Normal quiz 6 (renal and spleen)

Kidney location

Retroperitoneal, posterior, just below diaphragm

Is the right or left kidney lower

Right kidney, liver presses down on it

Normal kidney size

Length: 9-12 cm

Width: 5-6 cm

Thickness: 2-4 cm

Kidney cortex

Outer portion of kidney tissue

Abnormal cortex thickness

<1 cm

Want to be thick

Kidney medulla

Inner portion of kidney tissue

Folded into pyramids, which empty into urine collecting system- renal pelvis

Functional unit of kidney

Nephrons

Nephrons

Renal tubules

Filter blood and send urine into renal pyramids

Nephron location

Located in renal cortex

Where is blood filtered

Renal corpuscle

renal hilum

Vertical slit on medial surface of each kidney

Entry point for blood vessels, nerves, ureter, and lymphatics

True capsule

Fibrous capsule attached to renal cortex

Perinephric fat

Covering over fibrous capsule

Gerota’s fascia

Renal fascia

Areola connective tissue covering over the perinephric fat

Covers kidney and adrenal gland

Renal pelvis

Upper, expanded end of the ureter

How long is the ureter

25 cm long tube

Ureter

Tube that carries urine from kidney to bladder

Where do calyces drain

Into the renal pelvis then to the ureter

urinary bladder

Large muscle structure that acts as a storage site for urine

What is bladder lined with interiorly

Transitional epithelium

Allows bladder to stretch

Urethra

Membranous tube from bladder to outside body

Major functions of kidney

To excrete urine

Excrete

Process of disposing metabolic waste

What does composition of urine depend on

What the kidney has to filter out of blood to maintain homeostasis

kidney functions

Excrete urine

Adjust electrolyte balance in blood

If blood glucose is very high, kidneys will spill glucose out into urine

True or false: all cells in body carry on metabolic activities that produce wastes

True

What is excretion done by

Skin (sweat), lungs (CO2), liver (multiple toxins), large intestine (feces), kidneys (urine)

Urinalysis

Series of lab tests performed on urine

True or false: diet affects urine pH

True

Specific gravity

Measures kidneys ability to concentrate urine

Hematuria

Blood cells in urine

largest numbers of RBCs associated with?

Trauma, stones, pyelonephritis, or glomerular or vascular inflammation

WBCs in urine associated with?

Infection, inflammatiom, or tissue damage anywhere in urinary tract

Hemoglobin

Found in urine when there is extensive destruction of RBCs

Excessive excretion of hemoglobin

Damages kidney and may lead to acute renal failure

when is protein filtered into urine

When damage to glomerulus

Albuminuria associated with:

Neoplasm, stones, chronic, infection, and pyelonephritis

Creatinine is a byproduct of

Muscle metabolism

Usually produced at constant rate

Where is creatinine excreted

Usually excreted in urine

Is there more or less creatinine in urine if the glomerular apparatus is malfunctioning

Less creatinine in urine

Creatinine clearance blood test

Measures how well your kidneys clear creatinine out of your blood

Serum creatinine blood test

Measures the concentration of creatinine in blood

What do increased levels of creatinine in blood indicate

Renal failure

Increased levels of blood urea nitrogen (BUN) indicate

Renal disease and increased protein breakdown

Kidney ultrasound used for?

To delineate renal mass, define perirenal fluid, determine renal size and parenchymal structure, detect hydronephrosis/urinary obstruction, image congenital renal anomalies

Normal kidney texture

Smooth contour

Renal capsule echogenicity

Echogenic

Renal cortex echogenicity

Medium level gray

Slightly Hypoechoic to liver

Renal pyramids echogenicity

Hypoechoic

Not always seen easily

Renal pelvis/sinus Echogenicity

Echogenic

Least Echogenic part of kidney

Pyramids

Most Echogenic part of kidney

Sinus

Renal parenchyma

Area from renal sinus to capsule

Which plane are renal vessels tubular

Transverse plane

Renal artery walls

Echogenic walls

Where does the right renal artery run in relation to the IVC

Runs posterior to IVC

Renal veins leave kidney at

At renal hilum and enter IVC

Where does the left renal vein run in relation to aorta

Runs anterior to aorta

Arcuate arteries

Echogenic foci at bases of pyramids

Define cortico-medullary junction

Where is the mid transverse image taken

At renal hilum

Most common location of ectopic kidney

Pelvic kidney

Pelvic kidney

Occurs when kidney moves causally with embryo axis as it lengthens

Failure to ascend to lumbar position

Horseshoe kidney

Occurs when right and left areas of metanephric mesoderm are located very close to each other and fuse in midline

Which kidney pole does horseshoe kidney usually fuse

Inferior pole

Is horseshoe kidney more inferior or superior, why?

Inferior

Fused portion (isthmus) gets caught on IMA, therefore isthmus is usually located at pelvic brim

Cake kidney

If fusion occurs at mid portion of kidney

Renal agenesis

Occurs when uretic bud doesn’t come into contact with metanephric mesoderm

No induction of nephron formation

Unilateral agenesis

Usually asymptomatic because there is still one functioning kidney

May be enlarged

Bilateral agenesis

Lethal

Usually occurs in conjunction with other defects

Ectopic ureter

Rare

Ureteric bud develops at abnormally inferior place in Mesonephric duct

What happens when bladder forms with ectopic ureter

Ureter is too inferior to be incorporated into the bladder, so it empties into the urethra in males and the vagina in females

Duplicated collecting system

Ureteric bud splits

The earlier the split occurs, the more proximal the location and the more complete the duplication of the collecting system

Duplicated collecting system sonographically

See two areas of renal sinus separated by a column of renal parenchymal tissue

Kidney usually large with smooth contour

Lower pole pelvis usually larger

Hyoertrophied column of Bertin

Prominent fold of renal cortical tissue that produces down into the medulla towards renal sinus

May mimic renal mass

Hypertrophied column of bertin characteristics

Clearly separated from renal sinus

Continuous with renal cortex

Echogenicity is same as renal parenchyma

Not over 3 cm in size

Dromedary hump

Bulge in renal cortex on lateral surface of kidney

Dromedary hump characteristics

Usually on left kidney

Echogenicity same as rest of renal parenchyma

Junctional parenchymal defect

Triangular indentation in upper pole or renal parenchyma

Junctional parenchymal defect results in

Partial fusion of two embryonic ranunculi that form kidney

Echogenic

Fetal lobulation

Variant in fusion of ranunculi that results in part of kidney being rotated

Fetal lobulation appearance

Upper and middle calyces may look splayed or large

Renal cortex has lobular indentation and may mimic a mass

Seen best in coronal or sagittal images

Sinus lipomatosis

Extra fat deposition in renal sinus

See: increased size and echogenicity of sinus

Renal sinus contains:

Fibrous tissue, fat, lymphatic vessels, nerves, blood vessels

Extrarenal pelvis

Enlargement of the proximal end ureter

See: cystic area at hilum of kidney that extends outside renal borders

are ureters easily seen on ultrasound

No, not unless dilated

Bladder evaluation

Cystoscopy

Bladder must be full to evaluate sonographically

Normal bladder appearance

Thin, smooth walls

Anechoic lumen- may have some debris posteriorly

Located midline

No irregular/asymmetric indention on wall

Duplicated ureters

Duplication of the collecting system that may involve complete or partial duplication of the ureters

If duplication of ureters is complete:

Ureters from upper pole will generally insert more inferiorly on bladder

If duplication ureters is partial:

Ureters will fuse before reaching bladder

Uterocele

Cyst like enlargement of distal ureter

Ureterocele caused by

Congenital/acquired stenosis of distal ureter as it enters bladder

Usually asymptomatic

Spleen location

Intraperitoneal

LUQ near the tail of the pancreas and superior to the left kidney

Largest mass of lymphoid tissue in the body

Spleen

Spleen

Lymphoid organ that destroys damages or worn out blood cells, pathogens, and foreign materials

Left kidney in relation to spleen

Sits inferior and medial

True or false: the spleen is a common site of primary disease

False

It is often affected by systemic disease such as infections or auto immune disease

Spleen consists of

Lobules and sinuses

What are spleen lobules filled with

Tissue called pulp

Red or white pulp

spleen sinus

Acts as a reservoir for blood and platelets