DI - Normal, Abn, Contrast

The upper urinary tract includes ___

kidneys and ureters

Which kidney is more cr?

right, in the cd lobe

How big should the kidneys be?

dogs - 2.5-3X L2, cats 2-3X L2

What organs do the left kidney touch?

greater stomach curvature, spleen, L pancreas

What organs do the R kdiney touch?

descending duodenum and R pancreus

which is more hyoechoic - medullary or cortical tissue of kidney on US?

medullary (darker)

What vessels are insid ethe kidney?

interlobar vessels

Will the renal cortex by darker or lighter than the liver on ultrasound?

hypoechoic (darker) or the same

What is the hyperechoic (white) V-shape in the transverse view of the kdiney on US?

renal sinus or hilum

What are the hypoechoic small circles in the sagittal view fo the kidney?

arteries

What population of cats will have the most noticable palpable kidnesy?

intact males

What are the dx for renomegaly?

inflammation (AKI, toxin), infection (pyelonephritis, FIP), neoplasia, hypertrophy, obst, subcapsular disease

What is an example of subcasular disease, causing renomegaly?

hemorrhage in the kidney capsule

What size difference would FIP and pyelonephritis cuase to the kidney?

renomegaly

Will a kidney with AKI be small or big?

big

What is a neoplasia that could cause big kidneys?

lymphoma

What are causes of small kidneys?

hypoplasia, fibrosis, CKD

Whwat causes irregularly shaped kidnesy?

masses, infarcts

T/F you will see ureters normally

false

What are normal suspended foci to see on US in the bladder?

fat, mucous, cells - should not be gravity dependent

Where is the ureteral papilla located in the bladder?

cd/dorsal aspect

A large organ is pressing into the bladder on US and is NOT a mass. What is this?

colon

What are reasons for NOT seeing the bladder?

empty, displaced, obscured by mass or colon, (just poor contrast - thin, effusion)

What are 2 congenital anomalies of the bladder and how would these look like on rads?

ectopic ureter, fistula. Bladder would appear small/unseen

What are causes of diffuse bladder wall diseas?

cystitis, hemorrhage, neoplasia, rupture

What would the bladder look like in a patient who has renal failure causing anuria or hypouria?

small bladder/would not be able to see

What are the dx for small/unseen bladder?

ruptrue, congenital abnormalities, bladder wall disease, renal fialure

What are the dx for increased bladder size?

obst, neuro, PU/PD, fluids, holdign it a long time!

What are dx for a large bladder that is ventrally displaced?

inquinal/abd wall wall, mass, displacement from other sick organ (uterus/colon)

What could cd displacement of the bladder indicate?

perineal hernia, abd mass (displacement), congenital anomalies, "short urethra,"

What is the ONLY dx for cr/dorsal displacement of the bladder?

prostatic disease

What does bladder wall mineralization indicate?

neoplasia

What is an iatrogenic reason for gas in the bladder?

cystocentesis, catheter, contrast study

What is a pathologic reason for gas in teh bladder?

emphysematous cystitis

What are reasons for urate crystals in the bladder?

breed (dalmation), portosystemic shunt, chronic HI

Why type of artifact will cystic calculi make on US?

acoustic shadow

Why do we doppler suspected cystic calculi?

will create "twinkle artifact"

What will you see on US for renal calculi?

hyperechoic focus with distal acoustic shadowing

When looking for calculi in a male dog you MUST have which view?

perineal

what issue does emphysematous cystitis indicate?

DM

What are your 2 dx for thickened, irregular bladder walls?

infalmmation, neoplasia

What can develop with chronic cystitis

polyps

You have a bladder whose whole wall is thick and irrecular. What is tis?

cystitis

cystitis typically causes thickening of the wall in which orientations of the bladder?

cr and ventral

How can you tell the differenve btw a polyp and a UCC?

they are both stuck to the bladder wall but the UCC is borad-based, UCC will also have "twinkle" artifact just like mineralization

What Us finding will be present with CKD?

mineralization

describe CKD kidnesy

"smudgey" small, irregular, reduced differentiation, maybe cysts

what do renal infarcts look like on a kidney in US?

snall kidney, hyperechoic in cortex where there is blood loss. Might also have wavy line through cortex

In which animals is polycystic kidney disease hereditary?

long haired cats and cairn terriers. Also just common in really old cats

You have a unilateral large kidney. What is your fist dx?

obstruction!

You have one abn large kidney and one ab small kidney. Why is this?

small kidney is CKD, so large kidney is compensatory

What are your two dx for subcapsular fluid?

#1 = acute nephritis (FIP) #2 = lymphoma

You have a large kindey with subcapsular fluid, irregular margin, and is hyperechoic. What is a good dx?

lymphoma or acute nephriitis

What are causes of renal pelvic dilation (pyelectasia/hydronephrosis)?

obs, pyelonephritis, diuresis, congential, renal fibrosis

You US the kidney but see a dark "V" shape in the renal pelvis. What is this?

pyelectasia aka dilation of the renal pelvis

Will you usually see hydronephrosis/pyelectasia in one or both kidneys?

one

Will a hydronephrosis kidney be smooth or irregular?

SMOOTH

What do you do in preperation for retrograd urethrogram?

empty colon with enema, take survey images

how do you take images for a retrograde urethrogram?

lateral and VD (oblique for male)

T/F it is normal to have a narrowing of the contrast at the prostate during a retrograde urethrogram

true,

What are the 3 portions of the urethra in the male?

prostatic, membranous, penile

How do you differentiate calculi from air bubbles in the urethra?

calculi - distend urethra, fixed, can radiograph on survey films Bubbles - no distention, will move

You see a narrowing of the urethra at the prostatic sight on a cat. Is this normal and what are your dx?

Not normal to see this in cat, so 1) stricture or 2) spasms. Must take again

You do you tell the difference btw urethral stricutre and peristaltic contractions in a cat?

retake

What are your dx for thickening/irregularity of the urethra? (Think of the same dx for the bladder)

urethritis or neoplasia

What CS will go with a strcitrue?

stranguria

What are the clinical indications for a contrast cystography?

dysuria, pollakiuria, chronic hematuria, cannot find bladder on rads

What do you use for positive contrast cystography?

iodinated contrast 20%

Where will air bubbles be located in a double contrast?

at periphery of positive ocntrast

What type of contrast study injects the whole animal with contrast and then traces it through the kidneys?

excretory urogram

What are the contraindications for excretory urography?

dehydration, anuric renal failure, hypotension,

What are the 3 phases of excretory urography?

vascular, nephrogram/pyelogram, pyelogram/urogram

If the kidneys look bright, what phase of EU is this?

vascular

What happens if you do not see the contrast past the kidnesy 20-40 mins after you start an EU?

give fluids! acute renal failure from the contrast

What phase of the EU signals we are safely past the risk of acute renal fialure?

pyelogram phase - see contrast in renal pelvis

In the ureteral phase, will you normally see teh whole urters?

NO

You see a dilated renal pelvis on EU. What is this and what caused it?

palectasia, obstruction

What will you see on pyelonephritis?

misshapen, dilated renal pelvis and prox ureter

What will hydronephrosis look like on EU?

dilated of pelvis, diverticular, ureter

You have a hydroureter on EU. What could be the causes?

obst, ectopic ureter

What is ureterectasia?

dilated ureter