Chest and Abdomen- Exam 3- Genitourinary Conditions

Concretion calcification in the luminal portion of the urinary tract, secondary to urinary stasis or lack of volume

nephrolithiasis

Neprholithiasis is secondary to

Urinary stasis or lack of volume

Although 90% of neprholithiasis are visible on radiograph, why are they hard to see sometimes

Cause they're so small in size or because they're so small the x ray can shoot right through them

What is a large nephrolithiasis called

"Staghorn" appearance

What has a possible false-negative rate with nephrolithiasis

Ultrasound

What are helpful with finding nephrolithiasis

Intravenous pyelogram (IVP) and especially CT

Symptoms of neprholithiasis

Bilateral Low back and flank pain (ureteric colic)

What is the flank pain with neprholithiasis called

Ureteric colic

What causes the symptoms of nephrolithiasis

Urinary obstruction

Where do kidney stones typically occur in the kidney

Candies and pelvis of the kidney

When do symptoms normally start with kidney stones

When the stone travels to the neck of the pelvis

Explain how symptoms work with kidney stones as it goes along its path

Typically show up when it gets to the neck of the pelvis of the kidney, then go away when reach the bladder, then back again when it goes into the urethra

Kidney stone on x ray

Where are kidney stones seen on lateral x ray in relation to the spine

Sometimes over the spine or anterior to the spine

-this is because of the angle of the kidneys on a lateral view

Difference between kidney stones and gallstones images

Location and shape difference between kidney stones and gallstones

Gallstones are a different shape and a little higher, also more anterior in the abdomen, near the ribs

Calcification in veins

Pheloboliths

Where do most phelobliths occur

Pelvic basin at the periphery and below the femoral heads

Example of stones in lower ureter with plastic stent to permit flow past the stones

Example of a bladder that is full of fluid on x ray

Where do the ureter insert into the bladder

Superior and lateral portion of the bladder

Example of a stone in the left ureter with a full bladder

Kidney stone right at the renal pelvis about to go into the neck of the ureter on CT

What technique is good for evaluating obstruction of stones causing complications

IVP (intravenous pylogram)

Example of intravenous polygrams (IVP)

An example of a normal kidney compared to one with kidney stones on IVP imaging

What is it called when there is too much fluid in the kidney? What can cause this

Hyronephrosis

-can be caused by kidney stones

Example of staghorn calculis

Example of staghorn cacluis in the pelvis of the right kidney

Example of stag horn calculi on lateral x ray

What is the appearance of kidney stones on MRI?

Why is this the case?

They appear dark because they are more like cortical bone density

Fancy name for kidney stones

Nephrolithiasis

Kidney stones less than what size are usually passed without surgical intervention

Less than 5 mm

Nephrolithiasis are associated with

Increased uptake of calcium, calcium oxalate, uric acid in our diet or with inadequate intake of fluids or gout

Diet risk factors?

Why are they risk factor

Tea, high protein, rhubarb, chocolate, peanuts, spinach

They are high in oxalates

What may show up on specialized imaging on the kidneys, but are no need to be concerned about

Renal cysts

Example of renal cysts on CT

Example of CT showing renal cysts compared to normal kidneys

Top right one is normal kidneys

Bosniak classification system of renal cystic masses go off what

Go off size and if they have septa (walls)

-typically not that big of a deal

What classification of renal cysts based off the Bosniak system is a minimally complex cyst, with multiple hairline septae and may have thick calcifications but no enhancement

II F

Minimally complex cyst

Risk of malignancy with Minimally complex cysts (II F) level renal cysts

3-10%

What Bosniak classification of renal cysts has thicker or more irregular walls with measurable enhancement

III

Complex cyst

Complex cysts (III) have what risk of malignancy

50%

What Bosniak classification of renal cysts has class III plus enhancing soft tissue components

IV

Clearly malignant

Risk of clearly malignant (IV) renal cysts

75-90%

Phlebolith vs renal stone

Phelobliths may go from a solid to target appearance

Kidney stones are always pure solid

What is it called when a phlebolith goes from a solid to a target appearance

Recanlization

What is formed from urinary stasis usually due to obstruction or inability to empty the bladder

Bladder calculi

Since bladder calculi are formed from urinary stasis, what type of formation do they typically have then

Layered formation

80% + of bladder calculi occur in who

Elderly males

Why are bladder calculi commonly occurring in elderly males

Longer urethra and prostrate hypertrophy narrow the urethra

Bladder calculi are associated with

Carcinoma

-increase risk from prostrate cancer

-but overwhelmingly found in patients without it still

What do bladder calculi look like on x ray

Oval radiodense shadows in the bladder but often not fully opaque (may result in lamination)

Bladder calculi can be related to infection secondary to

Irritation of the bladder wall (from stone rubbing on the bladder)

Bladder calculi symptoms can be similar to

A UTI

-poor wound healing, low grade fever, altered mental status

What is the most common type of make up for bladder calculi

Uric acid

Surprisingly patients with uric acid bladder calculi rarely have a documented history of

Gout or hyperuricemia

In many cases with bladder calculi, when it comes to make up?

The core consists of one chemical layers of different chemicals form around this core

The most common factors that promote uric acid stone bladder calculi formations are

Persistently low urinary pH

Dehydration leading to low urinary volume

High uric acid production

When could a person be at a bigger risk of bladder calculi formation? Why?

Post operation cause they don`t want to get up and pee so they decreased fluid intake

From low urinary pH, dehydration leading to low urinary volume

What is common pattern of occurrence for bladder calculi

Common to have 1 stone at first then to have more to follow after removal cause bladder wall already irritated from the fist on e

Example of x ray showing the layering that occurs in bladder stones

Example of an overexposed x ray shooting right through (almost) a bladder calculi

Why don`t uterine fibromas always show up on x ray

Fibromas don`t always calcify

Uterine fibroma typically occur

40% of women over 35 yrs old

(40% of women over 40)

3 different locations of uterine fibroma

Intramural

Subserosal

Submucosal

Where is an intramural uterine fibromas

Between the walls

Where is a subserosal uterine fibroma

Under serosal surface

Plain films may she uterine fibromas in what pattern of calcification

Popcorn or cauliflower calcification

(Calcify as a stippled appearance)

Most fibroids are

Asymptomatic and of littler concern

What types of problems do occur with uterine fibromas

Bleeding

Mass effect on viscera (taking up space)

Infertility

Malignant degeneration (3%)

How does uterine fibroma cause bleeding problems

Altered menses

-typically becomes excessive

Stippled appearance of uterine fibroid calcification on X-ray

What types of fibroid has higher potential to alter ability to implant in the uterus

Submucosal and intramural

What type of uterine fibroid is under the lining of the womb, can grow on stalk (called pedunculated)

Submucosal

What type of uterine fibroid is within the wall of the womb, the most common type, and may distort the uterine cavity or cause irregular external uterine contour

Intramural

What is the most common type of uterine fibroid

Intramural

What type of uterine fibroid is probably the least impactful clinically

Subserosal

What type of uterine fibroid is on the outer wall of the uterus and usually causes symptoms until it grows large enough to cause interference to adjacent organs, sometime they grow on stalk

Subserosal

What type of uterine fibroid can block the entrance of the uterus

Submucosal fibrous

TRUE or FALSE

Uterine fibroids don't always have to be midline

TRUE

Slight cystic appearance of a uterine fibroid but it is still considered a solid mass

Very large uterine fibroid shown on lateral CT

Uterine fibroid gives what type of signal intensity on MRI

Mixed signal intensity

Example of multiple uterine fibroids that are off midline

When a would a kidney stone sort of be in front of the spine on a lateral x ray shooting

When its in the inferior pole of the kidney

When would a kidney stone be more on top of the spine on a lateral x ray

When its in the superior and middle stone of the kidney

Example of someone with gallstones (in pink) and renal calculi (in blue)