings of varicocele

A

multiple veins w. slow blood supply

145
Q

enlarged ovaries w. thick sclerotic capsules and an abnormally high number of follicles

A

poly cystic ovary dz

146
Q

stein-leventhal syndrome

A

obesity

ammenorrhea

infertility

hirsutism

PCOD

147
Q

when you see stein-leventhal syndrome, think

A

PCOD

148
Q

what is this showing

A

blue ovary → ovarian torsion

149
Q

imaging to evaluate ovarian torsion

A

doppler US → shows blood flow to ovary

150
Q

what do you think when you see a pt w. extensive abscesses in tubes and ovaries (tuboovarian abscess)

A

long standing, untreated pelvic inflammatory dz

151
Q

CT/US findings of PID

A

fluid collections

152
Q

PID involves inflammation of the __ (3)

A

uterus

tubes

ovaries

153
Q

benign ovarian tumor

A

serous cystadenoma

154
Q

malignant ovarian tumor

A

carcinoma of the ovary → large, solid

155
Q

condition in which the uterine tissue is outside of the uterus in the adnexa or bowel

A

endometriosis

156
Q

benign tumor of the uterus

A

leomyomata/fibroids

157
Q

leomyomata is mc in __

and can lead to __

A

older pt

infertility

158
Q

condition similar to endometriosis involving endometrial tissue w.in myometrium

A

uterine adenomyosis

159
Q

symptoms of uterine adenomyosis

A

same as endometriosis:

painful menstrual cramps

uterine bleeding

dyspareunia

infertility

160
Q

what is dyspareunia

A

painful intercourse

161
Q

painful post menopausal bleeding is __ until proven otherwise

A

endometrial carcinoma

162
Q

rf for endometrial carcinoma

A

obesity

DM

breast ca

tamoxifen

nulliparity

increasing age

high estrogen levels

genetics

PCOS

163
Q

70% of cervical carcinoma can be prevented by

A

HPV vaccine

164
Q

what is parametrial invasion

A

invasion of tumor behind the uterus, which obstructs ureters

165
Q

cervical carcinoma that leads to masses that involve the bladder anteriorly and the rectum posteriorly → creates a shelf of tumor

A

frozen pelvis

166
Q

PE exam for frozen pelvis

A

DRE → can feel large pelvic masses

Clin Med II - Exam 4 (20 decks)

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