Urinary system

What is the functional and structural unit of the kidney?

Nephron

Three functions of the kidney during urinary production

- removes nitrogenous wastes

- regulate water levels in the body

- regulate acid-base balance and electrolyte levels of the blood (recycling of red blood cells)

What position best demonstrates mobility of kidneys?

Upright

Where do the kidneys normally lie?

Halfway between xiphoid process and iliac crest

T12-L3

The ______ urethra is approximately 3.5 cm long.

Prostatic

The ______ urethra extends from the penoscrotal junction to the external medius.

Penile

The innermost layer of the ureters is the

Mucosa

The urine formation process begins with

Glomerular filtration

Retrograde urethrograms are most effective in evaluating the posterior urethra, whereas the voiding cystourethrogram provides optimal visualization of the anterior urethra

False

Indications for an RUG include

Weak urinary stream

U.S. Food and Drug Administration regulations require all fluoroscopy units to be equipped with accumulative time or device that typically alerts the operator every ______ minutes of the length of time the patient has been exposed.

5

During an RUG examination, the patient is positioned in a ____ degree to ______ degree right posterior oblique position.

35; 45

RUG and VCUG complications include:

pain, minor hematuria and urinary tract infection

Signs and symptoms of urethral structure include

Weak urinary stream and post void dribbling

________ is it chronic inflammatory disease that affects the genital skin and causes destructive scarring in the urethra?

Balantitis xerotica obliterans

Extravasation of contrast above the urogenital diaphragm only is consistent with a type ________ urethral injury

II

Urinary consists of

Two kidneys, two ureters, one urinary bladder and one urethra

The kidneys filter _______, control ______ ________ and balance

Blood; BP; PH

The kidneys and ureters lie in the

Retroperitoneal space but it's not within the peritoneal sac

Which kidney is slightly lower due to the liver

Right

The ureter lies ____ to kidney

Anterior

The urethra connects the urinary bladder to the

Exterior

The kidneys are angled 30 degrees because of the

Midline location of vertebral column and the psoas muscles

30 degree angle for an RPO and LPO of kidneys to ,are each kidney __________ to IR

Parallel

Each kidney is surrounded by

Adipose Capsule or perirenal fat

An RPO position we are seeing the _____ kidney and the ureter moves out of superimposition of spine

Left

When the patient expires and is placed supine the kidneys normally lie halfway between

Xiphoid and iliac crest

Nephropoptosis

When upright kidneys drop more than 2 inches

Primary function of urinary system

Production of urine and it's elimination

Arterial blood is received by the kidneys directly from the ________ _______ via left and right ______ ________

Abdominal aorta; renal arteries

Renal veins connect directly to the _____ ______ _____ to return blood to the right side of the heart

Inferior vena cava

Along the medial quarter of each kidney is essentially located longitudinal fissure termed the

Hilum

The Hilum serves to

Transmit the renal artery, renal vein, lymphatics, nerves, and ureter

If the kidney shows up dark, the kidney is not being

Vascularized

Outer covering of kidney

Renal capsule

Lower pole and

Upper pole

The cortex is where the filtration of

Blood haooens

Medulla

Urine concentration happens

Have renal pyramids: collecting ducts

Renal column

Dip of cortex between medulla

Renal pyramids

Collection of tubules that converge at an opening called the renal papilla

Minor calyces form renal papilla and converge to

Major calyx

Major calyces form renal

Pelvis

Renal parenchyma

Total functional portions of the kidneys

The functional area that creates urine

Kindey

Glomerulus

Pressure difference

Small arteries in the renal cortex form, tiny capillary tufts termed

Glomeruli

Afferent arterioles supply blood to the

glomeruli

Efferent arterioles take blood _____ from secondary capillary network in close relation to the straight and convulated tubules

away

Glomerulus capsule ——> proximal convulated tubule —> descending an ascending loop of Henle —> distal convulated tubule —> collecting tubule —> minor calyx

Waste pathway (when hits minor calyx then its termed urine)

Ureters

Allow transport from kidney to urinary bladder; where stones are

Slow _______ waves and gravity force urine down the ureters into the bladder

Peristaltic

3 natural indentations (constriction points):

1) Ureteropelvic junction (UVP): Which the renal pelvis funnels down into the small ureter

2) brim of the pelvis: where the iliac blood vessels cross over the ureters

3) ureterovesical junction (UVJ): Where the ureter connects into bladder (where most stones hang out)

Define urinary bladder

Musculomembranous sac that serves as a reservoir for urine

Voiding

Retention of urine

Retention of the urine in the bladder is maintained through the involuntarily controlled ______ _________ _________ and voluntarily controlled _________ ________ ________

Internal urethral sphincter (IUS) Neck of bladder

External urethral sphincter (EUS) more distal

The female EUS is more elaborate than males and composed of three areas that include

1) urethral sphincter 2) compressor urethrae 3) urethrovaginalis sphincter

When the EUS relaxes, normally voiding happens under _______ control

Voluntary

Weakening or damage to the EUS can lead to involuntary urination called

Incontinence

Female pelvic organs

Male pelvic organs

The urinary bladder, urethra, and male reproductive organs are

Infraperitoneal (inferior to peritoneal cavity)

Intravenous (Excretory) urography (IVU) prep:

NPO 8 hours

Bowel prep

Void prior to exam

Verify: contrast indications + signed consent

If pt has urinary catheter: close it!

Iodinated contrast

Water soluble

Triodinated

Ionic

Dissolved in water

Anion (-)

Cation (+)

Non ionic

Non-ionizing elements

Summary of mild reactions to contrast, medium

Summary of moderate reaction to contrast medium

Summary of severe reaction to contrast medium

Pt screening

ACR manual pg. 510

Normal Blood urea nitrogen (BUN) levels

8-25 mg/ 100 mL

Normal Creatinine levels

0.6-1.5 mg/dL

Normal Estimated Glomerular Filtration Rate (eGFR) in adults:

60 mL/min or greater

eGFR ACR manual pg. 37-38 and pg. 44

Metamorfin (ACR manual pg. 44)

Category one and category two

IVU is a ______ study

Functional

IVU protocol

Pt clinical history taken, Scout, nephragram, 5 min then 10 min timed images, 20 min obliques (RPO, LPO) + post void (after pt voids)

Nephrogram

Radiographs taken early in the series

1 min post injection

CR for nephrogram

Between xiphoid and iliac crest

Shows "flushing" of kidneys

IVU patient prep

-NPO 8 hours

- Void prior to exam

- check contraindications and informed consent

- if have catheter then close it!

- bowel cleansing + enema morning of

IVU routine

AP scout (KUB)

Nephrogram ( 1 min. after injection) CR: halfway beytween xiphoid + iliac crest

AP (5min. & 10-15min.)

RPO & LPO (20min.) 30 degrees oblique and CR: between vertebral column and iliac crest

AP postvoid upright (CR: 1" below iliac crest) make sure entire bladder is in image

Special: AP ureteric compression

Cystography

Urine bladder imaging

Retrograde Cystography procedure

Insert urinary catheter

Hang iodinated contrast on IV pole with extension tubing

Allow gravity to fill the bladder

10-15 degree caudal tube angle

CR at 2 inches superior to symphysis pubis

RPO/LPO: 45- 60 posterior oblique

2 inches superior to symphysis pubis + 2 inches medial to upside ASIS

- structural exam

Retrograde Urography (endoscopy) p.562

- non-functional

Treatments for retrograde Urography:

Catheter insertion

Stent placement

Other

VCUG

Functional study of urethra and ability to urinate

After routine cystogaphy

Routine cystography

Remove catheter and image while the patient voids

VCUG Clinical Indications

- trauma

- incontinece

- posterior urethral valves ( small leaflets of tissue + slit like openings that impede flows)

VCUG Positions

supine or erect

- women: AP or slight

- men: 30 degrees RPO

post void AP might be requested

Staghorn calculi

Stones that occupy the entire collecting system

Fills the renal pelvis

Know diff between RPO and LPO IVU

IVU patient prep

-NPO 8 hours

-void prior to exam

-check contraindications and informed consent

-if has catheter then close it!

-bowel cleansing and enema morning of

Metformin (Glucophage)

Biguanide (oral antidiabetic)oral anti-hyperglycemic agent to treat patients with non-insulin-dependent diabetes mellitus

Metformin limitation

<30 eGFR Discontinue Metformin for 48 hours after ERCP