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51 Cards in this Set

  • Front
  • Back
approach to hydronephrosis and megaureter
reflux present:
primary - primary reflex, prune belly
secondary - neuropathic bladder, posterior urethral valves

obx present:
primary - stenosis, ureterocele
secondary - stone, clot, obx by extrinsic tumor

neither reflux nor obx:
primary - congenital megauratur or adynamic segment
secondary - infx, post-op
pathophys of posterior urethral valves
2/2 membranous folds in prostatic urethra
US findings assoc with post urethral valves
thick walled bladder with dilated b/l renal cs and ureters
on VCUG, bladder is trabeculated
what factors predispose pt to primary reflux
intravesical portion of ureter acts like 1 way valve and prevents refulx, however if the ureter is abn in length, orientation, or location, the valve mechanism is disrupted
pathophys of mulitcystic dysplastic kidney
severe obx of renal cs during fetal development
appearance of MCDK
grape like clxn of variably sized cysts
course of MCDK
kdny usually decreases is size and eventually kidney is no longer visualized

potential increased risk for malig
multilocular cystic nephroma
rare type of cystic mass contianing multiple septae
it is not malig, but it is diff to distinguish from malignancy so is resected
what is mesoblastic nephroma
age
intrarenal heterogeneous soild mass
3 mo
ddx mesoblastic nephroma
wilms (indistinguishable)
pathology of nephroblastomatosis
persistent nephrogenic rests that can develop into wilms
when should it be suspected that nephroblastomatosis develop into wilm's
if spherical lesion becomes larger and demonstrates increased inhomogeneous enhancement
weigert meyer rule
in duplicated cs, the upper pole moiety inserts inferomedially --> obx by ureterocele

LP moiety scars down and it pushes down on the lower pole moiety which inserts normall and is prone to reflux and looks like a drooping lilly on VCUG
what is a ureterocele
what does it look like
dilatation of distal ureter
seen in bladder during early filling views, appeaers as filling defect
the dilated portion of the ureter is btwn mucosal and muscular layer of bladder
what is the urachus
embryologic structure that communicates btwn apex of bladder and ublicius
types of urachal abn
urachal sinus: blind ending umbilical pouch
patent urachus: cnxn btwn umbilicus and bladder
urachal cyst - no cnxn to bladdder/urachus (patent at mid-portion)
urachal diverticulu - patent urachus at bladder
complication of urachal remnant
increased risk of CA, therefore should be removed
appearance of chronic pyelo
loss of renal parenchyma/renal scarring
most common congenital obx in urinary tract
UPJ obx
other things assoc with UPJ obx
reflux
renal duplication
UVJ obx
main cause of most UPJ obx
congenital narrowing >
anomalous BV that causes extrinsic compression
pathogenesis of multicystic dysplasic kidney (MCDK)
severe obx of renal cs during fetal development
appearance of MCDK
grapelike collection of variably sized cysts that do not communicate
appearance of MCDK in older children
MCDK will usually decrease in size over time;
dysplastic renal tissue will no longer be visualized after time
management of MCDK
follow with U/S
complications of MCDK
HTN, which, if it develops is usually tx w nephrectomy
pathogenesis of ureteropelvic duplicationn
premature division or duplication of ureteral bud
most commonly u/l
pathophys of primary megaureter
aperistaltic segment of the distal ureter --> obx

GU equivalent of Hirschsprung's
which ureter is more commonly involved in primary megaureter
left
prune belly syndrome
hypoplasia of abd muscles
cryptorchidism
abn of urinary tract (severe b/l hydro, trabeculated, hypertrophied bladder, urachal diverticulum, hydroureter)
hydrometrocolpos
vagina and uterus dilate when fluid accumulates in the reproductive tract

there is ox of the genital outflox tract
presentation of hydrometrocolpos/hematometrocolpos
fixed midline mass may be palpable
mass be lrg enough to cause ureteral obx and hydro
appearance of hydrometrocolpos on US
mass appears tubular or elliptical, at midline

the vagina is more elastic than the uterus, so the bulk of hte mass is comprised of fluid in vaginal canal
appearance of kidneys in infantile polycystic kidney disease
1-2 mm cysts throughout cortex and medulla
kdnys are grossly enlarged and diffusely increasd in echogenicity

cystic structures are sometimes n/v b/c they are so big
appearance of juvenile polycystic kidney disease
pts present with hepatosplenomegaly and portal HTN
kdnys may be big and have varying sized cysts or may be nml
liver shows increased echotxt, 2/2 fibrosis
most common renal malig in children
wilms tumor
how does wilms tumor present
asx abd mass +/- pain (usually present if there is hemorrhagE)
conditions assoc with wilms tumor
beckwith widemann syndrome
congenital hemi-hypertrophy
common location for mets in wilms tumor
invasion of renal vein and into IVC
20% --> pulm mets
must also look for thrombus extending into right atrium
appearance of wilms tumor on US
lrg, well defined mass arising from kdny
increased echotxt, heterogeneous
which GU malig is generally assoc with "claw sign"
wilms
where does neuroblastoma commonly metastasize to
liver and bone
labs in neuroblastoma
elevated VMA
prognostic factors assoc with neuroblastoma
childrlen <1 yo, disease spreads to liver and skin, good prog

>1yo, spreads to bone, poor prog
which GU malig in children engulfs, rather than displaces BV
neuroblastoma
what is the most common malignant sarcoma of childhood
age
pelvic rhabdomyosarcoma
>/= 3 yo
locations of malignant sarcoma
pelvis
GU tract
head/neck
most common locations w/i GU tract for rhabdomyosarc
bladder
prostate
spermatic cord
paratesticular tussue
uterus
vagina
perineum
most likely dx for an extratesticular scrotal masS
embryonal rhabdomyosarcoma arising from the spermatic cord or epididymis
management of torsion of the testicular appendage
self limited, sx not required
appearance of testicular appendage torsion
mass of increased echogenicity seene btwn superior pole of tesis and epididymis
a testicular appendage is greater than 5mm is greatest indicator for torsion