URINARY TRACT-HY

[Anonymous]

URINARY TRACT

1) Plain Films
-very little can be learned by examining plain films
-standard plain film is KUB
-useful only for:
a) examining the general outline of kidney
b) any calcifications
c) if radioopaque stone are present

2) Intravenous Pyelogram/Excretory Urogram (IVP)
-contraindicated in pts with
a) dehydration
b) DM
c) multiple myeloma
d) prior severe reactions to contrast media
-reactions range from hives and flushingàfull blown anaphylaxis
-IV contrast is injectedàthen filtration and concentration allows for plain films to be
produced
-an initial “scout” film is performed and should be carefully examined as contrast can
obscure abnormalilities
-a one minute film (perfusion dependent phase or nephrogram phase) shows the outline
of renal parenchyma
-further films are usually shot at times and angles which vary depending on the nature
of the exam
-standard contrast enhanced study for urinary tract
a) kidneys
Size(note any abnormalities)
-nl adult kidney ranges between 10-16 cm vertically (no more than 1. 5cm of
variation between the two)
-unilateral or bilateral enlargement can occur due to:
a) masses
b) bifid collection system
c) hydronephrosis
d) renal vein thrombosis
e) lymphoma
f) compensation for an abscent second kidney
-bilateral enlargement due to:
a) polycystic dz
b) acute glomerulonephritis
-unilateral or bilateral decrease in size is usually due to:
a) chronic infx
b) granulomatous dz
c) prolonged obstruction
d) renal artery obstruction
e) radiation
-bilateral decrease due to systemic dz
a) HTN
b) DM
c) collagen vascular dz
d) chronic glomerulonephritis

Shape(note the outline of renal parenchyma)
-parenchyma (except at the poles) is 1.5-2cm thick and should show smooth outline
-indentations can be noted with those:
a) associatioed with nl calices are fetal lobulations
b) secondary to scarring
-bulges:
a) represent masses
b) should deform the caliceal pattern to be of significance

Position
-axis should parallel the psoas shadows
-significant deviation due to mass or congenital causes

b) calyx pattern
-should be evenly distributed and show characteristic cupped shaped
-dilatation can be seen and usually due to:
a) obstruction
b) papillary destruction secondary to
i) chronic obstruction
ii) infx
iii) papillary necrosis

c) renal pelvis
-variable in size, shape, and location
-look for filling defects due to
a) stones
b) can represent clot or tumor

d) ureters
-usually only seen segmentally on films secondary to peristalsis
-should not exceed 7mm in diameter
-nl increase seen in pregnancy and oral contraceptive use
-dilatation can be seen with vesicouretal reflux as well

e) bladder
-smooth outlined contrast filled structure which should empty post-micturition



3) Retrograde or Anterograde Pyelography
-contrast is introduced either percutaneously or via cystoscopically placed catheters
introduced into the renal pelvis or ureter
-limited use for when less invasive means available

4) Voiding Cystourethrogram
-contrast is introduced into the bladder then films are taken during voiding
-important in identifying:
a) vesicoureteral reflux
b) extravasation of contrast secondary to trauma
c) anatomy of the bladder neck and urethra with attention to valves and strictures
demonstrate bladder emptying

5) Urethrogram
-can be part of VCUG or done separately
-examine for stricture or injury

6) Renal Arteriography
-contrast injected into renal artery with resulting images
-primarily used to define vascular anatomy prior to surgery

7) CT scanning
-used primarily:
a) define masses vs. cysts (cysts have very thin walls that are sharply distinct from the
surrounding tissue and are fluid filled)
b) evaluation of injury (study of choice)

8) Ultrasound
-useful imaging tool when:
a) contrast studies cannot be used
b) contrast studies are inconclusive
c) need to further define abnormalities
-useful in definition of:
a) hydronephrosis secondary to obstruction
b) mass lesions (differentiate between cysts tumor, or abscess) and guide needle
examination of the mass lesions
c) measure renal size
d) transrectal exam of prostate and guide biopsy or theray placement
e) assess renal blood flow via Doppler




9) Nuclear Studies
Renogram
-Technetium labeled tracer is injected and serial images using gamma camera are taken
-computer analysis allows for generation of a curve which assesses renal fxn
-useful for evaluation of
a) non-invasive diagnosis of renovascular HTN
b) investigate obstruction
c) measure relative renal fxn
d) transplant viability

[Anonymous]

thank you very much for your effort,but do you really think we need this info?
it looks very scary,something for usmle2-too clinical.
i hope i am right on this,i hope no suprises like this will appear on my exame

[Anonymous]

The above information is more useful in our clincal rotations .But i heard that ,nowadays usmle -step-1 comes with some xray and explanation of investigation( radiological)--so i thought of adding this

May be i should change the subject

URINARY TRACT-IF YOU HAVE ADDITIONAL TIME GO THROUGH THIS.( not that HY)


What you think? Is it okay/