Chapter 16 Urinary System

Urinary System Anatomy

1. two kidneys

2. two ureters

3. one urinary bladder

4. one urethra

Main function Urinary System

production of urine and its elimination

how much do kidneys normally excrete a day?

1 - 2 liters of urine per day

suprarenal glands

aka Adrenal glands - are NOT part of the urinary system

what do the adrenal glands do?

secrete epinephrin and cortical hormones

Which kidney is larger and higher?

Left kidney slightly longer and narrower, lower than right

Where is the retroperitoneal located?

in contact with posterior abdominal wall

Where do the kidneys lie?

lie in oblique plane approx. 30 degree anterior toward the aorta

Kidney Anatomy: outer covering

Renal Capsule

Kidney Anatomy: outer layer of rental tissue

Renal Cortex

Kidney Anatomy = inner layer of renal tissue

Renal Medulla

Nehron

Essential microscopic component of kidney

how many cone shaped segments are the kidneys composed of?

8 to 15

how long are the ureters?

10 - 12 inches

What is the bladder

musculomembranous sac

Trigone

Triangular area of bladder base between three openings (bladder anatomy)

Urethra Size Females / Males

Females 1 ½ “ long

Males 7 to 8 “ long

what is a Scout Image

Demonstrated position and mobility of kidneys

Urography

general term used for radiographic procedure used to investigate the renal drainage system

What is always needed for Renal Parenchyma?

Contrast medium is needed, done in Antegrade

Antegrade

with the flow of bodily fluids

How is Antegrade administered

Percutaneous or IV

How is Antegrade work

Contrast enters kidneys in normal direction of blood flow, usually intravenously

Intravenous Urography

IVU - Includes all parts of Urinary System

Percutaneous Urography

involves direct injection into renal pelvis through percutaneous access of the kidney, NOT IV

Pyelography

means demonstration of renal pelvis and calyces only

Retrograde

against the flow; contrast is introduced against normal flow into ureters or bladder via catheter

When is Retrogade used?

bladder, lower ureters, urethra

What type of concentration is required for bladder studies and why?

Lower concentration; because a large amount required to fill bladder

What type of concentration is used for excretory urography?

Higher

Which contrast medias is less likely to cause an adverse reaction?

Nonionic

Patient Prep

• low residue diet for 1-2 days

• non-gas laxative when indicated the day before the exam

• NPO after midnight the day of exam

• pt should be well hydrated

Retrograde Urography hydration prep

should drink 4 - 5 cups of water several hours before exam

oscopy

through a scope

gram/graphy

x-ray pictures

Why is ureteral compression applied?

in excretory urography, compression is sometimes applied over the distal ends of the ureters

centered over the ASIS

When do you NOT use Compression?

if patient has:

Urinary Stones

Abd mass

Aortic Aneurysm

Colostomy

Suprapubic cath

Trauma inury

Respiration

made at end of expiration

Intravenous Urography demonstrates

structures and function of kidneys

Recurrent Urolithiasis

Stones cogenital abdnomalities

GFR

Glomerular Filtration Rate

Normal GFR

90 to 120 mL/min

Normal Creatinine

0.5 to 1.2mg/100mL

GFR With Renal Dysfunction

<90 mL/min

Time needed for Nephogram, Renal Pelvis, Kidneys

30 seconds - best demonstrates a nephrogram

2 - 8 min contrast begins to appear in the renal pelvis

15 - 20 min greatest concentration of contrast within kidneys

Most common IVU projections

AP with 3- 20min intervals

how often are obliques taken for IVU

30* posterior oblique taken 5 - 10 min intervals

AP Urinary Sytem PT Position

upright to demonstrate kidney mobility

kidneys drop 2” from supine to upright

to best demonstrate distal ureters

transdelenburg position, head lowered 15 - 20 *

Urinary System C/R

Perp to center of IR at level of iliac crest

Urinary System AP Demonstrates

kidney, ureters and bladder

pubic symphysis

prostate region for males

Can be done PA to demonstrate ureteropelvic region and for filling the obstructed ureter in presence of hydronephrosis

AP Oblique Part Position

30*

Kidney farthest away will appear parallel with IR

Kidney closest will appear perpendicular

AP Oblqiue C/R

Enters approx 2 inches lateral to midline on elevated side at the iliac crest

Lateral Urinary Sytem CR

Perp to IR at iliac crest

Dorsal Decubitus Urinary System CR

Horizontal and perp to center of IR

enters patient at MCP at level of iliac crest

Doral Decubitus Urinary Sytem demonstrates

UPJ in the presence of hydronephrosis

can demonstrate extrarenal mass in intraperitoneal or extraperitoneal

Hydronephrosis

Stones, kidney or bladder

Retrograde Urography

Done to examine pelcialyseal system and ureters by using catheters to administer contrast directly into the area against normal flow

Retrograde Cystography

Exams of urinary bladder after introducing contrast into bladder with a cath passing through urethra

Projections Retrograde Cystogram

AP/PA Axial, Lateral, AP Oblique, Post Voide

AP Axial urinary Bladder CR

Angled 10 to 15 * caudad to center of IR

enters 2 inches above upper pubic symphysis

CR depends on lumbar lordosis

PA Axial Bladder

angled 10 - 15* cephlada

enters 1 in distal to coccyx

exits above superior boarder of pubic symphysis

AP Oblqiue pt Position

40 - 60 * posterior oblique position

AP Oblique Bladder CR

Perp to IR

CR will fall 2 in above the upper boarder of pubis symphysis and 2 in medial to upper ASIS

IF bladder neck is of interest AP OBLIQUE

10 * CAUDAL of CR will project pubic bones below them

Lateral Bladder CR

perp to IR

enters patient level 2 in above upper boarder of pubic symphysis

Male CYSTOURETHROGRAPHY (on test) pt position

Recumbent 35 - 40 * posterior oblique