kidneys 4 lecture slides

What is derived from the cloaca?

the bladder and urethra

What is a hindgut structure that is a common chamber for gastrointestinal and urinary waste?

cloaca

In the 4th-7th weeks of development, the
cloaca is divided into two parts by what?

the uro-rectal septum

The DORSAL portion develops into the _______ and ________

rectum and anal canal

The VENTRAL portion develops into the _______

urogenital sinus

The urogenital sinus develops into……

– the urinary bladder, prostate gland,
– bulbourethral glands (Cowper’s gland),
– paraurethral glands,
– prostatic, membranous, and penile (spongy) urethra in males; urethra and lower vagina in females)

Bladder develops from what?

urogenital sinus

In infants and children, bladder is an abdominal organ, but after _____, bladder is a true pelvic structure

puberty

As the bladder grows and expands, the distal
ends of the mesonephric ducts are absorbed
into the wall of the bladder as what?

the trigone

Where is the urinary bladder located?

behind the pubic bone

The urinary bladder develops mainly from the cranial part of the urogenital sinus, called the allantois. The allantois soon becomes a thick fibrous cord known as _______ and extends from the apex of the bladder to the umbilicus.

urachus

What is also known as the median umbilical ligament in the adult?

urachus

Bladder apex points anteriorly and is connected to the umbilicus by what ligament?

the umbilical ligament (urachus)

The bladder is __________ to peritoneal cavity

inferior and anterior

Ureteric and urethral orifices demarcates what area?

the trigone area

Urethral orifice marks what?

bladder neck

What remains same shape, while rest of bladder can change shape and position depending upon the amount of fluid within?

Bladder trigone and neck

What is the tubular structure originating from the inferior and anterior bladder to the external genitalia to drain urine from the bladder?

Urethra

What sphincters control urine flow from the bladder?

internal and external

What sphincter surrounds the opening of the bladder to the urethra and is involuntary?

internal sphincter

What sphincter surrounds the urethra outside the bladder and is voluntary?

external sphincter

What is the wall layers from outer to inner?

Serosa → Muscle → Mucosa

What is posterior to symphysis pubis?

bladder

In females the bladder is anterior to what?

vagina and uterus

In males the bladder is anterior to what?

seminal vesicles and rectum

what is the normal bladder wall thickness when distended?

< 3 mm

What is the normal bladder wall thickness when non-distended?

< 5mm

Give 4 sonographic descriptions about the bladder?

• Anechoic structure
• Smooth, thin walls
• Ring down/reverberation artifacts seen anteriorly
• As bladder distends, bowel is displaced cephalad (or anterior) out of pelvis

The normal adult bladder is generally moderately full at _________ (a pint) of urine

500 mL

It is best to have a medium-filled bladder which is usually what?

greater than 100 mL

What is a rare disease where most infants are born stillborn?

Bladder Agenesis

What is type 1 bladder duplication?

complete or incomplete fold resulting in 2
bladders

What is type 2 bladder duplication?

may be multiple septa

What is a rare type of malformation of the
penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis. It can also develop in females when the urethra develops too far anteriorly.

epispadias

What is failure of the lower abdomen to close which allows UB to extrude through?

Bladder exstrophy

What is Bladder exstrophy associated with?

epispadias

What is a remnant of a channel between the bladder and the umbilicus (belly button) where urine initially drains in the fetus during the 1st trimester of pregnancy?

urachus

The channel of the urachus usually seals off and obliterates around what week of gestation?

12th week

What is a small fibrous cord between the bladder and umbilicus that is left after the 12th week?

the median umbilical ligament

Patent urachus is associated with what?

urethral obstruction

What results when urine is trapped between fused ends of the urachus?

urachal cysts

What results when the umbilical end of the urachus closes, but the bladder end remains open allowing urine to fill this partially open
urachus. It also has an increased incidence of carcinoma and stone formation.

Urachal diverticulum(5%)

What results when the bladder end of the urachus closes, the umbilical end remains open?

Urachal sinus(15%)

Urachal cyst is seen sonographically as a cystic structure where to the bladder?

superior and anterior to the bladder

What are pouch-like eversion of wall and usually located near ureteral orifice and can be congenital or acquired?

bladder diverticula

What is congenital bladder diverticula known as (and located near ureteral orifice)?

Hutch diverticula

For bladder diverticula, what is the most acquired result from?

Bladder outlet obstruction (Bladder mucosa herniates through weak wall areas typically postero-laterally near ureteral orifice)

What is the sonographic appearance of bladder diverticula?

out pouching sac from bladder; internal echogenicity depends on contents

What will be seen on prenatal ultrasound. However, after birth it will present typically with the following signs on physical examination: clear fluid draining from the periumbilical region or a small umbilical mass, possibly with red mucosa protruding outward. Typical symptoms in a patient with this may be either: 1) a mass in the dome of the bladder, 2) peri-umbilical pain, most often with voiding, 3) dysuria, or 4) urinary tract infection (UTI).

a urachal anomaly

What may also be seen on prenatal ultrasound in some cases. Typically, it can’t be detected on physical examination unless it is so large as to produce an abdominal mass. It is usually found on ultrasound. Potential signs of a patient with this are: UTI, bladder outlet obstruction, vesicoureteral reflux, ureteral obstruction, or asymptomatic findings on bladder ultrasound.

a congenital bladder diverticulum

What is inflammation of the bladder?

Cystitis

What does the following describe?

– Women increased risk because of short female urethra; males due to BOO(bladder outlet obstruction) and prostatitis
– E. coli is most common offending pathogen
– Findings: more prominent at bladder neck and trigone.
Clinical presentation– bladder irritability and hematuria
Sonographically – diffuse wall thickening

Infectious Cystitis

What most often occurs in female diabetics?

Symptoms – hematuria & bladder irritability.
Sonographically – echogenic foci within bladder wall, seen with “ringdown” artifact. Bladder wall thickened and echogenic, gas may be seen

Emphysematous cystitis

What is the most common organism that causes Emphysematous cystitis?

E. coli

What does the following describe?

– May result in a small, thickened bladder, but it is nonspecific.
– Solid areas of urothelium(It is the type of epithelium that lines much of the urinary tract including the renal pelvis, the ureters, the bladder, and parts of the urethra) may form that mimic neoplasms, which may become cystic or develop into glandular structures, which is a precursor for adenocarcinoma.
– Biopsy must be done for correct diagnosis.

Chronic Cystitis

What does the following describe?

– It’s an uncommon chronic granulomatous inflammatory disease of the bladder wall. (it means "soft plaque") can affect any organ, but
the urinary bladder is the commonest location.
– Rare infection, more women, peak age 6th decade, associated with DM, alcoholic liver ds, transplant
Symptoms – hematuria & bladder irritability
Sonographically – single or multiple mucosal-based masses 0.5-3 cm, bladder base.

Malakoplakia

What is the presence of calcification in the
bladder, most often result of migration of calculi from kidney, or bladder stasis?

bladder calculi

What is the major cause of bladder stones?

Urinary stasis

What is the clinical and sonographic presentation of bladder calculi?

Clinical presentation-- Can be asymptomatic, or bladder pain or foul smelling urine w/without hematuria
Sonographically – mobile, echogenic foci
– Occasionally can get stuck in bladder
wall

What forms in transitional cells that line the renal pelvis, ureters and bladder?
• Most common bladder neoplasm

transitional cell carcinoma

true/false: Bladder TCC is 50x more common than renal pelvis TCC

true

When discussing the bladder where does TCC most commonly occur?

Most frequently in trigone and along the lateral and posterior bladder walls.

What is the most common clinical presentation or symptom of TCC?

Hematuria

What is the sonographic appearance of TCC?

• Non-mobile mass or focal thickening.
• Hydronephrosis may be caused by TCC originating in ureter.
• Bladder biopsy must be performed for proper diagnosis

What does the following describe?

– Primary arises from lymphoid follicles in submucosa
• Submucosal tumors usually infiltrate other layers of bladder wall
– Most patients are 40-60 yrs old, women more than men.
Sonographically – wall mass, usually covered by intact epithelium

Bladder Lymphoma

What does the following describe?

– Rare
– May occur with malignant melanoma, lung, gastric, or breast carcinoma.
Sonographically---Variable echogenicity, Irregular bladder wall thickening or focal luminal bladder mass.

Bladder metastases

What is related to a history of brain/spinal injury or malformation, also seen with diabetes?
Clinical presentation--Patient has urinary infrequency and lack of urge to void .

Neurogenic Bladder

What is the sonographic appearance of a neurogenic bladder?

• Enlarged thin walled bladder that may extend up into the abdomen.
• Significant urinary retention on post-void images.
• Can be associated with bladder calculi.

What is a cyst-like enlargement of the lower end of the ureter which projects into bladder lumen at the ureterovesicle junction?

Ureteroceles

Ureteroceles is commonly associated with what?

Commonly associated with a complete duplicated collecting system

What is the sonographic appearance of Ureteroceles?

• Distal 1/3 ureters dilated
• Simple cystic structures projecting into the bladder lumen.
• Usually bilateral.

What is the treatment of choice for end stage
renal disease?

Renal transplantation

What is the most common cause that lead to
renal transplant?

Diabetes

Harvesting which kidney is favored due to its longer renal vein?

the left

The poor function can be due to what in the immediate post transplantation period?

acute tubular necrosis

What are some complications with renal transplatation?

1. Hematomas
2. Urinomas
3. Lymphoceles
4. Abscesses
5. Renal vein thrombosis

Sonographic findings of acute transplant rejection include---

• Renal enlargement
• Decreased kidney echogenicity
• Lack of corticomedullary differentiation
• Increased RI

What is normal wall thickness of the bladder?

less then 3mm