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Abdomen II

Abdominal sonography final prep

Average kidney measurements 10-12 x 4-5 x 2-4cm
normal renal cortex measurement >1cm
the shape of the kidneys Reniform
enters/exits at the renal hilum? Blood Vessels, Lymphatics, nerves and ureter.
outer layer of the renal capsule? Gerota's Fascia.
lies posterior/medial to the kidney Psoas Muscle
lies posterior to the kidney Quadratus Lumborum
adrenal gland location to the kidney superior, anterior and medial
liver location to the right kidney superior/lateral
right colic flexure location to the right kidney inferior
pancreatic tail location to the left kidney anterior to the superior pole
outer layer of renal parenchyma Cortex
Cortex boundaries capsule to base of renal pyramids
Part of kidney that contains nephrons Cortex
Inner portion of renal parenchyma Medulla
Portion of kidney that contains pyramids Medulla
Contents of renal sinus major/minor calyces, blood vessels, lymphatics, fat and fiberous tissue
Microscopic functional unit of the kidney nephron
nephrons are made up of Glomerulus, collecting tubules, vascular supply
the right renal artery passes posterior or anterior to ivc? posterior
renal artery segments starting at hilum segmental artery, interlobar, arcuate, interlobular
courses between the medulla and cortex arcuate artery/vein
courses from renal cortex to renal surface interlobular
left renal vein passes between the SMA and aorta
Transducer used for renal imaging 2.5-5.0 MHz
Renal Cystic disease common in newborns Multicystic Dysplastic Kidney (MCDK)
Sonographic appearance of MCDK multiple, non-communicating cysts, no visible renal parenchyma or sinus
autosomal recessive Renal cystic disease Infantile Polycystic Kidney Disease, Medullary Sponge Kidney
Sonographic appearance of Infantile Polycystic Kidney Disease bilateral enlarge, hyperechoic kidneys
Autosomal dominant renal cystic disease Adult Polycystic Kidney Disease
Complications of Adult Poycystic Kidney Disease infection, stones, cyst rupture/hemorrhage, cysts in liver,panc, spleen, ovaries/testes or thyroid
Clinical Symptoms of APCKD Asymptomatic early, progressive decline in kidney function, cerebral hemorrhage, cardiac disease, uremia, lumbar pain, HTN, hematuria.
Sonographic appearance of PCKD bilateral enlargement of kidneys, multiple cysts of varying sizes and loss of sinus/parenchyma visualization
Sonographic appearance of Medullary Sponge Kidney highly echogenic pyramids without shadowing
Cyst(s) arising from renal cortex Simple cyst, parapelvic cyst
Clinical symptoms of an infected renal cyst flank pain, fever, elevated WBC count
Cyst characteristic associated with malignancy calcifications
Cause of parapelvic cyst urine extravasation into renal sinus
Cause of peripelvic cyst lymphatic ectasia/obstruction
Sonographic appearance of a parapelvic renal cyst solitary and large, similar to a dilated pelvis.
Sonographic appearance of a peripelvic cyst small, multiple irregular but anechoic cysts. Similar to hydronephrosis
Time for complete obstruction to cause irreversible kidney damage 3 weeks
Time for incomplete obstruction to cause irreversible kidney damage 3 months
urine dilatation of the renal pelvis and calyces Hydronephrosis
Hydronephrosis is AKA Pelvicalyceal Dilatations
Intrinsic Definition Cause of problem is located within the system
Extrinsic Definition Cause of problem is located outside the system
Intrinsic Causes of Hydronephrosis Stones, tumor within tract, UPJ stricture, ureterocele, infection
Extrinsic Causes of Hydronephrosis Surgery, trauma, BPH, pregnancy, fibroids
Normal RI of renal parenchyma <0.7
Abnormal RI of renal parenchyma >0.7
Stones in the urinary tract Urolithiasis
Composition of renal calculi calcium, uric acid, cystine
Renal Calculi Risk factors males, dehydration, heredity, urinary stasis, metabolic imbalances, infections
Twinkle Artifact Doppler "twinkles" seen around renal calculi
Normal ureter width 6mm
Most common UTI bacteria E Coli
Acute bacterial inflammation of kidney Acute Pyelonephritis
Symptoms of Acute Pyelonephritis dysuria, frequency/urgency of urination, chills, fever, backache
Sonographic appearance of Acute Pyelonephritis possibly normal. Enlarged, hypoechoic parenchyma.
Basic acute appearance rule big, dark and fluffy
Basic chronic appearance rule small and bright
Chronic Pyelonephritis recurrent infections that cause scarring and thinning of renal tissue
Clinical symptoms of Chronic Pyelonephritis polyuria, nocturia, HTN, renal dysfunction
Sonographic appearance of Chronic Pyelonephritis Small, hyperechoic kidney with parenchymal thinning
Type of Chronic Pyelonephritis caused by chronic infection and UPJ obstruction Xanthogranulomatous Pyelonephritis
Associated with Staghorn Calculi Xanthogranulomatous Pyelonephritis
Classic Triad for X. Pyelo Staghorn Calculus, renal enlargement, loss of renal function
Fungal infection of the kidney Candidiasis
Parasitic Infection of the kidney Schistosomiasis
Sonographic appearance of Schistosomiasis Normal kidneys, bladder wall thickening
Causes of Cortical Diseases inflammation, HTN, transplant rejection, renal failure
Lab Values seen with Cortical Diseases Elevated BUN and Creatinine
Sonographic appearance of Cortical Disease decreased kidney size, more echogenic and smaller cortex
Medullary Disease diagnosis requirement height of pyramids is larger than the cortex
types of chemical imbalances that cause medullary disease hyperuricemia, nephrocalcinosis, hypokalemia
Increased Uric Acid int he blood Hyperuricemia
calcium in the nephrons nephrocalcinosis
decreased potassium in the blood hypokalemia
conditions that can cause chemical imbalances in the blood/urine gout, diabetes, inflammation, hypercalcemia, tumors, obstructive uropathy
Sonographic appearance of Medullary Disease brighter pyramids, calcifications with shadwoing
a prenchymal disease that alters the appearance of the renal sinus Sinus Disease
types of sinus diseases infiltrative, fibrosis/atrophy
Sonographic appearance of infiltrative disease sinus appears inhomogeneous and patchy
Sonographic appearance of fibrosis/atrophy of parenchyma loss of distinction between sinus and parenchyma
Most common benign kidney tumor Adenoma
Sonographic appearance of Renal Adenoma well defined, iso/hypoechoic mass, <3cm
Very Large Vascular Adenoma (up to 26cm) Oncocytoma
Sonographic appearance of oncocytoma large, well defined, homogenous, stellate scar, vascularity
Benign Renal tumor composed of fat, smooth muscle tissue and blood vessels Angiomyolipoma
Sonographic appearance of Angiomyolipoma hyperechoic with low velocity blood flow
Multiple bilateral angiomyolipomas are associated with tuberous sclerosis
Renal Cell Carcinoma AKA hypernephroma, adenocarcinoma
Most common malignant renal cell tumor RCC
RCC arises from renal cortex
Sonographic appearance of RCC unilateral, solitary hpyo/hyperechoic complex mass with vascularity
Classic triad for RCC Hematuria, palpable mass, flank/low back pain
Things to image if an RCC is visualized renal vein, IVC, para-aortic nodes, contralateral kidney
Renals mets occurs via lymph, blood
Most common sites for RCC to mets to lungs, liver, lymph, bone, contralateral kidney, adrenals, brain
Most common tumor in children under 3 Nephroblastoma/ Wilm’s Tumor
Nephroblastomas are associatd with Beckwith-Wiedman Syndrome
Sonographic appearance of Wilm’s Tumor large, well delineated, homogenous, hyperechoic mass with areas of necrosis
Most common tumor of the renal pelvis Transitional Cell Carcinoma
Renal Carcinoma most often associated with painless hematuria TCC
Renal Carcinoma not best visualized with US TCC
Renal Carcinoma associated with calculi and infections Squamous Cell Carcinoma3
Most common primaries that result in renal mets breast, lung
Sonographic appearance of Renal mets hypo/hyperechoic multiple masses
Renal Failure inability of the kidneys to remove accumulated waste from the blood
Renal Failure classifications acute, chronic, acute on chronic
Excess nitrogen products (BUN, creatinine, uric acid) in the blood Azotemia
2 phases of renal failure oliguria and diuretic
3 types of acute renal failure prerenal, intrarenal, postrenal
Results in loss of perfusion due to a system cause prerenal acture renal failure
Result of a medical disease intrarenal acute renal failure
Most common renal disease to cause intrarenal acute renal failure acute tubular necrosis
Acute renal failure resulting from urine outflow obstruction postrenal acute renal failure
Diminished function of nephrons, resulting in decrease filtration, tubular function and renal blood flow Chronic Renal Failure
Sonographic appearance of Chronic Renal Failure small (<8cm length) echogenic kidneys
Most common cause of renal transplant failure in the first week Acute Tubular Necrosis
Most common cause of renal transplant failure after 1st week rejection
Sonographic signs of renal transplant rejection increased kidney size, cortical echogenicity, cortical thickness and pyramids. Hypoechoic areas within renal parenchyma
Types of fluid collections associated with renal transplant hematoma, urinoma, lymphocele
Most common fluid collection that causes hydronephrosis lymphocele
Collection of urine outside the urinary system urinoma
RI indicating renal transplant rejection <0.9
RI formula PSV-EDV/PSV
Urinary/reproductive systems develop from mesoderm
Renal pelvis and ureters develop from mesonephric duct
Kidneys arise from the pelvis around 12 weeks gestation
Renal parenchyma that extens into the renal sinus Column of Bertin
Normal Variant that appears as a thin echogenic line from capsule to sinus Fusion Anomaly
Area of fusion that appears as a hyperechoic triangular defect in cortex Junctinoal Parenchymal Defect
Appears that the renal pelvis extends bulbously from renal hilum Extrarenal Pelvis
Outward projection of renal tissue Dromedary Hump
Excessive fatty deposits in the renal pelvis Sinus Lipomatosis
Absence of one kidney and ureter Unilateral Agenesis (aplasia)
Associated with bicornuate uterus or seminal vesicle agenesis Unilateral Agenesis
Underdevelopment of a kidney unilateral hypoplasia
Most common congenital anomaly of the urinary tract Duplicated collecting system
Presence of 3 kidneys Supernumerary Kidney
Most common kidney congenital fusion anomaly Horseshoe Kidney
Main renal Functions Renin-angiotensis system, regulation of pH and electrolytes, Filter/remove waste from blood
All kidney function takes place in the nephron
BUN elevates with acute/chronic renal failure, dehydration, obstruction
BUN decreases with overyhydration, pregnancy, liver failure, smoking, decreased protein intake
Non-protein found in blood that elevates when a large number of nephrons are being destroyed in the blood Creatinine
Is BUN or creatinine more sensitive for renal dysfunction Creatinine
Ureter measurements 30cm long, 6mm wide
3 possible areas of ureter constriction UPJ, UVJ, as they cross iliac vessels
Area of bladder where ureters enter and urethra exits trigone
Voiding urine is aka Micturition
Internal sphincter of urethra is regulated by Sympathetic Nervous System
Well-distended Bladder wall measurement <3 mm
Non-distended Bladder wall measurement <5mm
Pouch like eversions of the bladder wall Bladder Diverticula
Caused by herniations through defects in the bladder wall Bladder Diverticula
Prostatic urethra is dilated due to an obstruction Posterior Urethral Valves
Most common cause of urinary obstruction in newborn males Posterior Urethral Valves
Posterior Urethral Valves AKA Bladder outlet obstruction
Herniaton of ureter into the bladder Ureterocele
Candle Sign is associated with Ureterocele
Inflammation of the bladder Cystitis
Cystitis associated with infection/catheterization Bullous Cystitis
Sonographic appearance of Cystitis thickened bladder wall
Loss of Voluntary control of voiding Neurogenic Bladder
Fiberous band between bladder and umbilicus that remains open after birth patent urachus
Present as a palpable midline mass when part of urachus is closed urachal cyst
Most common symptom of urinary tract neoplasms painless hematuria
Benign urinary tract tumor Papilloma
Common site for Papilloma later bladder wall/trigone area
Most common malignant neoplasm of the bladder TCC
Most aggressive malignant neoplasm of the bladder RCC
Sonographic appearance of bladder TCC irregular echogenic mass
Cauliflower appearing mass in the bladder TCC
Bladder mets usually comes from cervix, uterus, prostate and rectum
Largest reticuloendothelial organ spleen
Average Slpeen Measurements 12 x 8 x 4 cm
Stomach position in relationship to the spleen anterior
Left kidney relationship to the spleen posterior/inferior
Splenic flexure position in relation to the spleen anterior/inferior
Pancreatic tail position to the spleen medial/inferior
The splenic artery arises from the celiac axis
The splenic vein what other vain make up the portal vain smv
Splenic part composed of lymphatic tissue white pulp
Splenic part composed of reticular cells and fiber red pulp
Major function of the spleen filter peripheral blood
White pulp function production of leukocytes, plasma and antibodies. Phagocytosis of bacteria.
Red pulp function rbc production during fetal life, culling, pitting
Process of removing defective RBCs from the blood stream culling
Process of cleaning RBCs then returning them to the bloodstream Pitting
Congenital Absence of the spleen asplenia
Migration of the spleen from the LUQ Wandering Spleen
Most common variant of the spleen accessory spleen
Accessory Spleen AKA supernumerary spleens, splenunculus
Normal location to find an accessory spleen hilum
Enlarged spleen < 13cm Splenomegaly
Causes of Splenomegaly PHTN d/t cirrhosis, anemia, mono, aids
Most common type of splenic cyst echinoccal
Spenic Infarct appearance wedge or rounded, hypocechoic area near the periphery
Most frequent abdominal organ damaged by blunt abdominal trauma spleen
Most common benign splenic neoplasm Cavernous Hemangioma
Sonographic appearance of hemangioma of the spleen hyperechoic leasions <4cm
Splenoma AKA Harmatoma
Sonographic appearance of Harmatoma well defined non-encapsulated mass with varying echogenicity
Splenic lesion that arises from the lymphatic vessels Lymphangioma
Sonographic appearance of Lymphangioma Hypoechoic solid mass
Primary tumor of the spleen Angiosarcoma
Sonographic appearance of angisarcoma nodular areas, splenomegaly, solitary complex mass
Most frequent primary for Speenic mets Melanoma
Adrenal Gland measurement 3-6 x 2-4 x 0.3-1cm
Arteries that supply the adrenal glands Superior, middle and inferior suprarenal
Arises from the inferior phrenic artery superior suprarenal artery
Arises from the aorta Middle suprarenal artery
Arises from the renal artery inferior suprarenal artery
Outer Layer of Adrenal Cortex Zona Glomerulosa
Middle Layer of Adrenal Cortex Zona Fasciculata
Inner Layer of the Adrenal Cortex Zona Reticularis
Secretes mineralcorticoids Zona Glomerulosa
Secretes Glucocorticoids Zona Fasciculata
Secretes gonadocorticoids Zona Reticularis
Adrenal Medulla secretion Epinephrine and Norepinephrine
Common Cause of Adrenal Hemorrhage traumatic birth/lack of oxygen
Most common form of chronic primary hypoadrenalism Addison’s Disease
Massive Acute distruction of the adrenals Waterhouse-Friderichsen Syndrome
Excessive secretion of Mineral Corticoids Conn’s Syndrome
Excessive secretion of glucocorticoids Cushing’s Syndrome
Excessive Secretion of Gonadalcorticoids Adrenogenital syndrome
Adrenal tumor that secretes hormones Adenocarcinoma
Adrenal tumor that does not secrete hormones Adenoma
Highly vascular unilateral adrenal mass Pheochromocytoma
Highly malignant adrenal tumor in children Neuroblastoma
Contents of Pararenal Space pancreas, 2nd part of duodenum, ascending and descending colon
Contents of Perirenal Space kidneys, adrenals, great vessels, perinephric fat, ureters
Contents of Posterior Pararenal space fat
Most common type of soft tissue tumore Liposarcoma
Benign mass of fat lipoma
Benign mass of fiberous connective tissue fibroma
Benign mass of connective tissue myxoma
Benign mass of muscle rhabdomyoma
Grape Cluster appearance lymphadenopathy
Created by: Relaruna