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Abdomen II
Abdominal sonography final prep
| Question | Answer |
|---|---|
| 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
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