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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