Kidney, Bladder, and Spleen

kidneys

retroperitoneal, posterior, just below diaphragm

lower ribs

the kidneys are protected by the ______________ from injury

lower

the right kidney is ______________ than the left kidney

9-12

the kidneys are _____________ cm long

5-6

the kidneys are _______________ cm wide

2-4

the kidneys are _____________ cm thick

cortex

outer portion of kidney tissue

<1

the cortex is abnormal if it is ______________ cm in thickness

medulla

inner portion of kidney tissue

pyramids

the medulla is folded into ________________

renal pelvis

the medulla pyramids empty into urine collecting system in the ____________

nephrons

• renal tubules

• functional units of the kidney

renal

glomerulus

network of capillaries

Bowman’s capsule

cup-like structure surrounding the glomerulus

afferent arteriole

blood enters glomerulus

efferent arteriole

blood leaves glomerulus

renal hilum

• vertical slit on medial surface of each kidney

• entry point for blood vessels, nerves, ureter, & lymphatic vessels

true capsule

fibrous capsule attached to renal cortex

gerota’s fascia

• renal fascia

• areolar connective tissue covering over the perinephric fat

• covers kidney & adrenal gland

renal pelvis

upper, expanded end of the ureter

renal pelvis

calyces drain into the ________________

ureter

25 cm long tube that carries urine from kidney to bladder

urinary bladder

large muscular structure that acts as a storage site for urine

transitional epithelium

the urinary bladder is lined with ___________, which allows the bladder to stretch

urethra

membranous tube from bladder to outside body

excrete urine

major function of the kidneys is to:

excretion

the process of disposing metabolic waste

urinalysis

series of lab tests performed on urine

urine pH

• part of urinalysis

• tests if urine is acidic or alkaline

specific gravity

• part of urinalysis

• measures kidney’s ability to concentrate urine

hematuria

checks if there are blood cells in the urine

renal disease

RBCs in urine can indicate early _____________

trauma, stones, pyelonephritis, or glomerular/vascular inflammation

large numbers of RBCs in urine associated with:

infection, inflammation, or tissue damage in urinary tract

WBCs in urine associated with:

hemoglobin

found in urine when there is extensive destruction of RBCs

plasma proteins

when there is damage to glomerulus, _____________ are filtered into urine

abuminuria

associated with neoplasm, stones, chronic infection, and pyelonephritis

creatinine

if glomerular apparatus is malfunctioning, then there is less ______________ in the urine

creatinine

increased levels of ____________ in the blood indicates renal failure

creatinine clearance

tests creatinine levels in the urine

serum creatinine

tests levels of creatinine in the blood

BUN (blood urea nitrogen)

increased levels indicate renal disease and increased protein breakdown

smooth contour

on ultrasound, the normal appearance of the kidneys has a __________________

echogenic

on ultrasound, the renal capsule normally appears ___________

medium-level gray (slightly hypoechoic to liver)

on ultrasound, the cortex normally appears ___________

hypoechoic (not always seen easily)

on ultrasound, the renal pyramids normally appear ___________

echogenic

on ultrasound, the renal pelvis/sinus normally appear ___________

renal parenchyma

area from renal sinus to capsule

cortex

outer portion of renal parenchyma

medulla

anechoic pyramids, separated by renal columns

renal artery

echogenic walls, tubular in transverse plane

renal veins

leave kidney at renal hilum and enter IVC

arcuate arteries

• echogenic foci at bases of pyramids

• define cortico-medullary junction

pelvic kidney

occurs when kidney moves caudally with embryo axis as it lengthens→failure to ascend to lumbar position

the pelvis

most common location of an ectopic kidney

horseshoe kidney

occurs when right and left areas of metanephric mesoderm are located very close to each other & fuse in midline, usually at inferior pole

cake kidney

when fusion of the kidney occurs at the mid portion

cross-fused kidneys

kidneys are fused on the same side of the body

renal agenesis

occurs when ureteric bud doesn’t come into contact with metanephric mesoderm→no induction of nephron formation

unilateral agenesis

• only develop one kidney

• usually asymptomatic because there is still one functioning kidney which may be enlarged

bilateral agenesis

• kidneys never develop

• lethal

• usually occurs in conjunction with other defects

ectopic ureter

• rare condition

• occurs when ureteric bud develops at abnormally inferior place on mesonephric duct

• ureter too inferior to be incorporated into bladder→empties into urethra (males) or vagina (females)

duplicated collecting system

• occurs when ureteric bud splits

• earlier split occurs→more proximal location→more complete the duplication is

hypertrophied column of Bertin

• prominent fold of renal cortical tissue that produces down into the medulla towards renal sinus

• may mimic renal mass

hypertrophied column of Bertin

• clearly separated from renal sinus

• contiguous with renal cortex

• echogenicity is same as renal parenchyma

• not over 3 cm in size as a rule

dromedary hump

• bulge of renal cortex on lateral surface of kidney

• thought to be result of pressure on developing fetal kidney from spleen

• usually on left kidney

• echogenicity same as rest of renal parenchyma

junctional parenchymal defect

• triangular indentation in upper pole or renal parenchyma

• on peripheral border of cortex

• result in partial fusion of two embryonic ranunculi that form kidney

• echogenic

fetal lobulation

• variant in fusion of ranunculi that results in part of kidney being rotated

• upper and middle calyces may look splayed or large

• renal cortex has lobular indentation & may mimic a mass

• best seen in sagittal/coronal images

sinus lipomatosis

extra fat deposition in renal sinus

extrarenal pelvis

enlargement of proximal end ureter

ureters

very difficult to see on ultrasound unless they are dilated

urinary bladder

• must be full to evaluate with sonography

• special attention must be paid to the entire wall

thin & smooth

the bladder should have ____________ walls

anechoic

the bladder should have a ___________ lumen

midline

the bladder should be located in the _______________

uterus or prostate gland

an enlarged ______________ may cause an indentation of posterior bladder wall

duplicated ureters

duplication of the collecting system that involve complete or partial duplication of the ureters

complete

if the duplication is ____________, ureters from the upper pole will generally insert more inferiorly on the bladder

partial

if the duplication is ______________, ureters will fuse before reaching bladder

women

duplicated ureters are more common in _____________

ureterocele

cyst-like enlargement of distal ureter

spleen

intraperitoneal and in the LUQ near the tail of the pancreas and superior to the left kidney

inferior & medial

the left kidney sits _____________ to the spleen

spleen

largest mass of lymphoid tissue in the body

spleen

lymphoid organ that destroys damaged or worn-out blood cells, pathogens, and foreign materials

spleen

rarely the site of primary disease

spleen

the primary function of the ___________ is to filter foreign material from the blood

pitting

removal of nuclei from RBCs

culling

filtering out of abnormal RBCs

spleen

the ___________ filters platelets

thrombocytopenia

with splenomegaly, more platelets are trapped in the spleen, causing ______________

thrombocytopenia

can decrease ability of blood to clot

leukopenia

with splenomegaly, more WBCs get trapped in the spleen, causing ______________

hematocrit

describes percentage of blood volume made up by RBCs

bacteremia

presence of bacteria in the blood stream—>sepsis

leukocytosis

elevated WBC count