Urinary System

Retroperitoneal space

Where do the kidneys and ureters lay?

Infraperitoneal

Where do the bladder and urethra lay?

suprarenal (adrenal) glands

Located at the superomedial portion of each kidney

Posterior to the lower portion of the liver

Where is the right kidney located?

Posterior to the inferior border of the spleen

Where is the left kidney located?

Ureters

Lie anterior to the kidney and follows the natural curve of the vertebral column

Urethra

conducts urine from the bladder to outside the body

150 g

The average adult kidney weighs about ...

Left kidney

Which kidney is a little longer but narrower than the other?

Psoas major muscle

What affects the position of the kidneys causing them to angulate (20 degrees) and rotate backward (30 degrees)?

20 degrees angulation, 30 degrees rotation backwards

Normal kidney angulation and rotation (backwards)

30° left posterior oblique (LPO)

A ... positions the right kidney parallel to the IR

30° right posterior oblique

(RPO)

A ... positions the left kidney parallel to the IR

adipose capsule (perirenal fat)

Each kidney is surrounded by a mass of fatty tissue termed ...

Fatty capsules (adipose capsule, perirenal fat)

The presence of ... around the kidneys permits radiographic visualization of the kidneys on plain abdominal radiographs

Xiphoid process and iliac crest

Kidneys normally lie about halfway between the ... and ...

1 cm

The left kidney normally lies about ... more superior than the right one

T11-T12

The top of the left kidney is usually at the level of the ... interspace

L3

The bottom of the right kidney is most often level with the superior endplate of ...

2.5 cm (1 inch)

The kidney normally drops about ... during deep inhalation

One lumber vertebra, 5 cm (2 inches)

When upright, the kidneys normally drop about ... or ...

Nephroptosis

Kidneys drop farther than normal position

Production of urine and its elimination from the body

primary function of the urinary system

1. Remove nitrogenous wastes

2. Regulate water levels in the body

3. Regulate acid-base balance and electrolyte levels of the blood

Functions of urinary system

Urea and creatinine

Nitrogenous waste products

Uremia

The buildup of nitrogenous waste in the blood and may indicate renal dysfunction

25%

About ... of the blood pumped from the heart with each beat passes through the kidneys

Abdominal aorta

Arterial blood is received by the kidneys directly from the ... via the left and right renal arteries

hilum

Along the medial border of each kidney is a centrally located, longitudinal fissure termed the ...

Hilum

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

2.5 L water/24 hours

Average water intake per day

Bloodstream (circulatory system)

2.5 L of water eventually ends up in the ...

2.5 L

... of water eventually ends up in the bloodstream (circulatory system)

1 L

... of blood flows through the kidneys every 60 seconds

1.5 L /24 hr

Average urine production 24 hours

99%

...% of filtrate volume is reabsorbed

Cortex

Directly under the renal capsule surrounding each kidney, forms the peripheral or outer portion of the kidney

Medulla

Under the cortex is the internal structure termed ...

Medulla

Composed of 8 - 18 conical masses

Renal pyramids

A collection of tubules that converge at an opening

Renal parenchyma

Is used to describe the total function portions of the kidneys

Nephron

Structural and functional unit of the kidney

1 million nephrons

Approximately ... nephrons exist within each kidney

28 to 34 cm

The ureters vary in length from ... to ...

Peristaltic waves and gravity

Urine is transported through the ureters by ... and ...

1 mm to almost 1 cm

The ureters vary in diameter from ... to almost ...

1. Ureteropelvic Junction (UP)

2. Pelvic Brim

3. Ureterovesical Junction

Point of constrictions:

Ureteropelvic junction

Point of constriction where the renal pelvis funnels down to the ureters

Pelvic brim

Point of constriction where ureters cross with iliac blood vessels

Ureterovesical junction

Point of constriction where ureters will join the bladder

350 to 500 mL

The total capacity of the bladder varies from ... to ...

250 mL

If the urinary bladder reaches a capacity of ..., there is an urge to urinate

Trigone

smooth triangular area in the urinary bladder in which the ureters enter and the urethra exits

Prostate gland

In male anatomy, the gland that surrounds the proximal urethra is the ...

Upward and forward

When the rectum contains fecal matter, the bladder is pushed ... and ...

Female urethra

Is a narrow canal, about 4 cm long, which extends from the internal urethral orifice to the external urethral orifice

Lactic acidosis and/or contrast medium induced acute renal failure

Combination of iodinated cm and metformin may increase the risk of ... and/or ...

24 hours before, 48 hours after

Metformin should be withheld ... before and ... after the procedure

Creatinine and Blood Urea Nitrogen (BUN) levels

These laboratory tests should be conducted and reported in the patients chart before the urinary system study is undertaken

Urinary bladder

A musculomembranous sac that serves as a reservoir for urine

0.6 to 1.5 mg/dL

Normal creatinine levels for the adult are ... to ...

8 and 25 mg/100 mL

BUN levels should range between ... and ...

venipuncture

The percutaneous puncture of a vein for withdrawal of blood or injection of a solution

Water-soluble iodinated contrast media

... contrast medium is used for Radiographic examinations of the urinary system

Bolus injection or drip infusion

Water-soluble iodinated contrast medium can be administered by ... or ...

Bolus injection

entire dose of contrast medium is injected into the venous system at one time

Drip infusion

a method whereby contrast media is introduced into the venous system via connective tubing attached to the IV site.

1. Sharp Containers

2. Tourniquets

3. Alcohol Wipe

4. Various sizes of butterfly and over-the-needle catheters

5. Disposable or prefilled syringes

6. IV infusion tubing

Prepare equipment and supplies (Venipuncture):

sclerotic (hardened), tortuous (twisted), rolling, or overused

The technologist should avoid veins that are ..., ..., ..., or ...

Vein

Size of the needle is determined by the size of the ...

23- to 25-gauge needles

Gauge needles for pediatric patients

18- to 22-gauge needle

For bolus injections of 50 to 100 mL of CM into adults, a ... to ...-gauge needle is generally used

Ionic and nonionic

Two major types of iodinated contrast media used in urology:

Ionic organic iodides

This contrast agent contains iodine as the opacifying element and other chemical components that create a complex molecule

ionic iodinated contrast medium

Contrast medium that contains a positively charged side chain element called cation combined with a negative charged component called anion

ionic organic iodides

Higher Osmolality and greater chance of reaction

Nonionic organic iodides

Lower Osmolality and less chance of reaction

Nonionic Organic Iodide

These contrast agents also contain iodine needed for opacity but contain no positively charged cations

- Omnipaque

- Isovue

- Amipaque

- Optiray

Common commercial names of Nonionic contrast media:

Low-Osmolality organic iodide

A third type of contrast medium has been developed that is ionic in nature but has the nondissociating characteristics of a nonionic contrast medium

- Visipaque

- Ultravist

- Hexabrix

Common commercials names of low-Osmolality ionic contrast media:

- give a test dose with a small cc or mL

- wait for 5 minutes for any reaction

Before giving contrast media, the technologist should:

Hot flash and metallic taste

Two common side effects that may occur after an IV injection of iodinated contrast medium are temporary ... and ... in the mouth

- local reactions

- systemic reactions

Reactions to cm:

Local reactions

Are those that affect only the specific region of the body at which the contrast medium has been injected into the venous system

Systemic reactions

Are those that do not affect the site of injection, but rather the entire body or a specific organ system

Extravasation and Phlebitis

Two local reactions to contrast medication injection can be found at or near the site of IV access

Extravasation

Leakage of iodinated contrast medium outside the vessel and into surrounding soft tissues

Infiltration

Extravasation is sometimes also referred to as ...

Phlebitis

Inflammation of a vein

Mild, moderate, and severe

Three general systemic categories of contrast medium reactions have been identified into:

Intravenous urography

radiographic procedure in which contrast media is injected intravenously

Urography

General radiographic examination of the urinary system

Excretory urography - intravenous urography

... visualized the minor and major calyces, renal pelvises, ureters, and UB after an intravenous injection of contrast medium

Excretory urography - Intravenous urography

... is a true functional test because the contrast medium molecules are rapidly removed from the bloodstream and excreted completely by the normal kidney

Excretory Urography - Intravenous Urography

Most common special radiographic examination of the urinary system and can produce a radiographic image demonstrating renal cortical tissue well saturated with contrast medium

intravenous pyelography (IVP)

Excretory Urography - Intravenous Urography is also referred to as ...

1929, Roseno and Jepkins

In ..., ... and ... introduced a compound containing sodium iodide and urea

1929, Swick

In ..., ... developed the organic compound uroselectan

having an iodine content of 42%

Ureteric compression

... allows the renal collecting system to retain the contrast medium longer for a more complete study